Pediatric Allergies: 101

If your child has a persistent runny nose throughout the spring or fall seasons, or sneezes in rapid fire upon proximity to dogs or cats, he or she probably doesn’t have a cold. More likely, it’s allergies.

What are allergies? Allergies are an overreaction of the immune system to substances that usually cause no reaction in most individuals. The word “allergies” itself commonly refers to allergic rhinoconjunctivitis (rhino- refers to the nose and conjunctiv, to the lining of the eyes and eyelids). Therefore, allergies primarily affect the eyes and nose, but may also affect the throat and palate.

A substance that plays a major role in many allergic reactions is histamine, which is released in response to an allergenic substance such as pollen. Histamine causes many of the symptoms of allergies such as sneezing, nasal congestion, runny nose, watery eyes, post-nasal drip, red eyes (conjunctivitis), and itching of the eyes, nose, and palate.

Sometimes it is important to know which allergens your child is allergic to. Therefore, your child’s doctor may elect to do allergy testing. Two main types of testing exist. The first is an allergic skin test. This involves introducing small amounts of allergen into the skin. If your child is allergic to any one of those allergens, a small bump called a wheal will form. The size of the wheal is an indication of the severity of the allergy. The results of the skin test are immediate, it is the most accurate allergy test, and it is the most inexpensive. However, the test can be uncomfortable, it cannot be done in patients with certain skin problems, and the results are affected if a person is taking allergy medications.

The second test is called the radioallergosorbent test or RAST. The RAST is done by testing a patient’s blood for antibodies directed toward known allergens. This test causes less discomfort, it works while a person is taking allergy medications, and it can be done for those who have skin problems. However, it is more expensive, takes days to weeks to get results, and is less accurate.

What is the treatment for allergies?

The first step of treatment for allergies is to remove the allergens. Those suffering from environmental allergies can strive to remove known allergens from the home. Also, it is helpful to use allergen-proof encasings for pillows and mattresses. Sheets should be washed weekly in hot water (greater than 130°F). HEPA filters, which filter out allergens, can be used in furnaces.

For those suffering from seasonal allergies, avoidance of allergens can be more difficult. It is not generally recommended that people avoid going outdoors, owing to its health benefits. However, those with severe allergies may need to avoid the outdoors during the specific season during which known allergens are in the air. The next step in treatment is using medication. Because topical medications don’t generally come with side effects, nasal sprays and eye drops are a good first choice. The most effective nasal sprays are steroid sprays. Other available nasal sprays are antihistamines and decongestants.

Oral antihistamines are the next line of treatment. Medicines like Atarax and Benadryl are antihistamines which easily cross into the brain and cause sedation. However, antihistamines such as Zyrtec, Claritin, or Allegra do not cross to the brain as easily and, thus, cause less fatigue.

The last line of therapy is immunotherapy. This is reserved for severe allergies. Immunotherapy is also known as “allergy shots.” Generally, the patient goes to an allergy clinic weekly for a period of months to years and receives injections that contain known allergens. This will slowly decrease the person’s allergic response to allergens. If you would like to learn more about allergies, contact your child’s doctor.

By evaluating the child’s symptoms, severity of allergies, and treatments already attempted, you and your child’s doctor will determine the best plan for diagnosis and treatment.

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