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Hard-to-Control Allergies

Pediatric Allergy Basics


Updated September 28, 2011

An itchy nose is a classic sign of allergies.

An itchy nose is a classic sign of allergies.

Photo © Rebecca Ellis

Allergy Medicines

In addition to avoid allergy triggers, your child with allergies will likely need to take one or more allergy medicines to help control his allergy symptoms, including some that are now available over-the-counter.

Keep in mind that for the child with hard-to-control allergies, choosing the right allergy medication can take a little more thought than choosing one off of the shelf at the pharmacy.

Allergy medicines include:

  • Antihistamines (first generation, meaning older) - usually very sedating
    • Diphenhydramine (Benadryl)
    • Chlorpheniramine (Extendryl, AH-Chew)
    • Brompheniramine (Ala-Hist)
  • Antihistamines (second generation)
    • Allegra
    • Clarinex (desloratadine)
    • Claritin
    • Xyzal (levocetirizine)
    • Zyrtec
  • Leukotriene Antagonists - Singulair
  • Nasal Steroids
    • Flonase (fluticasone)
    • Nasocort AQ (triamcinolone)
    • Nasonex (mometasone)
    • Rhinocort Aqua (budesonide)
    • Veramyst (fluticasone)
  • Nasal Antihistamines - Astelin (azelastine)
  • Allergy Eye Drops
    • Acular (ketorolac)
    • Optivar (azelastine)
    • Pataday (olopatadine) - once a day
    • Patanol (olopatadine)
    • Zaditor (ketotifen) - over-the-counter

With so many choices, how do you know which allergy medicine will be best for your child?

Your pediatrician will likely start with an age-appropriate allergy medication, either a second-generation antihistamine or Singulair. If that doesn't work, the next step will likely be to change to a different medication.

For the child with continued allergy symptoms, your pediatrician may add in a second allergy medication, typically a nasal steroid.

Keep in mind that some allergy medications do a better job of treating certain allergy symptoms than others. For example, antihistamines usually do not relieve congestion, while Singulair and nasal steroids do.

Allergy eye drops can also be helpful if your child's main allergy symptoms are red, itchy eyes.

A decongestant, either by itself, or in combination with another allergy medication, such as Allegra-D, Claritin-D, or Zyrtec-D, is also sometimes helpful for children with hard-to-control allergies.

Allergy Shots

Allergy shots are overlooked as an option to treat children with hard-to-control allergies. Some parents don't think that they are available for children, while others don't think that children will tolerate getting allergy shots every week.

Children can actually start getting allergy shots as young as age five and for those kids who need them, the benefits usually outweigh any possible downsides, such as side effects, the cost of therapy, the inconvenience of getting allergy shots once or twice a week, the high probability of a relapse of allergy symptoms when you eventually stop the allergy shots, and the fact that younger school-age children may not want to get shots at all.

On the other hand, your child likely doesn't want to suffer with allergy symptoms every day, especially if he has hard-to-control allergies that aren't responding to allergy medications and attempts to avoid allergy triggers. And in the long run, the cost of allergy shots may be less than the cost of your child's allergy medications.

Allergy shots can also have the added benefit of preventing your child from developing new allergies or to keep simple allergies from progressing to asthma.

How often will your child need to get allergy shots? It depends, but children usually get allergy shots one or two times a week for three to six months during their initial build-up phase. The time between allergy shots is then increased to every two to four weeks during the child's maintenance phase, which can continue for three to five years.

Because your child will get allergy shots so often, it shouldn't be surprising that one of the biggest reason that some parents stop allergy shots early is that they are inconvenient to get. Taking a child out of school once or twice a week to get an allergy shot can be especially difficult. Seeing an allergist that is near your home can be helpful, especially one that gives allergy shots during after-school hours.


Adkinson: Middleton's Allergy: Principles and Practice, 6th ed.

Allergen immunotherapy: a practice parameter second update. J Allergy Clin Immunol - 01-SEP-2007; 120(3 Suppl): S25-85

Allergic rhinitis and its impact on asthma update: allergen immunotherapy. Passalacqua G - J Allergy Clin Immunol - 01-APR-2007; 119(4): 881-91

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