Childhood Allergies

Your child has had a runny nose and cough for several weeks now. You realize that this is her third or fourth cold this winter. In fact, they never really seem to get completely well in between the colds. This is a common scenario and specially with declining infection rate and improved vaccination coverage.

Most Common Signs of Allergy

  • Nasal congestion
  • Clear runny nose
  • Itchy nose
  • Crease across the top of the nose from constant wiping
  • Excessive sneezing
  • Itchy, watery, red eyes
  • Dark circles under eyes
  • Wheezing
  • Persistent cough, often rattling
  • Recurrent ear infections
  • Recurrent colds
  • Nighttime cough and nasal congestion

While all of these symptoms can be signs of allergies, they can also be signs of the simple, common cold.

Your child will often have two or more of these symptoms if allergies are present. For example, dark circles under the eyes without any nasal symptoms are probably not allergies.
Wait and see if symptoms persist longer than three months.

How much do the symptoms bother your child

  • Are the symptoms significantly interfering with sleep?
  • Do the symptoms significantly interfere with normal day-to- day activities?
  • Do the symptoms significantly decrease quality of life?
  • Do the symptoms slow your child down or interfere with sports or active play?

Decide how significantly the symptoms are interfering with your child’s well being. If your child coughs several times during the night, but in general gets a good night’s rest, you may want to leave well enough alone. If the runny or stuffy nose comes and goes and requires an occasional nose-blow, but does not bother your child or slow her down, you may just decide to wait and see if she outgrows it. Very mild, non-bothersome allergy symptoms in children don’t have to be extensively treated.

Continuous versus intermittent symptoms

Allergies usually cause continuous daily, or nightly, symptoms, at least during certain seasons of the year. Allergy symptoms in children will persist for five or more days a week for several months straight. Colds, on the other hand, will usually hit your child hard for a few days, and then slowly improve over the next week or two, followed by a period of complete wellness. If your child is experiencing two or more symptom-free weeks in between attacks, then it is more likely to be recurrent colds instead of allergies.

Family history

Studies have shown that if one parent suffers from nasal or skin allergies, your child has a 25% chance of having allergies as well. If both parents have allergies, your child may have up to a 75% chance.
Therefore, if one or both parents have allergies, be more alert to the possibility of allergy symptoms inchildren. If you have lucky genes, and allergies are virtually non-existent in your family, you can be slower to worry about allergies.

Steps to Track and Prevent Your Child’s Allergies

The following steps will help you determine what’s causing the allergies and how to minimize exposure to the allergens.

STEP 1- DETERMINE WHEN AND WHERE THE ALLERGY SYMPTOMS ARE OCCURING

  • Nighttime and upon waking – if your child seems to be fine during the day, but has allergy symptoms during the night and wakes up with severe symptoms in the morning, then you can suspect that your child is allergic to something in the bedroom. The most common bedroom allergens are dust, mold and bedding.
  • Seasonal allergies – if your child seems well all year, but suddenly develops allergy symptoms during a particular season (usually spring), or seems to have symptoms only on windy days, then your child probably has allergies to particular pollens or plants that are prevalent during that season. These can cause symptoms during the day or night or both.
  • School allergies – if your child only experiences symptoms at school or daycare, but is generally well at home and during the night, then the allergen is probably something at school.
  • Year-round allergies – if your child has allergies all year long, then the culprits could be any of the above as well as other common causes such as pets, smoking, foods, or dairy products.
  • Friend’s or relative’s house – if you notice that your child only has symptoms at other people’s house but not at school or your house, then he may be allergic to something unique to that house such as smoking, pets, plants or grass.

STEP 2 – UNDERSTANDING THE DIFFERENT ALLERGENS AND WHERE THEY CAN BE FOUND

  • Pollens – these are tiny, dust-like, yellow seeds that are found in the middle of flowers.
  • Dust – dust itself does not cause allergies. It is actually dust mites, microscopic organisms that live in dust, that cause the allergies. The dust mites excrete tiny pieces of feces that float around in the air just like pollen.
  • Mold – this is another source of allergies that can be found throughout the house.
  • CIGARETTE SMOKE – exposure to second-hand smoke is one of the most ignored and preventable causes of allergy symptoms and asthma.
  • Pets – it is not actually the pet hair that causes allergies, it is the pet dander – tiny flakes of skin mixed with saliva that shed off animals and float around in the air.
  • Grass – some children will be allergic to a specific type of grass. This is often caused by direct contact or playing around the freshly mowed grass.
  • Cosmetics – perfume, hairspray, makeup powder, baby powder, and strong-smelling deodorants can be irritating to a baby and child.
  • Dairy products – this is another easily identifiable and preventable cause of allergies.
  • Formula allergy – if you notice your infant developing allergy symptoms, and she is on formula, consider changing to another type.

If using a cow’s milk formula, change to soy.
If using a soy formula, change to cow’s milk formula.
Allow two weeks for symptoms to improve.

