People with ADHD are more likely than the general population to have asthma, allergies and eczema. Although experts debate whether dietary allergies can cause ADHD like symptoms, nasal allergies and eczema can easily cause restless sleep which can manifest itself in lack of concentration, and in young children, hyperactivity. If, when the allergy goes away, the person does not have symptoms of ADHD, then the person does not have true ADHD and should not be treated with ADHD medications. However, many times allergies and ADHD coexist. Asthma and allergy medications also affect symptoms of ADHD, particularly in the area of hyperactivity.
Antihistamines, such as loratidine, diphenhydramine, and cetirizine, can make a person drowsy, but in younger children, the opposite can be true. In an effort to keep awake, a child can exhibit increased hyperactivity. If your child has this reaction, its best to stay away from antihistamines for a time, if possible. He or she may outgrow the reaction. A few non-drowsy alternatives for allergies exist. These include:
- montelukast (Singulair)–available by prescription only, and often requires a doctor’s note of necessity.
- steroid nasal sprays– can slow growth and suppress the immune system and usually reserved for severe symptoms (such as wheezing, uncontrollable coughing, or symptoms which interfere with sleep).
- phenylephrine–cannot be give with stimulants used for ADHD, but could possibly be given with nonstimulants. Phenylephrine can cause worsening nasal congestion if used daily.
- allergy shots–involve a needle and the risk of an allergic reaction, but work for several years after the last shot.
Asthma Rescue Medications. All of these medications (albuterol, salbutamol, levalbuterol, ipratropium, steroids taken by mouth) can make hyperactivity worse. For some patients, levalbuterol (Xoponex) has less of an effect on hyperactivity than plain albuterol/salbutamol (Ventolin, Proventil). For the most part, however, when you are dealing with an exacerbation and your breathing needs a rescue, breathing is more important than control of ADHD. Typically, you can expect that you will be off rescue medications in a few days, so try to hang in there and be extra patient with your ADHD symptoms. Do your best to get plenty of rest and to eat properly, avoiding anything you know makes your symptoms worse. If you’re having trouble sleeping because you feel wired, you might try a relaxing bath, melatonin, or lavender aromatherapy (if you know it does not exacerbate your asthma).
Controller medications other than antihistamines.
Inhaled steroids generally speaking do not cause increased hyperactivity or other behavioral symptoms in children. At higher doses, with certain medications, a rare patient might experience worsening of their ADHD symptoms. If this is the case, do not stop your controller medicine, but make an appointment soon with your doctor to change to a different controller. Budesonide supposedly has the least amount of systemic absorption of the inhaled steroids and would be a good second choice if you have not already tried and failed with it.
Salmeterol (found in Advair, Serevent), formoterol (found in Symbicort, Foradil), and arformoterol (Brovana) can definitely increase ADHD symptoms. If you notice this to be a problem, you could try a switch to a stronger inhaled steroid, or perhaps add montelukast. However, when you have asthma severe enough to require these medications, often you really need them to keep your breathing normal. If you do, you can still let your doctor know that you’re struggling with side effects and perhaps get a referral for ADHD coaching or counseling.
Montelukast (Singulair). This medication is not known to cause worsening of ADHD symptoms specifically, but the package insert lists both behavior disturbances in children and suicidal thoughts as rare side effects. These side effects are controversial, so its best not to stop your medication until you speak with your doctor. If suicidal thoughts are a concern, be sure that you are seen as soon as possible. If your doctor cannot see you soon enough, consider seeking emergency care with a psychologist, psychiatrist, or emergency room.
Chang, Hyong Yoon, Ju-Hee Seo, Hyung Young Kim, Ji-Won Kwon, Byoung Ju Kim, Hyo Bin Kim, So-Yeon Lee, Gwang Cheon Jang, Dae Jin Song, Woo Kyong Kim, Jung Yeon Shim, and Ha Jung Kim. “Allergic Diseases in Preschoolers Are Associated with Psychological and Behavioural Problems.” Asthma, Allergy, and Immunology Research. N.p., 1 Aug. 2013. Web. 10 Mar. 2014.