A mother brings her 5-year-old son with sneezing, itchy eyes, and runny nose, worse in summer. What is the most appropriate first-line management?

• A. Cetirizine oral solution
• B. Loratidine tablets
• C. Intranasal corticosteroid spray
• D. Montelukast chewable tablets

Answer: (A)

In seasonal allergic rhinitis in a young child, starting with a non-sedating oral antihistamine that comes as a liquid is a practical, effective first step. For a 5-year-old, a cetirizine oral solution fits well because it directly reduces sneezing, itchy eyes, and rhinorrhea, which are the main symptoms described. It has a rapid onset and a convenient once-daily dosing, and it’s generally well tolerated in children. The liquid formulation is easy to administer for this age.

While intranasal corticosteroids are very effective for nasal symptoms and are often used, the initial choice in mild cases is usually an oral antihistamine due to ease of use and good symptom control. A tablet form, as in the other option, isn’t ideal for a 5-year-old who would have trouble swallowing it. Montelukast can help some children with allergic rhinitis but is not considered first-line for simple, seasonal nasal symptoms. If symptoms are mainly nasal congestion or persist despite an oral antihistamine, an intranasal corticosteroid could be added.