Nasal congestion and nighttime cough - children's zyrtec not helping:(

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Hi moms
I am waiting for allergist appt as of now for my daughter. But the earliest appointment is in August , so I would appreciate any inputs you would have, if you have faced something like this with your kids.

My daughter is almost 9 years old, and has always had some environmental allergies. We are not sure what she is allergic to but every now and then, she would start sneezing and I would give her zyrtec for few days and she would be okay. She had bad eczema as a baby, so back then I had tried cutting out most food from my diet to check for food allergies, but nothing made a difference and we decided it was something environmental. She outgrew the eczema around year 1 but allergy symptoms such as sneezing, runny nose, itchy eyes continued on n off over the years. It wasn't bad but this year seems to have gotten worse/persistent.

History of medications so far:

When she was around 3 years old, she was diagnosed with croup one winter. That was the first time we took her to ER for an infection as she was making a weird noise while breathing (stridor?!)and they treated her for croup. She was fine after that.

Many years later, when she was 7, she had a respiratory infection / viral fever which led to fast breathing and maybe retractions. This was post covid, so I had an oximeter at home and her oxygen levels showed low. So we took her to ER , and she got nebulizer and steroids.
We ended up in same situation the following month when she had fever and cold again.

After that, I have albuterol at home and have given it to her few times as a precaution when I noticed some heavy breathing or cough.

We met a nurse practitioner once (since pediatrician was not available), she looked at my daughter's chart and said this could be mild intermittent asthma. I know asthma can be a lifelong illness and it's scary as well. We are not using albuterol every time she has a cold or cough, so I am not certain of this diagnosis. Would a kid with asthma have symptoms where they don't need albuterol or that gets better on it's own without neb treatment? Both parents, her brother, both set of grandparents, our siblings - do not have asthma but we have environmental allergies( dust/mold etc) In our Extended family , my husband and I have aunts and uncles with asthma.

Since last year end, I am noticing persistent symptoms after another viral infection. She was fine all summer, but in October she was sick again with viral fever. Post that, in Nov and Dec she was coughing on and off esp in the evenings. We assumed it's a lingering cough after the infection and we were on a vacation in a different country. Zyrtec, and hot water , honey helped with the cough. I would give it, only if she showed the symptoms and she would not cough anymore until next evening.

After we are back from vacation, she had viral fever couple times again in Jan and Feb. She changed schools in 2023, so this winter has been bad for her as she came down with something or the other as it was her first winter in a public school setting. During pediatrician visit, he had informed us that he saw lot of post nasal drip and cough might take a while to go away. I started her on daily zyrtec , as it was hard to hear her coughing every night. Zyrtec always helped her with her allergy symptoms earlier but these days it seems to be effective only during daytime. It's been almost 2 months now since I started daily zyrtec, but she still has allergy symptoms ( nasal congestion) in the night even on 10 ml zyrtec. I made an appointment with her pediatrician again last week, and he has referred her to an allergist but I am able to get an appointment only in August :(

So am looking for ways to help her in the meantime. Few things I habe noticed since Jan/Feb:

  1. she has started coughing suddenly in the middle of night. It's persistent where she keeps coughing with every few breaths. Hot water and honey is the only thing that I have figured out that calms down the cough. She sleeps just fine after I wake her up and give her few sips of hot water and 1/2 tsp honey, no cough anymore. Next day she is okay too. As though nothing happened during the night!
  2. Since I started using humidifier, I noticed cough got better for sometime. She did not have any night time cough for few weeks last month. But last week she has coughed couple times, after outdoor walks during the day. We live in Texas and apparently it's a bad allergy season this year. So I assume it's due to allergies?
  3. Since she is just fine during the day, I believe Zyrtec might be helping during the day but not in the nighttime? Since last couple weeks I am noticing she has bad nasal congestion in the night. She had nose bleeds for 2 days ( when she woke up in the morning and blew her nose) , so I am using saline spray every night before bed. It helped with her nose bleed but not really helping with nasal congestion much.
  4. I am not sure what else to try right now. I have not been using albuterol at all, her pediatrician asked us to hold off until the allergist appt. Her lungs were clear during the pediatric appt last week, though she had coughed a lot the previous night. The wait time to meet allergist is making it hard. I am worried if its asthma. We do have a dog and I am keeping my fingers crossed my daughter does not have any pet allergies. Seems unlikely as her symptoms do not get triggered around the dog, but I sometimes worry how I would handle the situation if she has become sensitive to pet dander as we can't imagine having to make any choices regarding our sweet pup.
  5. For now, Pediatrician suggested flonase for nasal congestion . But my daughter does not do well with anything put in her nose. Even with saline spray, it's not easy as she keeps pulling away. I am worried flonase might get in her eyes.

