Allergies in Children

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• QWhat should I do if my child is diagnosed with an allergy?

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  A Dr. Daniel R. Spogen, MD , Family Medicine, answered on behalf of Univ. of Nev. School of Medicine, Family Medicine

  There are a number of different things you might do if your child is diagnosed with an allergy. For example, if your child is allergic to a food that, if eaten, causes a severe reaction (difficulty breathiing, throat swelling), not only should there be an EpiPen close by but the child and everyone else in the family should avoid eating that specific food. If your child has a severe allergy to cats your family most likely cannot have cats as pets. This depends on how severe your child's allergy is and if his or her symptoms can be well controlled with medication if your family is unable to make lifestyle modifications first. If your child's allergies are mild, he or she may only need to be on an antihistamine, and significant lifestyle modifications may not be needed.

   

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• QDo children outgrow allergies?

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  A Dr. Paul M. Ehrlich, MD , Allergy & Immunology, answered

  The conventional wisdom is that the child will probably outgrow one allergy related problem or another. They might, but chances are that each condition they outgrow will be followed by another down the road -- accompanied by the psychological problems that come from having spent their childhood sneezing, wheezing, and scratching.

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• QWhat treatment options are available for pediatric allergies?

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  A Dr. Carla L. King, MD , Pediatrics, answered on behalf of Capital Area Health Network

  A variety of treatment options are available for children with allergies.  Antihistamines whether short acting (Benadryl) or long acting (Claritin, Zyrtec or Allegra) taken daily can be very effective.  Nasal steroids and normal saline nasal mist are also helpful at decreasing the symptoms of nasal congestion and mucus production.  Children who have persistent allergy symptoms may be better treated with immunotherapy or "allergy shots".  Immunotherapy may take several years before treatment can be discontinued.  For the most effective relief of symptoms start treatment before the child's allergy season starts.

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• QAre there any natural remedies for seasonal allergies for children?

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  A Dr. Michael R. Land, MD , Gynecology, answered on behalf of Duke Medicine

  There is not enough strong evidence to recommend the use of herbal supplementation, acupuncture, or "special diets" for the treatment of allergic rhinitis. Some patients benefit symptomatically from nasal saline rinse, which washes out debris and pollens.
  Allergy shots are considered by some to be a natural way of dealing with allergies, although they are still a medical treatment given by a doctor. These injections actually expose your body to small amounts of what you’re allergic to. By starting with tiny amounts and gradually increasing regularly, these injections slowly change your immune system to be able to tolerate larger amounts of the allergens.
• QHow are seasonal allergies treated in kids?

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  A Stacy Wiegman, PharmD , Pharmacy, answered

  If your child suffers from seasonal allergies, the best way to treat her is to keep her away from whatever is causing her symptoms (the allergen) as much as possible. Since it's likely that it's something that she encounters every day, though, such as pollen, there are other steps you can take to help her cope with her sneezes and sniffles:
  

  • Keep windows closed and use air conditioning. If pollen is the cause of her seasonal allergies, keep her indoors as much as possible when pollen counts are really high.
  • If your child plays outside during allergy season, have her wash her hands and change clothes when she comes indoors.
  • Talk to her doctor about medication. There are many medicines that can help relive allergy symptoms, such as decongestants, antihistamines and nasal sprays. Your child's doctor can suggest the best options.

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• QShould my child get allergy shots?

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  A Dr. Paul M. Ehrlich, MD , Allergy & Immunology, answered

  When they work, allergy shots are a tremendous relief not only from the symptoms of allergy but also from the other precautions we ask our children to take. They're not a panacea, however. They certainly shouldn't be done for very mild allergies; the treatment could be worse -- or at least more annoying, time consuming, and expensive -- than the disease. For children with really serious asthma or who are very allergic, this treatment can be beneficial but also slightly risky. Experienced allergists can really prove their worth by treating these children. There is a real question as to whether immunotherapy should be attempted before the age of 5. An allergist will make a decision based on how sick the child is and after conferring with the child's pediatrician and parents.

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• QCan kids with allergies participate in sports and other activities?

