Maggie McKay (Host): It's that time of year again, allergy season. So how do you treat your child's springtime allergies? We'll find out today with Dr. Jay Portnoy, Medical Director, Telemedicine, and member of the Division of Allergy, Asthma, and Immunology. Welcome to the Parentish Podcast, where experts at Children's Mercy Kansas City talk about the little everyday things parents experience with their babies, teens, and in betweens.

I'm your host, Maggie McKay. Thank you so much for being here today, Dr. Portnoy.

Jay Portnoy, MD: Thank you for inviting me. This is an exciting time, allergy season.

Host: What causes seasonal allergies?

Jay Portnoy, MD: Well, seasonal allergies are caused by allergies that are outdoors, so that they happen on a seasonal basis. They're usually caused by pollens. Pollens in the early spring are usually from trees. Tree pollen occurs early in the spring because the trees produce their pollen before they make their leaves, so that the air can flow through the branches, collect the pollen, and get them airborne.

Then we get into the grass pollen season, which is like May and June, and then we have a break in the summer, and then we get into the fall allergy season. So the reason it's seasonal is because different things pollinate at different times.

Host: I never, ever knew that. How many types of pollen are there?

Jay Portnoy, MD: Oh gosh, an unlimited number. How many plants are there? But the main two types of pollens are entomophilous and anemophilus. Entomophilous are insect pollinated. That's where the entomology is the derivative. For plants that rely on insects to carry their pollen from one plant to another, produce flowers. And so we don't call those weeds, we call those flowers.

And, they don't tend to produce pollen that gets into the air because the insects carry the pollen. Anemophilous, which is wind pollinated plants, on the other hand, do not make flowers. So a lot of the trees, grass for example, those don't make showy flowers. And in the fall, plants that don't make flowers are called weeds.

So that's why you're allergic to weeds and not to flowers because weeds are the kinds of plant that produce pollen that gets into the air.

Host: Interesting. Can my child be allergic or have reactions to only one specific pollen? And how do you know what pollen they are allergic to?

Jay Portnoy, MD: Absolutely, you can be allergic to one or, you know, all of the pollens, I suppose, as many as we can measure. The only way you can know for sure if you're sensitive to a seasonal allergen, because it's hard to go outside and tell if you're allergic to this pollen or that pollen because, they're in the air and you just don't see them; is to get tested. Your friendly neighborhood allergist should be able to perform allergy testing, and then they can tell you precisely which kind of pollen you're allergic to.

Host: Are there more effective over the counter medications than others?

Jay Portnoy, MD: Are they more effective? I think many of the over the counter medicines are effective, and in fact there are no prescription medicines for nasal allergies that are more effective than the ones that are over the counter. So you're not really sacrificing at all. I usually recommend that patients start with an antihistamine, probably a non sedating one like Zyrtec is my favorite, also Claritin and, Allegra, because they have minimal side effects and they're usually pretty effective.

I don't recommend Benadryl because it makes you sleepy and it's a relatively weak antihistamine. So what antihistamines will do is dry the nose out and get rid of the sneezing and the itching. If you want to do something for the congestion, then there are some nasal sprays, fluticasone or Flonase is a commonly prescribed one.

It's a steroid that reduces congestion. And then there's an antihistamine nose spray called Astelin, which can get rid of the sneezing and the itching. So depending on what symptoms you have, you can choose your nasal spray or antihistamine.

Host: Depending on age groups, are there better medications for say little young kids like under 10 and then different ones for teenagers or adults?

Jay Portnoy, MD: Not really. Just remember the medications treat symptoms. They don't treat allergies. The medicines don't care if you have allergies or not. They just take care of the symptoms. For different ages, there's different doses. So, a very small person might take a smaller dose of the medicine than a larger person.

And if somebody is very small, then it may be harder to use a nasal spray because it has to fit into their nostril. But for the most part, these medicines are very safe and they can be used at pretty much any age that a patient has symptoms that suggest that they would benefit from them.

Host: There's no age that's too young. Like how young is too young to start allergy medication?

Jay Portnoy, MD: They have to be born. We don't give intrauterine allergy medicine. Once they're born, for the most part, they're not having allergy symptoms in the first year of life or so. But after that, once they've had exposure and they've gone outdoors and have symptoms suggesting that they may have allergies, then the allergy medication is certainly can be tried.

