From the Guidelines
For a 6-year-old with seasonal allergies, I strongly recommend starting with a non-sedating antihistamine like children's Zyrtec (cetirizine) or Claritin (loratadine), as they are effective in reducing symptoms like sneezing, runny nose, and itchy eyes, with a favorable safety profile, as noted in 1 and 2.
Key Considerations
- The appropriate dose for a 6-year-old is typically 5 mg once daily, available as a chewable tablet, liquid, or dissolving tablet.
- Begin treatment at the start of allergy season and continue daily throughout the season for best results.
- Nasal saline rinses can also help clear allergens from the nasal passages.
Additional Treatment Options
- For persistent symptoms, consider adding a pediatric-formulated nasal steroid spray like Flonase (fluticasine) or Nasacort (triamcinolone), using 1-2 sprays per nostril once daily as directed for your child's age, as recommended in 1.
- Intranasal antihistamines like olopatadine (Patanase) or azelastine (Astelin) can be considered for children aged 6 and above, as listed in 2.
Important Precautions
- Always consult your child's pediatrician before starting any medication, especially if your child has other medical conditions or takes other medications.
- Reducing allergen exposure by keeping windows closed during high pollen days, having your child wash hands and face after coming indoors, and regular bathing before bedtime can significantly help manage symptoms.
Treatment Goals
- The primary goal is to alleviate symptoms and improve quality of life, while minimizing potential side effects and risks, as emphasized in 1 and 2.
- Regular follow-up with a clinician is essential to assess response to treatment and adjust the treatment plan as needed.
From the FDA Drug Label
Patients being treated with Fluticasone Propionate Nasal Spray, USP, should receive the following information and instructions Some patients (12 years of age and older) with seasonal allergic rhinitis may find as-needed use of 200 mcg once daily effective for symptom control
For a 6-year-old patient with seasonal allergies, fluticasone propionate nasal spray may not be the best option as the label mentions that some patients 12 years of age and older may find it effective for symptom control. Alternatively, cetirizine can be considered as the label states it is suitable for children 6 years and older. The recommended treatment for a 6-year-old patient with seasonal allergies would be cetirizine, as it is explicitly stated to be suitable for this age group 3.
From the Research
Treatment Options for Seasonal Allergies in a 6-year-old
- For mild, intermittent symptoms, an oral second-generation antihistamine such as cetirizine, loratadine, or fexofenadine can be used on an as-needed basis 4
- For patients with more persistent, severe symptoms, intranasal corticosteroids such as fluticasone propionate or mometasone furoate are indicated 4, 5
- Azelastine nasal spray, which has anti-inflammatory activity in addition to its antihistamine effect, can also be considered for patients with persistent, severe symptoms 4
- Combination therapy of an intranasal corticosteroid and an oral antihistamine may be effective for some patients, but the choice of treatment should be patient-specific, based on type, duration, and severity of symptoms, comorbidities, prior treatment, and patient preference 5, 6
Medication Options
- Cetirizine and loratadine are approved for children under 5 years of age, while fexofenadine and azelastine nasal spray are approved for children under 12 years of age 4
- Fluticasone propionate is approved for children aged 4 years and older, and mometasone furoate is approved for children aged 3 years and older 4
- Bilastine 20 mg and loratadine 10 mg have been shown to be effective in improving health-related quality of life in patients with allergic rhinitis, with equivalent effectiveness 7