Q&A about summer holiday health issues

In June 2013, Dr Roger Henderson joined us to talk about about summer holiday health. Whether travelling abroad or staying in the UK this summer, Dr Henderson answered your questions about dealing with insect bites, hay fever and prickly heat.

Dr Roger Henderson is a senior partner in a busy general practice and regular broadcaster and writer in every area of health. He has 25 years of medical experience and has regular columns in the Sunday Times and other national newspapers and magazines. He is also the medical consultant to NetDoctor.

Insect bites

Q. Waswondering: I react badly to mosquito bites. They spread hugely and become very painful. I take precautions, using repellent and covering up. We are camping in France this year. What should I take with me to treat bites if my precautions don't work? I have previously used hydrocortisone creams.

"There's no doubt in my mind that some people seem to be tastier than others to biting insects! Fortunately, most insect bites and stings cause symptoms such as itching and swelling that usually clear up within a few hours and require little or no treatment."

A. Dr Roger Henderson: There's no doubt in my mind that some people seem to be tastier than others to biting insects! Fortunately, most insect bites and stings cause symptoms such as itching and swelling that usually clear up within a few hours and require little or no treatment.

If necessary, these can be treated by washing the affected part of the body with soap and water and then putting a cold compress (such as a flannel or cloth that has been put in cold water) over the area to reduce swelling. Try not to scratch the area however itchy it may be, since this can cause it to become infected.

If it stays painful you can take painkillers, such as paracetamol or ibuprofen (children under 16 years old should not be given aspirin) or use a spray or cream that contains local anaesthetic, antihistamine or mild hydrocortisone (1%) on the affected area to prevent itching and swelling. It is also often worth taking a non-sedating antihistamine tablet to help reduce swelling and itching, some people report that if they take these every day when on holiday any insect bites they suffer cause much less trouble but this is anecdotal rather than scientific. Specific creams such as Anthisan Bite and Sting Cream are also reported to be very useful in reducing the irritating symptoms that can otherwise spoil a great holiday!

Q. IwishIwasmoreorganised: My son (seven) and I (much older) seem to get bitten far more than my other son and my husband. Not only that, but the bites then get very inflamed, itchy and sore.
Is there any prophylaxis that we can take before going into high-risk locations to reduce our chance of being bitten? Are there any quick fixes to ease the aftermath? Also, would it be safe for us both to take Piriton for two weeks while we're in Portugal this summer?

A. Dr Roger Henderson: Some people do seem to be more susceptible to insect bites than others and there is no obvious reason why this should be so. However, taking a regular antihistamine every day when abroad or in a high-risk location may significantly reduce the effects of being bitten. This can safely be taken when you are abroad but I would use a non-sedating antihistamine if possible rather than a sedating one such as Piriton (chlorpheniramine). Specific creams such as Anthisan or hydrocortisone 0.5% - 1% can be helpful in easing the inflammation of a bite or sting and cold compresses are also very useful for this.

Q. OddSockMonster: I react massively to bites, and have done since a horsefly bite swelled up like a melon several years ago. I also like camping but am a magnet to midges. What can I do (don't say stop camping)?

A. Dr Roger Henderson: I certainly would not want you to stop camping! When you go, take an insecticide spray and spray your tent each night. At dusk or when midges are at their busiest, use an insect repellent spray on exposed areas of skin (especially the ankles) and wear long cotton sleeves and long slacks/trousers in the evenings, this will help you avoid getting bitten. You can also buy special sprays that impregnate material to make clothes unattractive to biting insects, camping shops are a good source of these items. If you do get bitten, antihistamines can help and these are available over the counter as well as steroid creams that can help relieve itching.


Q. SchmaltzingMatilda: My older child suffers from hay fever and the advice has been, and I've also read, to take antihistamine medicine from about March through to October in order to build up some kind of resistance, rather than just as and when they display symptoms. Is this sound advice? Are there any issues with children taking antihistamine for such a prolonged period?

A. Dr Roger Henderson: I think this is sound. I often advise exactly this to parents of children with hay fever as it is better to start treatment early and get in before serious symptoms develop, and then keep on top of things through the usual hay fever season. Modern non-sedating antihistamines are very safe when given in the correct dosages to children and these have been in use for many years, and there is plenty of safety data on these. In addition, since these became over the counter, millions worldwide have started using them so there is enough experience now with these medications that I am not worried about their long term use in children.

First aid

Q. Cleanandclothed: What would you advise to put in a basic first aid kit for an overseas holiday with young children?

A. Dr Roger Henderson: Whether your holiday is abroad or in the UK this summer, there is a good chance that during the usual frantic packing of luggage you will stop to consider including a simple first aid or travel health kit. Sensible as this is, most people end up with either too little in such a kit or enough to fill an extra suitcase. However, with some simple planning it is possible to put together a health travel pack to cover most common eventualities for both adults and children. Some of these simple medications are available from your doctor as well as over the counter from a pharmacist.

"With some simple planning it is possible to put together a health travel pack to cover most common eventualities for both adults and children."

Antihistamines are extremely useful during the hay fever season as well as helping to cope with allergic responses that can occur after bites or eating particular foods. For young children, antihistamines such as chlorpheniramine can be used but often cause drowsiness. In older children and adults, less sedating options are available as well as nasal sprays if a runny nose is a major problem.