Host: So should I treat my child's allergies the same way I would treat my own?

Jay Portnoy, MD: Pretty much. If they have a runny nose and sneezing, then you use an antihistamine to dry the nose up. If their nose is stuffy, then there's nasal steroid to unstuff it. And depending on what your symptoms are and your child's symptoms, if they're the same, you can kind of synchronize the treatment.

And in fact, I usually make an effort to do that so that different members of the same family don't have different treatments if their symptoms are the same. I try to make it so they all have the same treatment.

Host: That's nice. That's very considerate. Doctor, when will I notice or what signs should I look for that my kids allergies might be more than just allergies, like a sinus infection, strep, cold, etc.?

Jay Portnoy, MD: yeah, it can be difficult, but I usually say as a rule of thumb that if you have allergies, you're more itchy and sneezy. The symptoms are more persistent, lasting four to six weeks, during an allergy season. And they're not usually that intense, although they can be very itchy and your eyes can get really red. When you have a respiratory infection, it's usually more acute.

You have an acute onset, there's more pain, you get a little bit of a sore throat, you get a low grade fever, because even though they call it hay fever, there's no fever associated with allergies. A fever is a sign that there's probably some kind of a respiratory infection going on. And those usually last a week or two and then they go away rather than lasting for a whole allergy season.

 That is one way that you can tell the difference between the two, but you're right, in many cases it's hard to tell which one you have. And quite honestly, the medicines don't care either. They will treat the symptoms regardless of what the cause.

Host: Should I be concerned for allergy induced asthma and what is that?

Jay Portnoy, MD: Allergies can trigger asthma, particularly in highly allergic individuals. However, in children, most asthma is triggered by respiratory infections. That is by far and away the most common cause. We know that because during COVID, the allergies were exactly the same, and yet nobody had asthma because they weren't getting colds, even though they had lots of allergies.

So, I'm kind of quite skeptical about how strong the role is for allergies as a trigger for asthma. Most of the time it's colds in kids. Adults, on the other hand, may have more allergy induced asthma. And perennial things like pet dander and things like that, where you're exposed for a long period of time, could, in fact, probably trigger some allergy symptoms and certainly could trigger asthma.

Host: My kids love being outdoors, so how long is too long outside during allergy season if you know they're prone to it?

Jay Portnoy, MD: Well, you don't want them to miss dinner. I don't think there's any limit to how long they should be outside. If they want to be outside and are unable to because their allergy symptoms are limiting them, I think that's our job to better treat them so that they can be outside. I really hate to limit kids outdoor activity. I think they need to be outside. They need to have fun. We need to do whatever it takes to make sure that their allergies are well enough controlled so that they can do that.

Host: So with you on that. Should I be bathing my child right after they play outside during allergy season?

Jay Portnoy, MD: If they're dirty. Yeah, to get the pollen and mold off. Maybe there's a little bit of a contribution to that, but I don't know that it's something that would really necessitate bathing them right after they come inside. I think that's probably not going to make a whole lot of difference.

You're more likely to have pollen brought in by the pets where they roll around in the grass and stuff like that, and then they bring it in. That's more likely to be a problem than the child.

Host: Dr. Portnoy, if it's already been established by my child's primary care provider that they have bad allergies, what are some things I can do for my child while they're at school and have outdoor recess?

Jay Portnoy, MD: Make sure that they have their medications so that their symptoms are controlled. If they have asthma and the asthma is being triggered, they might need to use an inhaler before they go out to recess. A lot of our patients do that. So basically just prevention, knowing that it's their allergy season, they're going to be outside, give them their medications, give them their inhaler, and then let them go outside.

 Because they're going to want to be with their friends. You really don't want their activities to be limited. Then they feel like they're not as good as their friends. They get bullied. There's a lot of bad implications that occur if you restrict a child's ability to play outside with their friends. So we do whatever we can so that doesn't happen.

Host: So pets, do they bring allergens inside with them and how can we fix that?

Jay Portnoy, MD: They can, if they roll around in the grass, then they can pick up a lot of grass pollen. If the tree pollen is still laying on the grass, they can pick that up too. And then they can bring it in, so it is possible for a pet to bring outdoor allergens indoors.

