By Sherri Gordon | Published on January 18, 2023 | Fact checked by Sarah Scott
Sneezing, coughing, and watering, puffy eyes are the hallmark of environmental allergies. Not only are they annoying for your child, but they also can impact their quality of life, causing everything from irritability and scratching to sleepless nights and poor school performance.1
With all that in mind, knowing how to pick the best treatment becomes paramount. Sometimes this might mean using over-the-counter (OTC) allergy medications. Other times, it might mean turning to non-medicated options like saline sprays or rinses.
Below, we’ll take a look at how allergy medications work, with expert tips on how to choose the best one. Read on to learn how you can ease your child’s discomfort.
How Do Allergy Medicines Work?
When a person is exposed to something they are allergic to like pet dander or tree pollen, the mast cells in their immune system release histamine. As this histamine travels through the blood, it latches onto the histamine receptors in other cells, says Farah N. Khan, MD, an allergist, immunologist, and assistant professor of pediatrics at Nationwide Children’s Hospital. Once attached, the histamine creates inflammation in the body, which causes many familiar allergy symptoms.2
People often use medications like antihistamines to deal with allergies because they block the histamine that travels through the body and keep it from affecting the cells. In addition to antihistamines, some people might opt for topical steroids.
“Antihistamines work by blocking histamine receptors,” says David Berger, MD, a board-certified pediatrician and founder of a health education company Wholistic Pediatrics & Family Care. “Steroids act as a general anti-inflammatory. Reducing inflammation reduces the release and effect of histamine.”
If your child is frequently experiencing sneezing, runny nose, itching, watery, itchy, swollen or red eyes that are persistent or significant enough to interfere with their daily life, then allergy medication may be warranted says Sarah Adams, MD, FAAP, a pediatrician at Akron Children’s Hospital. This is especially true if their allergy symptoms are impacting their sleep, school performance, appetite, or mood.
Which Allergy Medicine Is Best for Kids?
With a wide range of over-the-counter (OTC) medications on the market to treat your child’s environmental allergies, it can be challenging to decide which one is the best for your child. A large portion of the decision will be based on your child and their individual symptoms, as well as any input or advice from their pediatrician or healthcare provider.
“There are no head-to-head studies comparing one allergy medication to another,” says Dr. Khan. “I will tell you that many families come to clinic and swear by one medication over another, but really every child is different. What may work for one child will not be effective for another. The goal should not be that you figure all of this out by yourself at the pharmacy. Instead, you should be having a conversation with your provider to determine what to do next.”
It is especially important that you consult with a healthcare provider if your child is younger than 6 years old, says Dr. Adams. They can provide you with dosage recommendations and help you determine which medications are approved at different ages. What’s more, using the correct dosage for your child’s age and weight is important, as allergy medications can cause serious side effects if not used appropriately, she adds.3
There are several long-acting, non-sedating antihistamines approved for use in kids that are available over the counter, says Allison Burbank, MD, an allergist, immunologist, and assistant professor in the department of pediatrics at UNC Health. The most common ones include fexofenadine (Allegra), cetirizine (Zyrtec), loratadine (Claritin), and levocetirizine (Xyzal). Recently, nasal antihistamine sprays like azelastine (Astepro) and antihistamine eye drops like olopatadine (Pataday) have become available over the counter as well, she adds.
“Children’s cetirizine is approved and recommended for use in children as young as 2 years of age for allergy symptoms and hives,” Dr. Adams says. “What I like about cetirizine and loratadine is that they are less likely to cause drowsiness and work for 24 hours versus diphenhydramine (Benadryl), which can cause sedation and may require additional doses every 6 hours for symptom relief.”
Diphenhydramine (Benadryl) is not the first choice for treatment of allergies in children because of its sedating properties, adds Dr. Burbank. Additionally, some children can have the opposite reaction to diphenhydramine, becoming agitated and hyperactive, she adds.4
“I feel the inhaled nasal steroids work the best and do not require the child to swallow a medication,” says Dr. Adams. “But remember the nasal sprays will only help with allergy symptoms of the upper respiratory system and will not help with hives, eye symptoms, or a serious allergic reaction.”
