Management of Upper Respiratory Infection and Seasonal Allergies in Children

First-Line Therapy for Seasonal Allergies

The American Academy of Allergy, Asthma, and Immunology recommends intranasal corticosteroids as the most effective medication class for controlling symptoms of allergic rhinitis, including sneezing, itching, rhinorrhea, and nasal congestion, with high-quality evidence supporting their use over oral antihistamines or leukotriene receptor antagonists 1
Intranasal corticosteroids are more effective than oral antihistamines for comprehensive symptom control, particularly for nasal congestion, according to the American College of Allergy, Asthma, and Immunology 1, 2
Monotherapy with intranasal corticosteroid is strongly recommended over combination therapy with oral antihistamine for initial treatment, based on guidelines from the American Academy of Pediatrics 3, 1

For children 6 years and older, cetirizine 5-10 mg once daily is an appropriate second-generation antihistamine, with a dose of 10 mg once daily for ages 6 and older and 5 mg once daily for ages 2-5 years, according to the American Academy of Pediatrics 2
Second-generation antihistamines like cetirizine or loratadine cause less sedation than first-generation options, with rates of sedation ranging from 0.4-3% at recommended doses, as reported by the American Academy of Allergy, Asthma, and Immunology 1, 2

The American Academy of Pediatrics advises against using oral corticosteroids for routine management of allergic rhinitis, reserving them only for severe, intractable cases, and against assuming combination therapy is always superior to monotherapy, as intranasal corticosteroid alone is often sufficient 1
The American College of Allergy, Asthma, and Immunology recommends against exceeding the maximum dose of 200 mcg/day of fluticasone nasal spray, as higher doses are not more effective, and against using first-generation antihistamines due to sedation and cognitive impairment in children 2