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  A Dr. Lawrence T. Chiaramonte, MD , Allergy & Immunology, answered

  An allergic child may have true limits when it comes to sports and other activities: Running in cold air may bring on wheezing and shortness of breath, for instance. For their part, the well children may take this opportunity to shine, to forge an identity outside the home, with all its special rules. Let them go as far as they want. Teams provide an alternative social structure to the close-knit, regulated home - an important outlet even when there is no allergy in the home, but even more crucial where a sick child is the focal point of so much psychic and physical energy.
  
  As for the allergic child, provide the best allergy care you can and then let them find a level of activity that they are comfortable with. Kids are good at finding their own limits; just let them know these may change at different times depending on their status at the start of activities.

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• QHow do I know if my child is having an allergic reaction to a medication?

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  A RealAge answered

  A true allergic reaction to a medication usually involves hives, wheezing, or difficulty swallowing or breathing (all can be a true emergency). Your child may have a nonallergic reaction or side effect that may include stomachache, diarrhea, or sun sensitivity. Side effects do not necessarily mean that your child should stop taking the medicine, but call your doctor right away and check if you suspect something is wrong. 

  Most reactions are not serious. Since kids are typically taking only one medication at a time for an acute condition (such as an ear infection), we don’t have to worry quite as much as we do for adults, who might be taking several medications at once, which can complicate things. 

  If your child breaks out in hives, for example, call the doctor, who’ll advise you what to do next, such as stop the medicine or switch to something else. Your doctor will note the reaction in your child’s medical record so that the medication won’t be prescribed again. Add this to your home records, too, and tell the pharmacist so the reaction is in your child’s prescription record. The chance of a reaction is worrisome, I know, but the benefits of a needed medication usually far outweigh the possible side effects.

  From The Smart Parent's Guide: Getting Your Kids Through Checkups, Illnesses, and Accidents by Jennifer Trachtenberg.

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• QWhat are the signs and symptoms of allergies in children?

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  A Dr. Paul M. Ehrlich, MD , Allergy & Immunology, answered

  Parental allergies are the best predictor of allergies in children, although there are many variations. In general though, the timeline is pretty standard:
  
  First weeks
  

  • Colic. Indicative of allergy to components of formula, such as milk, eggs, and soy.

  
  Up to 2 years of age
  

  • Atopic dermatitis, eczema.
  • Red, rosy cheeks, or "healthy baby" look. Progresses at a few years of age to dry, itchy skin and lichenification in the front of elbow (the antecubital area) and behind the knee (the popliteal).
  • Recurring bronchiolitis (two or more episodes). Should prompt examination of family history, total IgE levels for age, and other signs of allergy.
  • Food allergy. Immature digestive system absorbs whole proteins instead of breaking them down into useful components.

  
  Two to three years of age
  

  • Nasal symptoms with dark rings.
  • Frequent ear infections (aerotitis, serositis). Until age 5 or 6.
  • Asthma. Generally appears after age 2 and before age 10.

  
  After five years of age
  

  • Seasonal allergies. Become important after several pollen seasons and continual exposure to household allergens such as dust mites, molds, and cockroaches.

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• QWhy should I take my child with allergies to a pediatric allergist?

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  A Dr. Paul M. Ehrlich, MD , Allergy & Immunology, answered

  There's a good reason to go to a pediatric allergist for your child's allergies, not just a regular adult allergist. Apart from the differences in the way the allergic diseases present themselves at different ages, and the way they should be treated, there's the matter of what we might call "crib-side manner." That is, we try to relate to the child as close to his own terms as we can. This gives us a chance to become children again if just for a moment. We have to love doing this or it will show. Because of our training and because of our frequent collaboration with pediatricians we have tricks up our sleeves to gain the confidence of both parents and children that make difficult, annoying treatment go more smoothly.
  
  An important "trick" we have in the office is doing whatever has to be done to Mom, Dad, or even ourselves first. Shot? We have the parents roll up their sleeves and give them a shot of saline. Or a dummy scratch test. We might use our stethoscope on Dad's chest or Mom's back to put the child at ease, or allow the child to listen to ours.

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