As of now, I use humidifier and air purifier daily. Hot water and honey. Gargling and saline spray as needed. I was regularly using vicks baby rub, but have stopped now as I read it's not good to use it for chronic cough.

We cut off dairy for sometime but she LOVES milk. She had a habit of drinking cold milk straight from refrigerator but now we give her warm milk. I am trying to avoid cold food/drinks as much as possible. But it's hard when her friends eat icecream etc, so I sometimes have no option but to let her eat and later salt water gargle before bedtime helps.

Sorry it's been a long post , but is there anything else I can try (other than flonase or neti pot), until we see the allergist in August. Thanks!

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Sounds like you’ve got all your bases covered.
You’re working with your doctors and that’s good.
I’m guessing she’s up to date with all her shots?
Ask the doctor, since she seems to be dealing with a chronic cough, if she might benefit from pneumococcal and rsv shots.

Try her on some of the non dairy milks that are available now.
She’s old enough for you to show her illustrations of her sinuses and explain that’s where the mucus causing the cough is coming from - and that rinsing out with saline (either spray or a neti pot) can help soothe her sinuses.
A little saline in the eyes isn’t a problem - eyes like saline.
It might be an acquired taste, but I love a neti pot to help get sinus irritation under control.
I had an ear/nose/throat doctor recommend it to me and it’s often kept my sinus issues from becoming congested lung issues.

See what the allergist says.
Hopefully whatever it is - it’s something she grows out of sooner than later.

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Allergies can be tough to deal with because sometimes, even when you know the triggers, they are things like grass or dust which are really challenging to avoid. But knowledge is power and I know you will feel better when you know. You might want to try friends and family for other allergist options who don’t have such a lengthy wait. Does your community have a facebook group for local moms? Try them, you will probably get more replies than on this site which has become pretty inactive after a period of time with no moderators and plenty of prank posts. Or see if your doctor has other ideas. If he is really concerned about her, then he might be able to advocate for an earlier appointment or refer you to a different allergist.

If your daughter does get a diagnosis of asthma, I know that sounds scary, but many people learn to manage well, even with pets. Doctors will often advise to get rid of pets, but I think cats are worse than dogs, and both types of animal allergies can often be managed. Unless your daughter is really getting triggered by the dog, try to let that worry go.

The good news is also that it sounds like she is fine most of the time. Personally, I wouldn’t wake her at night if she is coughing unless the cough is really interfering with her sleep. Some of what you are describing just doesn’t sound unusual or serious to me, like having a lingering cough after a virus, or nasal congestion at night. It isn’t clear from your post how miserable she is with these symptoms.

I think she is old enough to make some choices about whether or not the nasal spray or cutting out dairy or cold/hot things is worth it to her. It isn’t clear from your post if you have noticed those things to make a big consistent difference for her, so I would try to include her in your decision making. If you see that every time she drinks milk or eats ice cream her symptoms worsen, point that out to her, but if she isn’t bothered by the symptoms as much as you are, then I’d support her decision. It’s one thing if her symptoms are causing her to miss school or be so miserable she can’t enjoy her usual activities, in which case you have to insist on what you know is best. But, it’s another thing if she is feeling good most of the time with the other helpful things you do, like the humidifier and hot water/honey.