We are currently in the midst of the tree pollen hay fever season, with the grass pollens soon to follow. We spoke to Professor George Du Toit, a leading Consultant Paediatric Allergist at The Portland Hospital (HCA Healthcare UK), to better understand the symptoms of hay fever in children and when exactly a parent should take their child to see a specialist.

Here’s what he told us:

What are the signs and symptoms of hay fever?

Classic signs of hay fever include those involving the eyes, nose and throat. The typical symptoms include:

  • itchy, red eyes
  • a runny nose
  • excessive sneezing
  • nasal obstruction
  • throat irritation

Excessive sneezing and a runny nose alternates with nasal obstruction and throat irritation, the throat irritation is is often associated with anti-social ‘throat-clearing noises’.

Lesser recognised symptoms include allergic wheezing and very itchy skin, sometimes with rashes or an exacerbation of eczema around pollen seasons. Together these symptoms can lead to poor sleep patterns, altered mood and decreased concentration. Together, these symptoms may negatively affect school performance, therefore, it’s important to recognise symptoms in order to get the right treatment for your child.

Children with hayfever often have a typical facial appearance, these may include dark rings (called allergic shiners) around and skin folds under the eyes. A pale horizontal nasal crease may also be visible at the area where the nasal cartilage meets the nasal bone, all these signs arise due to repetitive forceful rubbing motions. Mouth breathing may result in a smelly breath and dry dentition which is a risk for poor dental hygiene. The skin around the mouth and under the nose may be troubled by a lip-licking eczema.

If these symptoms appear during spring, then it is likely due to tree pollen, whereas in mid-summer, it is more likely caused by grass pollen and towards the end of summer, weed pollens and mould. Perennial symptoms of ‘hayfever’ may be due to house dust mite, pet or mould allergies and appear with similar symptoms as to those that arise due to pollen allergies.

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At what age does hay fever usually start?

“Hay fever generally only develops after having lived through, four or more summers but in very allergic children this can start earlier in childhood. Of course, hay fever can also present later in life and in the teen years.”

If suspected, should you visit a doctor or specialist?

There is no immediate need to see a doctor or specialist for mild hay fever symptoms. A non-sedating antihistamine, taken daily, may be trialled. For patients with mild hayfever, this will often provide sufficient symptom control. For troubling symptoms which are interrupting their sleep, mood, behaviour, and concentration then the impact becomes more significant and indeed prudent to see a primary healthcare practitioner to receive additional medications.

For more severe symptoms, a specialist should be consulted as disease-modifying immunotherapy, a new and effective form of allergy treatment can be commenced from 5-6 years of age. This entails taking medications that are rich in the pollens to which the child is allergic over sequential years in an attempt to induce tolerance and minimise symptoms and the need for associated medication.

Practical tips to help reduce hay fever symptoms in children?

“It is difficult to entirely avoid pollen as children need to enjoy outdoor activities and pollens can travel great distances. It will not always be the visible grass or tree species that are causing symptoms, pollen can travel great distances, particularly if associated with pollution. Nonetheless, you should be cautious when the allergic child will knowingly be exposed to pollens:

  • The child should be dressed in long-sleeved outfits when walking through pollen-rich areas.
  • Sunglasses can be used outdoors.
  • Smear some Vaseline around the nostrils to trap pollen.
  • Car windows should be shut and the internal aircon used.
  • The child’s bedroom windows should be kept shut and you can run an air purifier overnight to reduce circulating pollen.
  • Once a child returns from a pollen-rich environment, it would be sensible for them to shower, wash their hair and change clothes to reduce ongoing exposure.

Medical treatments:

A stepwise approach is generally adopted to manage hay fever in children. The first step typically entails a daily non-sedating antihistamine which can be started just before the season and usually required most days throughout the season.

Antihistamines are variably effective in reducing itch and sneezing and are available as syrups, tablets and nose and eye drops. Saline nasal douching may also provide relief and minimize the need for additional medicines, but this can be difficult for younger children to perform. If these interventions prove insufficient, then a steroid nasal spray can be added to this regimen ensuring the correct administration technique is used to minimize nasal irritation and bleeding. The steroid nasal spray is likely to offer the most symptom relief for obstructive nasal symptoms and may also serve to help treat itchy eyes and even reduce asthma exacerbations. For itchy eyes, eye drops will provide relief and your Doctor will advise you on the product and strength required. The disease-modifying intervention of immunotherapy is ultimately required for children with troublesome hay fever.

Article by Professor George Du Toit, a leading Consultant Paediatric Allergist at The Portland Hospital (HCA Healthcare UK).

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