What treatment options are available for allergic rhinitis in a 6-year-old child?

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Last updated: April 28, 2025 • View editorial policy

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

Considerations

  • The choice of treatment should be based on the severity and duration of symptoms, as well as the patient's age, comorbidities, and prior treatment 4, 5
  • Patients with severe or poorly controlled symptoms may require referral to a specialist for further evaluation and treatment 8

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Clinical prescribing of allergic rhinitis medication in the preschool and young school-age child: what are the options?

BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy, 2001

Research

Quality of life in patients with allergic rhinitis: a clinical trial comparing the use of bilastine versus loratadine.

Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery, 2017

Research

Allergic rhinitis.

Medicina clinica, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.