We are currently in the midst of the grass pollen-induced hay fever season, so some parents may be wondering if their child’s sneezing-fits or persistent runny nose is in fact, a seasonal allergy that needs medical attention or something else, like a cold. So we spoke to Professor George Du Toit, one of our top consultant paediatric allergists, to 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 signs should parents observe for 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
Usually, excessive sneezing and runny nose alternates with nasal obstruction and throat irritation and 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. Hayfever has even been shown to negatively affect school performance.
Children with hayfever often have a typical facial appearance that may include dark rings (called allergic shiners) around and skin folds under the eyes and a pale horizontal nasal crease may also be visible. 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.
Can hay fever cause food allergy?
Additional symptoms associated with hay fever include ‘oral allergy syndrome’ also known as ‘pollen-food syndrome’. This is a milder form of food allergy that comes about due to cross-reactivity between proteins in some foods and pollens. These proteins are heat-labile so generally only cause symptoms when eaten raw. These strange phenomena will then present that a child who used to eat the food who will then develop an aversion with mild symptoms complaining of an itchy mouth and throat, perhaps with a hive or two around the mouth or at worst, a swollen lip. The intraoral sensation may be described as a metallic-taste, spikey or fuzzy sensation.
For example, a child may have tolerated tomatoes during their early years but as grass pollen sensitisation has developed, cross-reactivity may be noted when eating uncooked tomato; but not tomatoes when cooked, such as tomato sauce or tomato soup. If tree pollen allergic, similar symptoms may be noted with stone fruit, typically peaches, pears and apples and other foods such as certain raw nuts e.g. almond and hazelnut, soya and melon.
Severe allergic reactions (anaphylaxis) is very unlikely to occur with this syndrome and so if more severe allergies have been excluded, simple avoidance and use of a non-sedating antihistamine is all that is needed. If the food is tolerated cooked/roasted, then there is no need to avoid it. There is more information on the oral allergy syndrome and indeed on hay fever on allergy UK and UK anaphylaxis support networks.
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 sooner. 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 and non-sedating antihistamines as needed can be trialled. For patients with mild hayfever, this will often provide sufficient symptom control. Of course, if the child is suffering from 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 the right 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.
What practical tips do you have for reducing children's exposure to pollen?
It is very 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 releasing the pollen, 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
What medical treatments can help reduce the effects of hay fever in children?
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.
If you want to take your child to see an expert paediatric allergist, visit Professor George Du Toit’s Top Doctors profile and check his availability to book a consultation.