Other Tips for Treating Allergies
You also can help reduce your child’s allergy symptoms by avoiding the offending allergen as much as possible, cleaning frequently, and having your child shower after being outside.5
“The biggest defense after confirming a child has an allergy is to avoid it if possible,” says Dr. Khan. “So, if we know tree pollen is an issue, we want to avoid opening all the windows, even if it is a beautiful spring day. That can be a trigger for your child and their symptoms. The same applies when driving around in car. Keep your car windows closed as well.”
She also recommends changing clothes after spending time outside and showering before bed so that your child is not trying to sleep with pollen clinging to their hair, clothing, and skin.5 Likewise, saline sprays and sinus rinses also can be helpful tools at minimizing exposure—if your child can handle them.
“Sinus rinses can sometimes be harder for young kids and can take a little time to learn how to do them correctly,” she says. “In those cases, use a saline spray to flush things out.”
Dr. Berger suggests looking for ways to treat the allergies before reaching for an OTC medication. He recommends optimized home filtration, HEPA filters, and testing for mold in the house and remediating if needed.
“I never turn to medications first, unless a more serious allergic reaction is occurring, or if the nose is so congested the child can’t breathe to the point of it interfering with eating, drinking, and sleeping,” he says. “I also recommend a natural antihistamine called Natural D Hist that contains vitamin C, n-acetyl cysteine, bromelain, stinging nettles, and quercetin.”
You also may want to get your child evaluated by an allergist, especially if their symptoms are not improving or you cannot find a medication that gives them some relief.
“Consultation with an allergist can help to identify allergy triggers through testing,” Dr. Burbank says. “An allergist can also help to develop avoidance strategies and, depending on the severity of symptoms and the preferences of the patient and family, prescribe or recommend medications. Allergists can also provide allergen immunotherapy (also called allergy shots) for patients who did not respond adequately to medications or who prefer not to take medications.”
Oral or Nasal Medication?
Nasal sprays differ from oral antihistamines in that they go directly into the nasal passages where the symptoms occur, unlike oral antihistamines, which need to enter the bloodstream. There are two main forms of nasal sprays that are used to treat allergies. These include antihistamines and topical steroids. There also are nasal decongestants, but Dr. Adams indicates that these are rarely used in children due to the risk of dependance.6
“Some people do not like medications that circulate throughout the body or that cause side effects,” says Dr. Berger. “Nasal sprays only work at the site where they are administered.”
Another potential downside to oral medication is that it requires your child to drink it or swallow it. Then, it needs to absorbed into the blood stream before being delivered to the area that is experiencing symptoms, explains Dr. Adams.
“Meanwhile, nasal sprays tend to work faster and can be as effective or more in relieving the rhinitis or congestion, and can also help with fluid in the middle ear,” she says. “But nasal sprays do not help with what we call systemic symptoms such as hives, because they only work in the nasopharynx. Nasal sprays also will not help with symptoms involving the eyes.”
Keep in mind, though, that nasal antihistamines are only approved for kids ages 6 years and older, according to Dr. Adams. And, nasal steroids can be used for used in kids that are age 4 and older.
“I also caution families from using OTC medications that are combination treatments such as those with an antihistamine, decongestant, cough suppressant, and fever reducer,” says Dr. Adams. “It is best to use remedies that have one medication, and to always consult your doctor before starting any medication. I discourage decongestants and cough suppressants and recommend more natural remedies such as fluids, rest, running a humidifier, nasal saline drops, and suctioning baby’s nose if needed.”
A Word From Verywell
Whether it’s pets, pollens, or perfumes that are causing your child’s discomfort, knowing how to effectively treat your child’s environmental allergies is important. Doing so can drastically improve their quality of life and help them feel better overall.
Sometimes finding the right over-the-counter allergy medications is a matter of trial and error, but most parents eventually land on a treatment option that works. Just be sure you also discuss your child’s symptoms with their pediatrician or another healthcare provider. They can help you pick the best allergy medication for your child or determine if additional testing or treatments might be warranted.