Alternative remedies for kids allergies? Not yet.

When it comes to alternative remedies for children's allergies, my mantra is "buyer beware." At best, some herbals are viewed as "promising," but the scientific research into their therapeutic benefit has just begun.

If your child has respiratory allergies – to springtime tree pollen or to grass or ragweed pollen later in the summer or fall – you may have considered alternative remedies due to worries and fears about over-the-counter and prescription allergy medications or the desire to provide more 'natural' relief for your child. Here's what you should know:

Do alternative therapies for allergies work? The jury's still out. We have to approach alternative therapies for allergies the same way we approach pharmaceutical drugs – by starting in the lab to see what the agent does to the cells, then moving to animal models and finally conducting clinical trials in humans. There is simply not enough good evidence out there for me to recommend herbal remedies, acupuncture, or manipulative therapies, such as massage, for the treatment of allergies. If families are reading Web sites that promote certain alternative remedies, I remind them that the jury is still out and they should proceed with caution. These treatments are not necessarily harmless, and they may have no clinical effect, either.

Is long-term use of allergy medicines dangerous? No. Parents who are worried about long-term use of allergy medicines should know that the products on the market today have been continually tested and improved. There are a number of good, safe medications for allergies that produce virtually no side effects. Nasal steroid sprays such as Veramyst and Nasonex are often the first line of control. Combining these with over-the-counter antihistamines such as Allegra and Zyrtec as needed offer many children good allergy relief without a sedating effect.

Are inhaled steroids safer than oral and injected steroids? Yes. Parents sometimes have steroid phobia. They hear the word "steroid" and want to avoid it at all costs. But what parents need to know is that topical and inhaled steroids do not have the significant side effects associated with oral and injected steroids. While chronic use of oral steroids can produce a whole range of physical and mental side effects and should be discouraged, internasal (inhaled) steroids have the benefits but with minimal risks. People should not be afraid of using inhaled steroids to treat allergies, even on a prolonged basis. The side effects are usually limited to minor hoarseness and soreness of the throat and occasional nose bleeds. On the other hand, naturally occurring steroids have been found to be unwittingly present in herbal products that are taken by mouth.

Are nasal washes a good idea? Yes. Many families ask about products that irrigate the nose, such as the Neti pot. This little device sold over the counter looks like a teapot and basically blasts saline wash (salt and water) in one nostril and out the other. Some kids, particularly younger ones, can't tolerate this technique. But for those who can, it is an effective way to clear the nasal passages, and we do not discourage it. Many people swear by this simple irrigation treatment that has been around for centuries.

The bottom line: In general, the allergy meds on the market are safe and effective. Most kids do well on them and experience few side effects. Supplemental therapies such as saline wash can also provide relief. While herbs and traditional Chinese medicine may have immunologic properties, we still don't have good scientific evidence that they actually work any better than a placebo. Stay tuned.

Christopher C. Chang, M.D., Ph.D., is division chief of the division of pediatric allergy/immunology at Nemours/Alfred I. duPont Hospital for Children.