From the Guidelines
The first line treatment for allergies in a 6-year-old child is typically a second-generation oral antihistamine such as cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra). For cetirizine, the recommended dose is 5-10 mg once daily; for loratadine, 5 mg once daily; and for fexofenadine, 30 mg twice daily. These medications are preferred because they cause less sedation than first-generation antihistamines and don't require multiple daily doses.
Key Considerations
- For nasal symptoms, intranasal corticosteroids like fluticasone (Children's Flonase) at 1-2 sprays per nostril daily may be added.
- For eye symptoms, antihistamine eye drops such as ketotifen (Zaditor) can be used, typically 1 drop in each affected eye twice daily.
- It's essential to use these medications consistently during allergy season rather than as needed.
- These medications work by blocking histamine receptors or reducing inflammation, which are key mechanisms in allergic reactions.
- If symptoms persist despite these treatments, the child should be evaluated by a healthcare provider as additional or alternative treatments may be necessary, as supported by studies such as 1.
From the FDA Drug Label
Pediatric patients (4 years of age and older) should be started with 100 mcg (1 spray in each nostril once daily). Treatment with 200 mcg (2 sprays in each nostril once daily or 1 spray in each nostril twice daily) should be reserved for pediatric patients not adequately responding to 100 mcg daily The first line treatment for allergies in a 6 year old child is fluticasone at a dose of 100 mcg (1 spray in each nostril once daily) 2.
- The dose can be increased to 200 mcg (2 sprays in each nostril once daily or 1 spray in each nostril twice daily) if the child does not respond to the initial dose.
- It is essential to monitor the child's growth regularly while using this medication, as intranasal corticosteroids may cause a reduction in growth velocity in pediatric patients 2.
From the Research
First-Line Treatment for Allergies in Children
The first-line treatment for allergies in a 6-year-old child typically involves the use of antihistamines or intranasal corticosteroids, depending on the severity and frequency of symptoms.
- For mild intermittent or mild persistent allergic rhinitis, a second-generation H1 antihistamine (eg, cetirizine, fexofenadine, desloratadine, loratadine) or an intranasal antihistamine (eg, azelastine, olopatadine) may be recommended 3, 4.
- For persistent moderate to severe allergic rhinitis, an intranasal corticosteroid (eg, fluticasone, triamcinolone, budesonide, mometasone) is often the first-line treatment, either alone or in combination with an intranasal antihistamine 3, 5.
- Second-generation oral antihistamines, such as cetirizine, desloratadine, and fexofenadine, have been shown to relieve symptoms of nasal congestion and are considered safe for use in children 4, 6.
- Intranasal corticosteroids, like fluticasone propionate, are effective in reducing nasal symptom scores and are often recommended for moderate to severe allergic rhinitis 5, 7.
Considerations for Treatment
When selecting a treatment, it's essential to consider the severity and frequency of symptoms, as well as patient preference and any potential side effects.
- Antihistamines are commonly used to treat allergic rhinitis in children, but it's crucial to choose the right type and dosage to minimize adverse effects 6.
- Intranasal corticosteroids are generally well-tolerated, but patients should be instructed on proper use and potential side effects 3, 5.
- Combination therapy, such as using an intranasal corticosteroid with an oral antihistamine, may be effective for some patients, but should be tailored to individual needs 5, 7.