The Best Seasonal Allergy Meds For Kids

And a Few Expert Tips

Spring is on the way and seasonal allergies are on the rise. Most sneezing and snotty-nosed kids can be treated for allergy symptoms with over-the-counter (OTC) medications, but that allergy aisle in Target is confusing!

Here’s my short list of favorite OTC allergy medications** for your kids.

Dr. Natasha's OTC Allergy Med Dosing Chart

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My preferred OTC allergy meds for kids with dosing recommendations.

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Allergy symptoms in children are very similar to adults - runny nose, congestion, cough, itching eyes, sneezing and dark undereye circles. For most kids, these symptoms are simply an annoyance. But kids with uncontrolled allergies can experience poor sleep, fatigue, decreased attention at school, asthma or eczema flares and behavior changes. Meds to help allergy symptoms are easy-to-use, safe and can prevent these complications.

Not all allergy meds work the same. Knowing the symptoms you are targeting, while working in a step-up approach, will keep effectiveness high and side effects low.

Step One: Nasal Steroids

Nasal steroids decrease snot production and swelling, making them the #1 choice for congestion and stuffy noses. Allergists recommend nasal sprays as first-line therapy, adding oral medications only if nasal therapies aren’t tolerated or effective.

My experience is that parents under-utilize nasal steroids, even though they are the singularly most effective medication for persistent allergic symptoms. Parents think little kids can’t use nasal sprays or assume they will hate something in their nose. But with correct technique and a little practice, nasal sprays are well-tolerated by most Littles.

When you start nasal steroids, be consistent and patient. Sprays can take up to a week of consistent use before your child experiences symptom relief, and these sprays have to be taken daily through the allergy season.

I like nasal steroids with minimal systemic absorption and are pleasant to use. In order of preference, I recommend:

• Flonase Sensimyst - Flonase Sensimyst is approved for 2-yrs+, scent-free and alcohol-free. The active ingredient in Flonase has very little systemic absorption and can also help itchy, watery eyes. This formulation has a smaller volume per spray and more effective steroid molecule, but isn’t available as a generic — it can be pricey.

• Flonase Allergy Relief (fluticasone proprionate) - Approved for 4-yrs+. Larger volume per spray than Sensimyst and contains alcohol, which can be irritating. However, it’s available in a generic, so much more cost-effective than Sensimyst.

Expert Tip: There is no difference between adult and children’s nasal products, except the number of sprays per bottle — the dose per spray is the same. Shop wisely.

• Rhinocort (budesonide) - A generic, scent-free, alcohol-free option. Head-to-head studies show Rhinocort is more effective than Flonase Allergy Relief, but it’s approved for kids 6-yrs+. There is slightly more systemic absorption of budesonine vs fluticasone, but the significance to kids is not clear.

• Nasocort OTC (triamcinolone) - A cheaper scent-free/alcohol-free option for kids 2-yrs+. Slightly more systemic absorption than the active ingredient in Flonase.

• NasalCrom (cromolyn sodium)- If you prefer a non-steroid option, Cromolyn is a mast cell stabilizer that is not systemically absorbed. This nasal spray has a great safety profile and can be used in young kids. The challenge, however, is that NasalCrom has to be administered at least 30 minutes prior to allergen exposure and 3-4 times per day.

Expert Tip: Using nasal saline to clear out the snot and crusties before administering the nasal steroids can help improve effectiveness.

For all nasal sprays, technique matters.

• Tilt head forward

• Right hand to left nostril

• Left hand to right nostril

• Wipe the drips, no snorting

Step Two: Oral Antihistamines

Antihistamines block pollens from triggering itch-producing, snot-making chemicals. This class of medication is great for itching and drippy noses, but not great for stuffy noses and congestion. These meds work quickly, so they can be used on and off throughout the allergy season for mild, intermittent symptoms. 

I choose oral medications that work fast and don’t make kids drowsy. In order of preference, I recommend:

• Zyrtec (cetirizine) - Zyrtec can be given to children as young as 6-months and has a quick onset of action (1 hour). It’s more likely to cause drowsiness than Claritin, but more effective than Allegra. Xyzal has the same active ingredient as Zyrtec, save your money.

• Claritin (loratidine) - Less sedating than Zyrtec, but takes longer to work (3 hours) and approved for kids over 2-years-old. Clarinex has the same active ingredient as Claritin, save your money.

Expert Tip: Antihistamines come in various children’s formulations, but the medication is the same as adults. Generic tablets can be crushed, saving money over liquid or dissolvable tablets.

• Allegra (fexofenadine) - Least sedating (vs. Zyrtec and Claritin), but slightly less effective and shorter-acting so offered twice a day. Approved for kids 2-yrs+.

FYI: Benadryl is no longer recommended for seasonal allergy management due to risk of sedation, cardiac complications and overdose risk. Learn more about the concerns about Benadryl in this post.

What about watery, itchy eyes?

Nasal steroids can help eye symptoms, but sometimes they aren’t enough. When eyes are still a bother, add an allergy eye drop. Most OTC drops use an antihistamine as the active agent. (Think: Zyrtec for your eyes.)

In my order of preference: 

• Pataday Once Daily (olopatadine) - For kids 2-yr+, this is a great drop used once-per-day. A bit pricey, but a generic is available.

• Zaditor 12-Hour - A twice-a-day drop for kids 3-yr+. Often cheaper than Pataday.

Need tips on how to get eye drops in your kids’ eyes? Here’s a video. 

Don't forget other ways to decrease environmental allergens and help symptoms. Keep windows closed on windy days, try nasal saline rinses, and remove shoes/changing clothes soon after arriving home to help decrease allergen exposure.

With correct and consistent use, most seasonal allergy symptoms can be controlled with simple OTC regimens. If OTC meds are not helping or your child’s symptoms are getting worse, make an appointment with your child’s doc.

Happy Spring,

** This post is NOT sponsored by any of these manufacturers and is my personal opinion, not medical advice. Talk to your child’s physician if you have questions, concerns or need expert opinion.