An Integrative Medicine Approach to Seasonal Allergies in Pediatrics

Allergies in kids seem to be on the rise, with no end in sight. As of 2021, the CDC reported 27.2% of kids in the U.S. had at least one allergic condition, and allergic rhinitis (also known as seasonal allergies) may be the most common chronic condition in the pediatric population. In addition, one observational study in Pediatric Allergy and Immunology found that food-induced anaphylaxis visits to the emergency room for kids increased by 214% between 2005 and 2014.

Pediatric allergies fall into three main categories: Seasonal (such as hay fever, allergic rhinitis, and allergic conjunctivitis), eczema (atopic dermatitis), and food allergies. Traditional management of pediatric allergies usually involves avoiding the allergen and using various pharmaceutical and over-the-counter treatments. However, exploring the underlying factors that contribute to the heightened immune response may help provide more significant relief and improve quality of life.

The development of allergies, including seasonal allergies, is multifactorial, but gut health may play a role in the issue. This article will share how integrative providers approach pediatric seasonal allergies.  

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What are Seasonal Allergies?

Before we get into seasonal allergies, let's review the background of allergies. In general, allergies result from your body trying to protect itself from foreign invaders (antigens). Essentially, allergens signal the regulatory T cells of your immune system to make immunoglobulin E (IgE) antibodies. These antibodies then bind to mast cells and basophils (immune cells), which trigger the inflammatory response and the release of chemicals like histamine into the blood. The result can be serious, as in anaphylaxis (swelling of the airway), but other symptoms include:

• Rash (atopic dermatitis)
• Rhinitis (congestion, runny nose, sneezing, itching)
• Hives (urticaria)
• Flushing
• Itching
• Nausea
• Vomiting
• Abdominal cramps
• Asthma (wheezing, shortness of breath, bronchospasm)
• Fainting
• Swelling of the lips and tongue

Seasonal allergies (also called allergic rhinitis) occur when the immune system overreacts to outdoor or indoor allergens, most commonly plant pollen. Kids can develop seasonal allergies at any age, and symptoms are usually at their worst during pollen season, which can vary depending on the type of pollen you're sensitive to and where you live.

Seasonal Allergies Symptoms in Pediatrics

It can sometimes be difficult to determine if your child has seasonal allergies or is simply experiencing a common cold. While each child will react differently, common signs and symptoms of seasonal allergies in kids include:

• Sneezing
• Itchy eyes
• Coughing
• Runny nose
• Nasal congestion
• Watery eyes
• Red eyes
• Nasal itching
• Itchy throat
• Fatigue

Most of these symptoms can accompany a cold as well, but you can assess nasal drainage as a way to distinguish between the two. When seasonal allergies are present, nasal drainage will be thin and clear, whereas it will be thicker and yellow or green if a cold is the cause. Additionally, seasonal allergies will occur roughly the same time every year and last longer than the common cold. 

Other symptoms that may suggest seasonal allergies rather than a cold include your child routinely rubbing their eyes and face, sounding stuffy and congested, or suddenly eating with their mouth open.

What Causes Seasonal Allergies Symptoms in Pediatrics?

For kids experiencing seasonal allergy symptoms, it may seem difficult to pinpoint the cause. While the development of seasonal allergies is complex, kids with a family history of allergies, a personal history of food allergies, or atopic dermatitis (eczema) may have a higher likelihood of developing seasonal allergies. One common factor in all of these immune-mediated conditions is gut health.

Seasonal allergy symptoms are the result of an improper immune response. When your body comes into contact with an allergen like pollen, it releases chemical mediators like histamine, which increase blood flow and trigger inflammation, ultimately creating uncomfortable side effects. 

The majority of the immune cells in the body reside in the intestinal tract and are influenced by gut bacteria. So, a balanced gut microbiome and overall gut health are important for a normal, healthy immune (and thus histamine) response, which may help manage seasonal allergy symptoms and risk.

It's well-accepted that exposure to a vast array of microbes early in life is beneficial and necessary for healthy gut microbiome development. Unfortunately, over the past several decades, kids have experienced less and less exposure to beneficial microbes. We've prescribed antibiotics frequently, moved toward a highly-processed diet, used hand sanitizers extensively, and kept our kids from playing in the dirt. All of this has culminated in less microbial exposure and diversity, which may increase the risk of seasonal allergies (and other chronic conditions). In fact, as reported in Frontiers in Immunology, kids with dysbiosis (an imbalance of gut bacteria) may have a higher likelihood of developing seasonal allergies. And infants with seasonal allergies have been found to have lower levels of healthy gut bacteria and higher levels of pathogenic (disease-causing) gut bacteria. 

