Some days allergies may seem to be everywhere: In the news; on the Internet; the topic of friends’ conversations; even on television and in the movies. Yet many parents still have questions. Does my child have allergies? How do I find out? What do I do? (And just what is an allergy anyway?)
This article is an introduction to seasonal allergies and will help you address these questions.
What is a seasonal allergy?
An allergy is a sensitivity in which the immune system reacts to harmless substances. In allergic people, the body makes a type of antibody, called IgE, to substances in the environment (called allergens). Allergic symptoms occur when a person is exposed to an allergen to which he or she has made IgE. Examples of allergens include pollens, molds and pet dander. Seasonal allergies occur when the triggering allergen is present only for part of the year. Pollens are responsible for most seasonal allergies.
Symptoms
The symptoms experienced by a person with seasonal allergies vary and may affect the eyes, nose, lungs and/or skin. School-age children may be able to tell you their symptoms. Babies and very young children often cannot communicate symptoms verbally but may give you clues by their behaviors.
Symptoms to watch for include:
Eyes (allergic conjunctivitis):
- Itching, “burning” or the sense that something is in the eye
- Rubbing
- Visible blood vessels in the white of the eye
- Clear, white or yellow discharge
Nose (allergic rhinitis):
- Stuffy and/or runny nose. The mucus may be clear, white ,yellow or green
- Frequent sniffling, throat clearing, rubbing or wiggling the nose
- Mouth breathing, snoring or being tired during the day
- Cough
- Headaches
- Trouble hearing or paying attention
- Dark circles or lines under the eyes
Lungs (allergic asthma):
- Cough
- Wheezing (Note: not all children with asthma have wheezing and not all children with wheezing have asthma.)
- Chest tightness or shortness of breath
- Trouble keeping up with other children in physical education or while playing; reluctance to engage in active play or sports; “running out of air” or always being tired
- Difficulty catching his or her breath, increased effort to breathe
Skin:
- Eczema
- Hives (pink or red itchy welts that come and go).
Diagnosing seasonal allergies
A diagnosis of seasonal allergies may be suspected based on the types and timing of symptoms (“history”). Examination by a physician may find physical signs suggesting allergy. Often initial treatment is chosen based upon the patient’s history and examination findings.
Consultation with an allergist/immunologist (a physician with specialty training in the diagnosis and care of allergies and asthma) and allergy testing can confirm the diagnosis and identify which specific allergens are triggering your child’s reactions. Allergy testing may involve skin tests and/or blood tests. If asthma is suspected, lung function testing may also be recommended. You can find an allergist/immunologist in your area by visiting the physician referral directory at www.aaaai.org.
Symptom triggers:
A reaction can occur anytime your child comes in contact with the pollens to which he is allergic. The pollens that cause allergies are often microscopic; the plants that produce them generally don’t have showy, fragrant flowers. Which pollens are most prevalent varies with both the time of year and geographic location. Generally, tree pollens are present in spring; grass pollen in summer; ragweed pollen in fall. Pollen season lasts until the first frost. Mold allergy may have a seasonal pattern of allergy symptoms, but the amount of mold spores is tied closely to weather patterns.
Preventing and controlling symptoms
Identifying and avoiding triggers
First, consult an allergist/immunologist to identify your child’s allergy triggers. Pollen and mold counts may be followed on the National Allergy Bureau’s website,
www.aaaai.org/nab. Limit exposure by keeping house and car windows closed and running the air conditioning. Avoiding lawn mowing and some types of gardening may be helpful as well – especially at times of high pollen counts, such as early morning.
Medications
Remember that not all medications are approved for all ages of children. Proper dosing often depends on a child’s age and/or weight. Always check the labeling and indications of any medication before giving it to your child. Discuss any questions with your physician.
Medications for allergic rhinitis include oral antihistamines, prescription nasal sprays (corticosteroids, antihistamines, cromolyn sodium) and leukotriene receptor antagonists (LRA’s). Over-the-counter or prescription oral antihistamines can help itching, runny nose and sneezing. These medications can be taken as needed to alleviate symptoms or regularly to prevent symptoms. Antihistamines may also provide some relief for itchy watery eyes. Nasal sprays can control congestion, runny nose and the inflammation associated with allergic rhinitis. Most prescription nasal sprays are more effective if taken regularly to control and prevent symptoms. LRA’s can treat a stuffy, runny nose, itching and sneezing. Allergic conjunctivitis may be treated with eye drops with antihistamine or mast cell stabilizing effects.
Medications for asthma include anti-inflammatory medications to control and prevent symptoms and quick-relief bronchodilators. All children with asthma should have an action plan developed with a physician to maintain asthma control and to treat attacks.
Treatment of atopic dermatitis, an allergic skin disease, typically includes oral antihistamines, skin care, trigger avoidance and topical anti-inflammatory medications (e.g. corticosteroids). Hives are treated with oral antihistamines.
The treatment of both asthma and eczema can be complex and a complete discussion is beyond the scope of this article. If your child has either condition, develop a treatment plan with your child’s physician.
Allergen immunotherapy (allergy shots):
Allergen immunotherapy is an effective treatment for allergic rhinitis and asthma for selected patients. It should be given under the supervision of an allergist/immunologist or other physician with appropriate expert training.
Next steps:
If you think your child may have allergies, discuss the matter with his physician.
Consider a consultation with an allergist/immunologist if your child has:
- Symptoms not well controlled by current medications
- Symptoms that interfere with your child’s quality of life or daily activities
- Complications such as sinus or ear infections, trouble hearing or poor sleep quality
- Allergic symptoms for which you would like to indentify the trigger
Rebecca G. Piltch, MD, FAAAAI, is an allergist/immunologist based in San Rafael, California. The American Academy of Allergy, Asthma & Immunology is the largest professional medical association devoted to the research and treatment of allergic disease. The AAAAI offers educational materials for patients online at www.aaaai.org.
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