Simple antacids are most often needed by adults rather than children on holiday, but can be used by children over the age of 6 (although your doctor can prescribe an antacid to babies and toddlers if needed). The important thing to know about these is that most preparations contain either aluminium or magnesium. Aluminium-containing antacids tend to cause constipation whereas the magnesium-based medicines can cause diarrhoea. Some people worry about taking aluminium-based medication but if there are no existing kidney problems then accumulation of aluminium does not appear to be a risk here.

Anti-nausea tablets are often needed for the prevention of travel sickness, and children aged three and above may benefit from tablets of hyoscine which are safe at this age and are often extremely effective if taken just before travelling. Children aged 10 and above can also use a patch of hyoscine that is placed behind the ear six hours before travelling and which can prevent travel sickness for up to 72 hours – ask your doctor for details of this if needed. Drowsiness and a dry mouth are recognised side effects but these are often preferred to the alternative!

Fluid replacement sachets such as Dioralyte (which also comes in a ready-to-drink carton Oralyte) are extremely simple, cheap and effective and basically constitute the essential minerals and salts that can be lost from the body during diarrhoea or vomiting. Remember that after making up a fluid replacement sachet, any unused solution should be discarded unless stored in a refrigerator, where it may be kept for up to 24 hours. In adults if diarrhoea is a problem, then over the counter treatments for this are extremely effective and should always be taken on holiday, but these are not usually recommended for children who should stick with the fluid replacement sachets.

For the treatment of a high temperature or the discomfort of minor bumps and bruises, paracetamol is recommended and this is probably the one thing most people remember to take with them on holiday! Always use the recommended dose, and seek medical attention if a fever does not settle with it or if the condition worsens, and avoid using aspirin or aspirin-containing medicines in children under the age of 12 since these are not suitable for children with minor illnesses.

The choice of antiseptic cream is a simple one here since most perform the same job, although many people now use tea tree oil as a natural antiseptic in treating cuts and grazes. If a wound becomes very red, hot and painful however then this may be a sign of bacterial infection and a medical opinion is sensible then.


Ear infections

Q. secretscwirrels: My son, now 15, is very prone to ear infections (as am I). Many a holiday has been ruined by him having an ear infection and therefore having to stay out of the water. Not to mention the cost of seeing a doctor.

Oral antibiotics tend not to do the trick. In this country he has been prescribed some kind of anti-inflammatory ear drops. He uses putty-buddy-type ear plugs which are quite effective but I would like to be able to take suitable medication with us just in case. Is there anything I can get without prescription? GPs don't like prescribing for just in case. Alternatively, could you suggest a generic item that I could ask for if we end up needing it abroad?

A. Dr Roger Henderson: Earache and infections can be common in children who are keen swimmers and so can spoil a holiday for them if they have to stay out of the sea or pool. However, using over the counter ear drops is often the first line of treatment to relieve ear discomfort, antibacterial and anti-inflammatory ear drops help to keep any bacterial infection localised and not spreading deep into the ear. There are a number of possible over the counter drops that could help here and it is a personal choice as to which may work best. These include the antiseptic drops Swim Ear, drying drops Auro Dri and Star Otic, and Earex Plus Ear Drops that help relieve earache due to inflammation of the ear. He should still use the ear plugs to keep his ears as dry as possible too.


Prickly heat

Q. EverythingIsTicketyBoo: My son, age three, has a heat rash developing all over his body. The poor little thing is very itchy and has new spots from it every day. He has a 1% hydrocortisone cream for it. How can we help him avoid it (he already has loose clothes, cool bedding and baths) and is there anything else we can try to get rid of it?

"If it is a classic heat rash, try to avoid heat and humidity and remember that cool baths can be soothing and help to avoid sweating. Simple creams such as hydrocortisone 1% can be helpful for soothing the skin and use loose cotton clothing or clothing that has breathable fabric."

A. Dr Roger Henderson: Miliaria (prickly heat) is a rash that develops in some children (and adults) when they sweat more than usual and is sometimes called a sweat rash or a heat rash. This is not serious, but it can be very itchy and uncomfortable. Caused by blockage of sweat glands in the skin, it is most common in children and babies as their sweat glands become blocked more easily.

First of all, make sure this diagnosis is correct – if new spots are developing every day make sure this is not chickenpox or a viral rash by letting your GP see it. If it is a classic heat rash, try to avoid heat and humidity and remember that cool baths can be soothing and help to avoid sweating. Simple creams such as hydrocortisone 1% can be helpful for soothing the skin and use loose cotton clothing or clothing that has breathable fabric. Antihistamine medicine can also help reduce itching and skin irritation so ask your pharmacist about this now too if you have not already done so.



Q. Slavetothechild: I suffer from brittle asthma and anaphylaxis. I have been in intensive care in the last year, but I would love to go abroad on holiday. I'm not sure it would be safe, so what should I consider?

A. Dr Roger Henderson: With such potentially serious conditions as these, prevention and planning is crucial. If you are flying, tell the airline of your life threatening allergy and mention to the flight attendant when boarding you have a serious allergy. Ask if they could request other passengers to refrain from eating the food you are allergic to on board the flight (eg peanuts). Always make sure you have adequate medical insurance before travelling (including your EHIC card if travelling in Europe) and have your allergens translated into the native language of your holiday destination to avoid any interpretation problems.

Before you go, check with your GP regarding your medication requirements for travelling and ask for a letter to explain your condition and your need to carry adrenaline pens on board the aircraft. There may be a small charge for this. Find out the location of the nearest hospital at your destination, and the phone numbers of the local emergency services. Keep your medication easily accessible and ensure any travelling partners are aware of the symptoms of anaphylaxis and know how to administer your medication in an emergency.



Last updated: 9 months ago