When Do Seasonal Allergies Start? 

Seasonal allergies are rare in kids under the age of 2, but your child can develop them at any time. Most cases of seasonal allergies are diagnosed after the age of 3 after repeated exposure to the allergen. There are some early warning signs to watch for in infancy that can predict seasonal allergy development. The first sign, according to one review, is a food allergy. Roughly 10% of 1-year-olds have elevated IgE antibodies to food (usually milk or eggs), which may increase the risk of developing seasonal allergies. Additionally, kids with eczema have a 35% increased risk of developing seasonal allergies. 

The emergence of seasonal allergy symptoms often depends on the specific allergen and the time of year. If your child begins to exhibit seasonal allergy symptoms and you've ruled out the common cold, it's time to investigate further. You may be able to determine what your child is reacting to based on the time of year. According to Yale Medicine, the most common allergens are tree pollen (prevalent in March and April), grass pollen (prevalent in June and July), and ragweed and mold (prevalent in the Fall).

How Long Do Seasonal Allergies Last?

If your child has seasonal allergies, they'll likely experience symptoms at the same time each year, depending on the specific allergen. According to the Cleveland Clinic, different allergens are present at different times of the year. In the spring, tree pollen is the highest and can last until summer. When summer rolls around, grass pollen takes over and can persist through early fall when ragweed and mold dominate. Wintertime usually means a break from outdoor allergies. But with recent environmental changes, the trend has been for people with seasonal allergies to experience symptoms all year round, with peaks during warmer times. Without effective management, symptoms can last from weeks to months until the offending allergen is no longer present in levels that cause symptoms. 

There's no "cure" for seasonal allergies. But, it's possible that your child could outgrow them, usually after many years. Traditional treatments can provide some relief, but an integrative approach that addresses the underlying factors of seasonal allergies (like gut health and immune response) may help them become less of an issue, and your child can thrive. 

Labs to Test for Root Cause of Seasonal Allergies in Pediatrics

To diagnose allergic rhinitis in kids, the healthcare provider must consider the symptoms and history. These considerations, along with skin prick or blood testing, can help confirm a diagnosis. 

Specialty labs can play a role in exploring the root cause of seasonal allergies by providing valuable insights into the biological processes and factors that contribute to a patient's symptoms. The following are some commonly run specialty labs that can help practitioners create a targeted and effective management plan that addresses underlying issues rather than just managing the symptoms: 

Comprehensive Stool Testing

Comprehensive Stool Testing via GI-MAP by Diagnostic Solutions: this test utilizes quantitative polymerase chain reaction (qPCR) technology to detect highly sensitive microbial DNA. This test provides comprehensive information about the microbiome by identifying pathogenic bacteria, viruses, and parasites, Helicobacter pylori and its virulence factors, opportunistic bacteria, and bacteria that may cause autoimmune reactions. Additionally, the test reveals markers for digestive function, immune responses, estrogen metabolism, and inflammation. As proper gut function is essential to immune function and proper levels of inflammation, this test can provide essential insights into this process.

Inhalant Allergens Panel

The 50 Inhalant Panel: IgE, by US BioTek, measures IgE antibodies to 50 of the most common allergens, including mites, molds, weeds, trees, grasses, and animal dander. This test may help determine specific allergens, which can help parents and practitioners make informed decisions regarding specific environmental recommendations.

Mold Panel

Mold testing via US BioTek measures IgE antibodies to 15 different species of molds to determine the cause of inhalant allergies. This test may help determine specific types of mold that are contributing to symptoms, which can help parents and practitioners make informed decisions about management. 

Conventional Management for Seasonal Allergies Symptoms in Pediatrics

Traditional therapies for seasonal allergies are targeted at minimizing exposure to the allergen (limiting time outdoors, using air filters), calming the immune response (antihistamines and steroids), increasing tolerance to the allergen (allergy shots), and providing symptom relief (decongestants and cough medications).

Allergy shots have been found to be effective for seasonal allergies in kids. As for pharmaceuticals and over-the-counter preparations, one review suggested limiting the use of first-generation antihistamines (like diphenhydramine HCl) in the pediatric population because these medications can cause side effects, most often drowsiness and impaired learning but also may cause hyperactivity. Second-generation antihistamines (like cetirizine, fexofenadine, and loratadine) are an option for this age group but must be dosed appropriately. Decongestants, over-the-counter cough medications, and intranasal corticosteroids can be used in kids over the age of 2, and nasal antihistamines like azelastine can be used in those as young as 5. 

