From the Guidelines
If your 2-year-old is struggling to breathe despite taking Zyrtec, seek immediate medical attention as breathing difficulties can be dangerous. While waiting for help, keep the child upright to ease breathing and remove any potential allergens from the environment. For severe allergic reactions, an emergency epinephrine auto-injector (like EpiPen Jr) may be needed if prescribed by your doctor, as guidelines recommend prompt epinephrine injection for the sudden onset of any anaphylaxis symptoms after exposure to an allergen that previously caused anaphylaxis in that patient 1.
Once the immediate situation is addressed, talk to your pediatrician about alternative or additional allergy treatments. Options might include trying a different antihistamine like Benadryl (diphenhydramine) at age-appropriate doses (typically 1.25ml of children's liquid Benadryl for a 2-year-old, but confirm with your doctor), adding a nasal steroid spray like Flonase (if recommended by your doctor), or using saline nasal sprays to clear congestion. Allergies in young children often require a combination approach, and Zyrtec alone may not be sufficient for severe symptoms. Your doctor might also recommend allergy testing to identify specific triggers that can be avoided, as food avoidance is the first line of treatment for children with food allergies 1.
Some key points to consider:
- Antihistamines should not be used in place of epinephrine for severe reactions, as they are useful only for relieving itching and urticaria, and do not relieve stridor, shortness of breath, wheezing, GI symptoms, or shock 1.
- Patients and caregivers need training in how to recognize anaphylaxis and use an EA, and technique can be practiced at home by using a “trainer” 1.
- After treatment with epinephrine for anaphylaxis in community settings, it is important for patients to be assessed in an emergency department to determine whether additional interventions are needed 1.
Remember that breathing difficulties should always be treated as an emergency, especially in young children whose airways are smaller and can become obstructed more easily.
From the FDA Drug Label
Albuterol sulfate inhalation solution is indicated for the relief of bronchospasm in patients 2 years of age and older with reversible obstructive airway disease and acute attacks of bronchospasm. The patient is 2 years old and can't breathe due to allergies, albuterol (INH) can be used for relief of bronchospasm in patients 2 years of age and older.
- Key points:
- The patient's age is within the indicated range for albuterol (INH) use.
- The patient's symptoms are consistent with bronchospasm, which is an indication for albuterol (INH) use. 2
From the Research
Allergy Symptoms in 2-year-olds
- A 2-year-old experiencing breathing difficulties due to allergies, despite taking Zyrtec, may require alternative or additional treatment options.
- According to a study published in 2023 3, epinephrine is the first-line treatment for anaphylaxis, and delayed administration can be a risk factor for fatal anaphylaxis.
Treatment Options
- The study found that patients treated with prehospital epinephrine were less likely to have uncontrolled reactions, receive intravenous fluids in the emergency department, and be admitted after the reaction 3.
- Antihistamines, such as Zyrtec, may also be beneficial in managing anaphylaxis, as patients treated with prehospital antihistamines were less likely to have uncontrolled reactions and be admitted after the reaction 3.
- However, the use of corticosteroids in anaphylaxis management should be revisited, as patients who received prehospital corticosteroids were more likely to require intravenous fluids and be admitted 3.
Considerations
- The study's findings are based on a predominantly pediatric population, with a median age of 8.8 years, and may not be directly applicable to a 2-year-old child.
- It is essential to consult a medical professional for personalized advice and treatment options for a child experiencing breathing difficulties due to allergies.