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Allergic rhinitis, or hay fever, is a common problem in infants and children. The symptoms are similar to those of adults and include a stuffy or runny nose with clear drainage, sneezing, itchy eyes and nose, sore throat, frequent throat clearing and a cough that may be worse at night and in the morning. Children may also be seen performing the 'allergic salute' - the habit of running their hand upwards on their nose to wipe away drainage or to relieve itching. These symptoms usually occur during certain times of the year for people with seasonal allergies, corresponding to being exposed to outdoor allergens, such as tree pollens, grasses and weeds. Those with "indoor" allergies, such as dust mites, pets, secondhand smoke and molds, may have symptoms year-round.

Allergic rhinitis does have a genetic component and is more common in children that have asthma or eczema. It is also more common in children who are exposed to secondhand smoke, air pollution and pets. Uncontrolled allergies can also place a child at risk for recurrent sinus and ear infections. One study found that children ages 6 and 7 with allergic rhinitis had a 10-fold increased risk of developing persistent wheezing and asthma. Atopic allergic diseases have been found to be less common in younger children who have three or more older siblings or those who attend day-care suggesting that repeated immune stimulation may have a protective effect.

Recommendations to prevent allergic disease in children include:

• Do not smoke in the home
• Do not smoke when pregnant
• Breastfeeding exclusively for the first 4-6 months of age
• Use caution in introducing new foods, especially those with high allergy potential (such as peanuts, egg, tree nuts and fish)

The best treatment for allergic rhinitis in children is avoidance of offending allergens as much as possible. For seasonal allergies, this includes keeping windows closed in the car and at home to avoid exposure to pollens and limiting outdoor activities when pollen counts are highest (early morning for tree pollen in the spring; afternoon and early evening for grasses in the summer; and midday for ragweed in the fall).

The medications that are used to control the symptoms of allergic rhinitis in children are the same as in adults, but in appropriate children's doses. These include over the counter decongestants, over the counter and prescription antihistamines and steroids. Nasal steroids have been associated with growth suppression when used in high doses. This is rare , however, and your pediatrician should monitor your child's growth rate to make sure this does not happen. Some children also benefit from nasal irrigations using saline nose drops 1-3 times a day for relief of sinus congestion.

For optimal relief of seasonal allergies, it is helpful to start using allergy medications just before the allergy season begins and then continue using the medications every day throughout the season (not just as needed). For perennial allergies (dust mites, pet dander, etc.) it may be necessary to administer the medications year round.