From the Guidelines
For an 11-year-old with seasonal allergies, intranasal antihistamines such as azelastine (Astelin) or olopatadine (Patanase) are recommended treatments, with azelastine being a suitable option at a dose of 1 spray twice a day 1.
Treatment Options
- Intranasal antihistamines are effective for treating seasonal allergic rhinitis and can be used as first- or second-line therapy.
- Azelastine (Astelin) and olopatadine (Patanase) are approved for use in children aged 6 years and older, with azelastine being a suitable option for an 11-year-old at a dose of 1 spray twice a day.
- Common side effects of intranasal antihistamines include bitter taste, epistaxis, somnolence, and headache.
Additional Considerations
- Intranasal corticosteroids, such as fluticasone (Flonase), may also be considered for treatment of nasal symptoms, with a recommended dose of one spray in each nostril once daily.
- Antihistamine eye drops, such as ketotifen (Zaditor), may be used to treat eye symptoms.
- Environmental measures, such as keeping windows closed during high pollen days, showering after outdoor activities, and using air purifiers, can also help alleviate symptoms.
Recommendation
Based on the evidence, azelastine (Astelin) is a recommended treatment option for an 11-year-old with seasonal allergies, due to its efficacy and safety profile 1. It is essential to consult a pediatrician if symptoms persist despite treatment, as they may recommend combination therapy or referral to an allergist for possible immunotherapy 1.
From the FDA Drug Label
Pediatric Use Safety and efficacy of SINGULAIR have been established in adequate and well-controlled studies in pediatric patients with asthma 6 to 14 years of age. The efficacy of SINGULAIR for the treatment of seasonal allergic rhinitis in pediatric patients 2 to 14 years of age
For an 11-year-old pediatric patient, montelukast (PO) can be used for the treatment of seasonal allergic rhinitis. The safety and efficacy of this medication have been established in pediatric patients between 6 to 14 years of age 2.
From the Research
Seasonal Allergy Medications for Pediatrics
Overview of Allergic Rhinitis
- Allergic rhinitis affects an estimated 15% of the US population and is associated with symptoms such as nasal congestion, rhinorrhea, postnasal drainage, sneezing, and itching of the eyes, nose, and throat 3.
- The condition occurs when disruption of the epithelial barrier allows allergens to penetrate the mucosal epithelium of nasal passages, inducing a T-helper type 2 inflammatory response and production of allergen-specific IgE 3.
Treatment Options for Seasonal Allergic Rhinitis
- First-line treatment for mild intermittent or mild persistent allergic rhinitis may include a second-generation H1 antihistamine (eg, cetirizine, fexofenadine, desloratadine, loratadine) or an intranasal antihistamine (eg, azelastine, olopatadine) 3.
- Patients with persistent moderate to severe allergic rhinitis should be treated initially with an intranasal corticosteroid (eg, fluticasone, triamcinolone, budesonide, mometasone) either alone or in combination with an intranasal antihistamine 3.
- A study comparing the effectiveness of fluticasone nasal spray and the combination of loratadine and montelukast in seasonal allergic rhinitis found that both treatments provided clinically meaningful responses, but the overall results favored fluticasone propionate 4.
- Another study found that bilastine 20 mg and loratadine 10 mg were equivalent in improving health-related quality of life in patients with allergic rhinitis 5.
Considerations for Pediatric Patients
- While the provided studies do not specifically focus on pediatric patients, the treatment options mentioned can be considered for children with seasonal allergic rhinitis, taking into account the child's age, weight, and medical history.
- It is essential to consult a healthcare professional to determine the best course of treatment for an 11-year-old child with seasonal allergic rhinitis.