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Itches and sneezes: Understanding allergies in children

March 19, 2014

As I prepare to write about allergies, my poor daughter is sitting next to me sniffling away, red-eyed, stuffy-nosed, and miserable. If you don’t live with allergies yourself, it can be hard to understand how bad this common medical problem can make people feel. But allergy sufferers know that as their season draws near, they can count on disrupted sleep, trouble smelling and tasting food, itching out of their skin, and blowing through boxes of tissues.

Types of allergies

Allergies can be perennial, meaning all year long, or they can be seasonal. Perennial allergies are to things like: pet dander, dust mites, molds, and, believe it or not, cockroaches. Here in Florida, where humidity reigns, most of these allergens are everywhere. Seasonal allergies are pollen allergies, and involve trees, shrubs, grasses and weeds. In Florida, where things bloom and pollenate year-round, some unfortunate allergy sufferers can react to multiple pollens during multiple seasons, with little relief between seasons.

Symptoms to look for

Symptoms of allergies are many, and are sometimes hard to tell from viral or other illnesses. A common cold follows a rather predictable course: sore throat with or without fever at first, followed by runny nose, followed in another few days by cough. Things get worse over the first week, and then improve over the second week. The flu is marked by high fever and body aches. The hallmark of allergy is the lack of fever, itching of eyes, nose, throat, and/or skin, and the ups and downs of symptoms. Some people have classic allergic rhinitis, with itchy, sneezy, runny nose. Some have allergic conjunctivitis, with red, runny, itchy eyes. Some patients have maddening itching in the back of the throat.  Cough is common in allergy sufferers, and can be from post-nasal drip or from bronchospasm (allergy-induced-asthma is wheezing caused by allergic inflammation). Some allergy sufferers also have itchy dry skin, or eczema.  Complications of allergies can include infections of the ears, sinuses, lungs, and skin.

How are allergies treated?

Treatment of allergies may involve determining triggers and eliminating or preventing whatever you can. Sometimes, identifying triggers is easy; for example, if every time your child visits grandma and curls up with the cat she starts to tear and sneeze, your child is allergic to cat dander. You don’t need a test to prove that. On the other hand, allergy tests, which can be blood tests and/or skin tests, can be very helpful in patients with severe symptoms. For example, if your child is often congested and has recurrent sinus or ear infections and turns out to be allergic to dust mites, you can remove carpeting and curtains from his bedroom, encase his mattress and pillow in allergy-control casings, limit plush animals in his bed to one or two, and even run a dehumidifier to kill dust mites. Prevention is considered to be preferable to treatment with multiple medications.

However, some allergy sufferers cannot avoid their triggers.  For example, my daughter is allergic to oak (along with half of the blooming planet). Unless we were to move away, every March she will go through a month or more of sniffley misery. That is when layering of medications comes into play. The single most effective, safest allergy medication is steroid nasal spray. These sprays are used every day to prevent and control eye, nose, and throat symptoms. Most of these are prescription only. Nasal steroid sprays do not work if they are taken “as needed” when symptoms flair; they only work if they are used daily during your child’s allergy season. Oral antihistamines also help; newer “non-sedating” antihistamines last 24 hours and most are available over the counter in generic forms. They can be taken as needed on bad days. There are also antihistamine eye drops and antihistamine nasal sprays that can be used on an as-needed basis. Finally, there are the “leukotriene inhibitors,” also available by prescription. One of these, montelukast, comes in sprinkles, chewables, and pills. All of these medications can be used together if needed and if recommended by your doctor.

If medications just don’t provide enough relief, immunotherapy is another option. That means allergy shots, or, in some cases, oral drops can be used. These must be given often at first, and then less and less often. They gradually teach the body’s immune system to “tolerate” the things that used to trigger allergy symptoms. They work quite well but require a serious commitment and also carry a small but real risk of severe allergic reaction. Patients being treated with immunotherapy should always have an epinephrine autoinjector on hand in case of severe allergic reaction, as should some other allergy and asthma patients.

For those who don’t have allergies, they may seem like no big deal.  But, if your child suffers from allergies, you know that they can be a huge deal, often interfering with normal function.  However, better living with allergies is possible. Ask your pediatrician to help you make your allergic child’s life as symptom free as possible.