STEP 3 – PREVENTING EXPOSURE TO SPECIFIC ALLERGENS AND ALLERGY- PROOFING YOUR HOME

SEASONAL ALLERGIES AND POLLENS

  • Stay indoors on windy days of the pollen season and when the pollen counts are high.
  • Don’t allow your child to play in fields with flowers and tall grass.
  • Keep all the windows and doors closed during your child’s specific allergy season. This keeps the pollen out.
  • Wash hats and jackets more frequently during pollen season.
  • Give your child a bath and wash hair before bedtime to get the pollen out.
  • Don’t hang-dry your child’s laundry outside as it can pick up pollen.
  • Pollen counts are usually highest during late morning and early afternoon. Limit outside playtime to early morning, late afternoon and evenings during allergy season.
  • Put window air conditioning units on recirculate to keep out the outside air.
  • Keep trees and bushes near the house well pruned to avoid heavy vegetation.

DUST MITES –Take all of the following dust-attracting items out of the bedroom:

  • Stuffed animals – you can wrap one or two favorites in a bag and place them overnight in a freezer once or twice a week to kill the dust mites Books on bookshelves
  • Piles of clothes
  • Down comforters or feather pillows – pillows filled with synthetic stuffing collect much less dust
  • Upholstered furniture – plastic, wood, metal or vinyl furnishings don’t collect dust
  • Stacks of boxes
  • Items stored under the bed
  • Wool blankets – synthetic or cotton blankets are less dusty
  • Heavy drapes and horizontal blinds – roll up or fold up shades or vertical blinds are preferable
  • Electric fans
  • Large house plants
  • Wash blankets, sheets and pillowcases in hot water (at least 130 degrees) once a week to kill the mites.
  • Use synthetic pillows that can be washed monthly and replaced yearly.
  • Damp dust when cleaning – don’t forget lampshades, picture frames on the wall, the tops of tall
  • dressers or wardrobes.
  • Vacuum the mattress every two weeks. Use a vacuum cleaner with a HEPA or other specialized filtering system that will prevent dust and other particles from spreading around the room.

PET DANDER –

Before buying a pet, take a test drive for a few days while letting child and pet play frequently together.

If you already have a pet and you suspect your child is allergic, try either keeping the pet outside for a week or quarantined in a room in the corner of the house. Clean the whole house and observe your child. If allergies improve, test it by letting pet and child play together for several hours a day. If allergy symptoms start again, continue the quarantine for another week or so. If child gets better again, then your child is probably allergic.

  • Give the house a thorough cleaning to remove existing pet dander.
  • Keep the pet out of your child’s bedroom at all times.
  • Keep the pet in one room as much as possible and keep this room well ventilated to the outside.
  • Keep the house well ventilated. Open the windows as much as possible and recirculate the air.
  • Wash your pet frequently to minimize dander shedding.
  • Use a vacuum with a special filter to trap allergens..

STEP 4 – CONSULTING A DOCTOR

The doctor may be able to pinpoint the most likely allergens that are affecting your child specifically so you can focus your prevention more precisely. The doctor can also spend more time educating you on allergy prevention.

Skin testing –this is to help identify specific allergens. A tiny needle is used to introduce a substance such as dairy protein or pet dander into the skin. The allergist can either do a small number of these at a time to test suspected allergens, or 30 to 40 different allergens (and skin pricks) at one visit to get a more complete allergy profile. A bump will form in the skin for each test that is positive. Note your child should be off of any allergy medications taken by mouth for several weeks prior to testing. These can interfere with the test. Advantages of skin testing:

  • If your child tests positive to several things, you can more accurately focus your prevention efforts at home.
  • It can also help you identify any hidden food allergies.
  • Very useful for older, more cooperative children.
  • For severely allergic children who have not improved with a variety of home preventative measures, skin testing can be very useful.

Disadvantages of skin testing:

For the items that your child shows no reaction to, this doesn’t guarantee he isn’t allergic to that item. A child can show no reaction, for example, to milk, but may still be severely allergic to it. The younger the child is, the more likely he will show no reaction on skin testing. Skin testing is more accurate for children over 5 years old.

It can hurt a little, and is very difficult to do on uncooperative children.

Blood testing – A blood test, called a RAST test, gives similar information to skin testing, although it is not as accurate as skin testing. Antibody levels to a variety of allergens can be measured. This can be very helpful if several items come back showing high antibody levels. However, RAST testing has the same disadvantage as skin testing – a normal test can be present and your child could still be allergic to that substance. This is truer for younger children. It is useful for severely allergic children who are too young for skin testing…

Treatment Plan

1. Decide if your child really has allergies and if so, whether or not they are interfering with his life enough to warrant evaluation and treatment.

2. Identify what the probable allergens are that may be causing the allergies.

3. Using the above prevention guidelines, take some simple, convenient measures to try to eliminate the possible allergens .Observe your child for two weeks to watch for improvement.

4. If no improvement within two weeks, talk to your pediatrician about blood RAST testing or see an allergist for skin testing to help you identify specific allergens.

5. It is best not to use any allergy medication during this time because if your child’s symptoms improve, you won’t know it this is due to medications or your preventative measures. However, if your child is experiencing moderate to severe symptoms that are dramatically interfering with his life, you can give him an antihistamine in appropriate doses after consulting your pediatrician.

 

Dr. Piyush Jain

 

 

 

Dr. Piyush Jain
Consultant Pediatrician, SSD Hospital.

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