Integrative Medicine Management for Seasonal Allergies Symptoms in Pediatrics

Seasonal allergies in pediatrics can be managed with integrative medicine, which involves a holistic approach to healthcare that combines conventional medicine with complementary and alternative therapies. Here are some integrative medicine approaches that may help manage seasonal allergies in pediatrics:

Nutrition Management for Seasonal Allergies Symptoms in Pediatrics

While there's no one specific meal plan for seasonal allergies, providing your child with breast milk (if possible) and then, after weaning, a meal pattern that promotes a healthy gut microbiome may help to support healthy immune system function. 

Breast milk, which is rich in nutrients and prebiotics that help resident bacteria thrive, is an important factor in the development of a healthy gut microbiome. In fact, infants who are born vaginally and are only fed breast milk seem to have a very healthy gut microbiome when compared to other groups. And for infants at high risk of developing seasonal allergies (i.e., those with a family history, food allergies, or eczema), research suggests exclusively breastfeeding for at least four months may be one way to decrease the risk of seasonal allergies. 

Once weaned, it's important to steer clear of the standard Western diet, which may negatively impact the gut microbiome, ultimately leading to poor gut health, inflammation, and altered immune system function. Instead, introduce your kids to a wide variety of plant-based foods (grains, legumes, fruits, and vegetables) and fermented foods, which contain the fiber, prebiotics, probiotics, and polyphenols needed to promote healthy gut microbiome balance. 

Additionally, since food allergies are a risk factor for seasonal allergies, you'll want to observe your child for any adverse reactions to food and work with an integrative provider to determine the best course of action.

Supplements & Herbs For Management of Seasonal Allergies Symptoms in Pediatrics

While numerous supplements and over-the-counter preparations are available for seasonal allergies, few have firm research to support their claims, and safety in children needs to be determined. 

Probiotics are one supplement option that kids can safely use, which have been found to improve seasonal allergy symptoms and quality of life.  One randomized, controlled trial found kids with seasonal allergies who took a Bifidobacterium mixture experienced significant improvement in allergy symptoms and quality of life. And a 2016 systematic review and meta-analysis found probiotics to improve seasonal allergy symptoms significantly and reduce the immune system activity that occurs in an allergic response. 

Probiotics likely exert their beneficial effects by supporting immune system function, reducing histamine levels, and promoting gut microbiome balance. 

Complementary and Alternative Medicine Management for Seasonal Allergies Symptoms in Pediatrics

There are a couple of research-backed complementary options for improving seasonal allergy symptoms and quality of life that may be appropriate for the pediatric population: 

Nasal saline irrigation (rinsing the nasal passages with a salt-water solution) may reduce seasonal allergy medicine use, improve the quality of life, and improve nasal symptoms in adults and kids. This practice is generally considered safe, but the rinsing devices must be cleaned properly, and filtered or distilled water must be used to prevent potentially serious bacterial infections.

Acupuncture (inserting very thin needles through the skin at strategic body points) has been found to improve quality of life and seasonal allergy symptoms. Most of the evidence has been found in using acupuncture for seasonal allergies in adults. However, in general, acupuncture has been deemed safe for pediatric use and should therefore be considered. One randomized controlled trial found acupuncture to reduce nasal inflammation. Another study showed that four weeks of acupuncture improved quality of life and seasonal allergy symptoms. And a systematic review and meta-analysis of 13 trials found acupuncture to improve quality of life and to reduce nasal symptoms and serum IgE levels.

Summary

Seasonal allergies result from an immune system that may not be functioning optimally and are on the rise. Depending on where you live, pollen, whether from trees or grass, can be present for almost half of the year and make kids uncomfortable. Traditional treatments for seasonal allergies, like avoiding allergens, can be tough on kids who like to play outside. It also limits their exposure to soil microbes and natural sunlight. Allergy shots are an option, but weekly shots can be no fun for kids. And while pharmaceuticals provide some relief, they often have side effects. None of these treatments are designed to address the underlying factors of seasonal allergies, which limits their effectiveness. 

An integrative approach to seasonal allergies explores the root causes, like gut health, that may be contributing to the altered immune system response. When you address the underlying factors, patients may experience much symptom relief and significant improvement in quality of life. An integrative approach to pediatric seasonal allergies may include exclusive breastfeeding (for the first several months of life) to support seasonal allergy risk reduction and then a personalized meal plan built around plant-based foods, probiotics, nasal irrigation, and acupuncture.