What is the Best Allergy Medicine for Kids?

Rev. 2019

Buds on the trees, first green blades of grass, and... Achoo! Spring is on its way and allergens are on the rise. As the allergens increase, so do symptoms. Here’s a quick primer on which over-the-counter (OTC) allergy medications are best for your kids. 

A few things to know:

  • Seasonal allergies are usually the worst in the spring. The spring season is dominated by tree pollens and flowering plants, followed by grass and weed pollen later in the summer. Remember that pollen can travel many miles in the air. Even without trees in your yard, allergy symptoms can be present. Pollen levels are highest in the morning hours on windy days, and counts drop after a good rain.

  • There are very effective treatments for seasonal allergies available without a prescription. In fact, most kids can be treated entirely by OTC meds when the correct medication and dosing is provided. Be sure to choose a medication for your child’s symptoms (see advice below) since not all OTC meds work the same.

  • Of the OTC meds, most allergists recommend nasal sprays as first-line therapy due to their effectiveness and minimal side effects.

  • Don't forget other ways to decrease environmental allergens and help symptoms. Keeping windows closed on windy days, nasal saline rinses, and removing shoes/changing clothes soon after arriving home can all help decrease allergen exposure.

  • Infants (under 1 year) very rarely get seasonal allergies. If your baby has a runny nose this time of year, it’s likely a from a viral cold. 

Commonly available OTC allergy medications: 

Oral Medications (antihistamines) 

Antihistamines block histamine from attaching to itch-producing, snot-making cells. This class of medication is great for itching and drippy noses, but not great for stuffy noses and congestion. These meds work quickly; they can be used on and off throughout the allergy season. Antihistamines are best for mild, intermittent symptoms. 

In my order of preference:

  1. Zyrtec - More likely to be cause drowsiness than Claritin, but quicker onset of action (1 hour.) Slightly more effective than Allegra. Less drowsiness than Benadryl. Zyrtec can be given to children as young as 6 months of age, with caution for drowsiness. Xyzal has the same active ingredient as Zyrtec, so save your money.

  2. Claritin - Less sedating than Zyrtec, but takes longer to work (3 hours.) Clarinex has the same active ingredient as Claritin, so save your money.

  3. Benadryl - Most commonly used antihistamine for allergic reaction with slightly faster onset of action then Zyrtec, but most likely to cause drowsiness. Can be dosed every 4-6 hours.

  4. Allegra - Least sedating (vs Zyrtec and Claritin), but slightly less effective and shorting acting. Approved for kids 12 yrs and older.

Nasal Sprays

Most OTC nasal sprays contain a small amount of steroid to decrease swelling. Nasal steroids are the best for congestion and stuffy noses. In fact, many allergists consider nasal steroids the thing to try for persisting allergy symptoms. No studies have shown significant differences in efficacy between the nasal steroids. The main differences are side effects, like taste. Unlike antihistamines, nasal sprays take up to 2 weeks of daily use for symptom relief, and need to be taken daily for the entire season. For best results, begin sprays 1-2 weeks before the sesason begins. 

In my order of preference: 

  1. Flonase - Some additional help for allergic eye symptoms vs Nasonex, with less systemic absorption. Flonase Sensimyst is approved for 2-yr+ which is scent-free and alcohol-free.

  2. Nasocort OTC - A cheaper scent-free/alcohol-free option. Slightly more systemic absorption than the active ingredient than Flonase.

  3. Rhinocort - Very similar to Flonase/Nasocort OTC, but typically more expensive.

  4. NasalCrom - This medication is not a steroid, but a mast cell stabilizer. This is an option for families who prefer not to use steroids, but it has to be administered 4 times per day for best coverage.

Be sure that your child is properly instructed on how to use a nasal spray because technique matters. See this video from Nationwide Children’s Hospital. 

Eye Drops

Common OTC eye drops use a combination of an antihistamine and mast cell stabilizer. Mast cells are body cells that release histamine. If you place a barrier around those cells, then no histamine can cause itching and watering. If some histamine sneaks past, however, the antihistamine is still there to do the job. 

In my order of preference: 

  1. Zatidor - Antihistamine and mast cell stabilizer to use 2 times a day, as needed.

  2. Visine-A/ Opcon-A - Cheaper, but antihistamine only and need to dose every 4 hours.

Need tips on how to get eye drops in your kids’ eyes? Here’s a video. 

Want more info about dosing allergy meds? Want to know how allergies are associated with global warming? Want to know why God invented seasonal allergies? What about allergy shots? Do nasal steroids affect growth?

The answers are in this Up To Date broadcast where I discuss seasonal allergies with Dr. Jay Portnoy from Children’s Mercy Hospital.