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Ask Dr. Matt 

Why have my children developed seasonal allergies? What’s the best course of treatment?

click to enlarge Ask Dr. Matt
  • Ask Dr. Matt

A. ‘Tis the season for sneezing, so get your tissues. For those prone to seasonal allergies, beautiful weather and blooming can herald a sea of mucus and misery. What is going haywire to produce hayfever? Try this analogy: Think of an allergic person’s nose as a prison, whose inmates (histamines and other chemical trouble makers) are kept in their cells (mast cells) behind lock and key. Things are fine until the keys show up, releasing the captives from some or many of the cells. Some noses are like country club prisons with mild-mannered accountants while some noses are like the state penitentiary with dangerous inmates. Therefore the severity of a prison break will vary, from mild sniffles to hives, swelling, breathing difficulties and possibly dangerous situations.

Every nose is different; that’s why people are affected by different triggers — from pollen and grass to mold. In the nose, the opening up of mast cells leads to itching, burning and secretions, but the mayhem can spread. Surrounding areas — eyes, throat and even the lungs and skin — can become involved.

So, what to do? Obviously, avoiding triggers is the first line of defense, but this can be tough, given the fact that people like to go outdoors after a long winter. Filtering out allergens through frequent washing of clothes and sheets, and the use of HEPA filters on the air system at home, can help. A third approach is washing away intrusive allergens by blowing your nose, and, even better, by using nasal lavage. Purchase an over-the-counter kit that contains a plastic bottle and some saline packets, and flush the nose and sinuses, clearing away inflammatory secretions and those nasty triggers.

Antihistamines like Zyrtec, Claritin and Allegra work by trying to tamp down the body’s response to allergic triggers. Depending on the severity of the riot, these medications may be just enough to take the edge off the situation.

For people with predictable symptoms at the same time every year, preventive measures include prescription nasal steroids — one of the most effective ways to keep things under control. There are also other prescription medicines (mast cell stabilizers) that reduce the agitation at the mast cells. Leukotriene inhibitors like Singulair work by disrupting communication between the aggravated mast cells and adjacent areas, preventing expansion of the reaction.

For some people with severe allergies, allergists can provide injections that in essence make the mast cells less susceptible to keys that previously opened them. There is progress being made in adults with these delivering these therapies orally, but for now kids are stuck with shots.Matt Thompson is a pediatrician at the Kids Clinic in Spokane.

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