Pollen allergies are increasingly common in children in Croatia. It is estimated that 15–25% of school-age children have some form of allergic rhinitis, and over the past decade that percentage has been rising. Timely recognition and treatment are important because untreated allergies in childhood increase the risk of asthma development.
How to recognize allergies in children
Children often do not describe their symptoms clearly. Parents should pay attention to:
- Constantly rubbing the nose — often with a characteristic upward palm stroke ("allergic salute"), over time it can create a visible crease across the nose ("allergic crease").
- Rubbing the eyes as if tired, especially during the day.
- Constantly open mouth — the child breathes through the mouth because the nose is congested.
- Snoring and restless sleep.
- Dark circles under the eyes ("allergic shiners") due to congestion.
- Frequent "colds" that last weeks and have no fever.
- Drop in school performance or concentration during season — fatigue and poor sleep are the cause.
- Irritability and grumpiness.
If a child has symptoms in the same period several years in a row (e.g., every April or every August), it is very likely to be seasonal allergy, not repeated infections.
Difference from a cold
Quick checks:
| Question | Cold | Allergy |
|---|---|---|
| Fever? | Often mild | No |
| Duration? | 5–10 days | weeks to months |
| Itchy eyes/nose? | Rare | Often |
| Clear discharge? | Becomes thick after a few days | Always clear and watery |
| Seasonal repetition? | No | Yes |
| Body aches? | Can occur | No |
When to see a doctor
A pediatrician or family medicine specialist is the first contact. Reasons for an examination:
- symptoms last more than a week or two and affect sleep or learning
- they appear every year in the same period
- the child frequently breathes through the mouth
- appearance of wheezing, shortness of breath, cough that doesn't resolve — possible associated asthma
With suspected allergy, a doctor can refer to a pediatric allergist for testing. Skin prick tests can be done even in young children (from about 2 years of age). Blood tests (specific IgE) are useful when skin is problematic or the child is taking antihistamines.
Specific aspects of therapy in children
Antihistamines
Most second-generation antihistamines are approved for children from age 2 or 6, depending on the formulation. Most commonly prescribed:
- cetirizine syrup or drops — from 6 months/2 years (depending on formulation)
- loratadine syrup — from 2 years
- levocetirizine — from 2 years
- desloratadine — from 1 year
- fexofenadine — from 6 years
Dosage depends on body weight. Follow package instructions or advice from a doctor/pharmacist.
Nasal corticosteroids
Safe for long-term use in children at recommended doses. Most are approved from age 2–4 years. Permanent side effects (on growth, bone development) are not documented when used at recommended doses according to studies.
Correct application is important — direct the spray toward the outer wall of the nose (not toward the center) to avoid irritation and bleeding.
Immunotherapy in children
Sublingual immunotherapy (SLIT) is approved from age 5 for grass allergy and certain other allergens. Subcutaneous therapy usually from age 5–6 years.
In children, immunotherapy is especially beneficial because it:
- can prevent asthma development,
- can prevent development of allergies to new allergens (the "march of allergy"),
- the effect is maintained long-term.
Children generally tolerate immunotherapy very well.
What at home
- Bedroom without carpets and stuffed toys that cannot be washed.
- Wash plush toys occasionally at 60 °C (or freeze for 24 hours then wash).
- Air filter for pollen in the car, drive with windows up.
- Do not dry children's laundry outside during season.
- Shower or wash hair after coming from the park.
- Pets: dogs and cats bring pollen on their fur — it's worth wiping them off after a walk.
- Sports move to indoor facilities during peak season.
- Talk to the school/kindergarten — inform them of the condition, especially if the child uses an inhaler.
Red flags — seek help immediately
Call emergency or go to the ER immediately if the child:
- cannot speak or cry due to shortness of breath
- has distinctly blue or gray lips/fingernails
- has an asthma attack that does not respond to inhaler
- has facial, lip, tongue, or skin rash swelling after food (suspect anaphylaxis)
Good things to know
- Allergies can change over the years. Some children "outgrow" allergies, others develop new ones.
- Genetics play a role. If both parents have allergies, the risk in the child is significantly increased.
- Early exposure to nature (time outside, animals, microbiome) is associated with lower risk of allergies. Excessive sterility is associated with higher risk.
- Flu vaccination is recommended for children with asthma every year.
Note
This is not medical advice. Medication doses and therapy for children must be determined with a pediatrician or pediatric allergist.