Host: Is it helpful to keep your windows and doors shut at all times during allergy season to kind of protect your kids?

Jay Portnoy, MD: You know, if you keep your doors and windows shut during allergy season, it will decrease the amount of pollen and mold that infiltrates into the house. So if that is one strategy for doing that. Fortunately during the summer it's usually too hot and humid to have your doors and windows open anyway, so it's not a problem.

But on those nice beautiful spring days when we want our doors open and our windows open and the pollen count is really high; I feel really bad telling people that they have to keep their windows and doors closed. So in that case, it might be worthwhile just having them take their medication so that they can live with the windows and doors open rather than keeping them shut.

 If there's like a bedroom where you can keep the door closed, maybe keep that room clean. Have an air filtration unit in there. But the other parts of the house, let them air out because it's just too nice live in a stuffy house where the windows are closed.

Host: Right. The air filter is a great idea in just like maybe the child's bedroom. You've mentioned mold a few times. Is that like airborne or what?

Jay Portnoy, MD: Yeah, we talk about airborne mold. Mold is outdoors also. The most common mold in outdoor air is Cladosporium, but there's also other molds like Alternaria and Fusarium. I can't give you common names for them because they don't have common names. That's just what they're called. Molds can trigger nasal allergies and they can trigger asthma, though I don't see them as being a significant cause unless they're present in really high concentrations.

 And that happens like when there's a thunderstorm, that cold front that comes in will pick up a huge plume of mold and then there can be epidemics of asthma; that's been reported. But the mold that you see with the mold counts that are just pretty common, usually Cladosporium, those don't usually cause that many allergy symptoms. I wouldn't worry too much about outdoor molds.

Host: Why is it that my child is fine while they play outside, but then the next day they're miserable or we notice the allergy symptoms more?

Jay Portnoy, MD: Yeah, I mean, it depends what their indoor exposure was, how high the counts are on the outdoors when they're out there because it can really fluctuate from day to day. One thing you could do is to keep track of the pollen and mold count for your local vicinity. It's nice if it originates locally rather than from some central predictive model.

 And if it's really high for something that the child is really allergic to, then that might be a time when they should limit their outdoor exposure. And, I'm not one to usually limit outdoor exposure, but in that case, it might be worth doing.

Host: How do you keep track of it? What do you mean to know the count?

Jay Portnoy, MD: Most communities have a way of getting access to the pollen and mold count. In Kansas City, for example, we do the pollen and mold count at Children's Mercy Hospital, though the collector is actually in my backyard right now, because we had a hard time installing it on the roof. Every morning I connect to the device. It's a machine and it counts the pollens and molds and reports out the amount. And I report it every day. So it goes to the news media and then they report it. It also goes to the radio and the all the different media, allergy offices get it. If you're interested, you could contact me and get the pollen count too, just get on the list.

Host: Wow. Kind of like a smog index.

Jay Portnoy, MD: It's a pollen and mold count. It tells you how much pollen, how much mold, and then which species are present at that time.

Host: That's so interesting. Well, this has been so informative. Is there anything else you'd like to add that we didn't cover?

Jay Portnoy, MD: I think the important thing is to realize that there are so many effective treatments for nasal allergies. There's no reason why you should limit your quality of life. You should be able to play outside, you should have a normal quality of life. If you're not able to, then there's a lot that we can do to help you be able to do that more.

 If over the counter medicines, if your primary care doctor is not able to; make an appointment with an allergist, find out what you're allergic to. You might even be a candidate for allergy shots, which can reduce your sensitivity to allergens, but there should be a way for all of us to be able to enjoy outdoor air and just enjoy life because life is too short.

Host: Very, very useful information. Thank you so much.

Jay Portnoy, MD: Well, it's been my pleasure.

Host: Again, that's Dr. Jay Portnoy. And if you'd like to find out more, please visit childrensmercy.org/parentish. That concludes this episode of the Parentish Podcast. For more parenting tips and tricks, visit us at parentish.org where we help you celebrate the craziness and challenges of parenthood. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening. I'm Maggie McKay. This is the Parentish Podcast from Children's Mercy.