Q & A on Children's Allergies

Nasal Stuffiness & Rashes

My 18-month-old daughter has a stuffy nose that just won't go away, and she sometimes vomits first thing in the morning. I thought it was a virus, but could it be allergies?

While a cold may be causing your daughter's stuffy nose, typically if symptoms go on for more than five to seven days, allergies often are the culprit. When an allergy causes congestion and a runny nose, some of the mucus drips to the back of the throat. This is called postnasal drip. Young children who can't spit up the mucus may swallow it and end up vomiting up the mucus, since it's irritating to the stomach. That sounds like what might be happening to your daughter. Talk to your pediatrician or a pediatric allergist, who will take a case history of her symptoms to look for the cause of the allergy. It may be something in her environment, such as dust mites, or animal dander.

You can cleanse her nose by moistening her nasal passage with saline drops. Then suction out the mucus using a nasal aspirator. Keeping a vaporizer or humidifier in her bedroom will also help to keep her nose moist and will make the mucus easier to dislodge. Your doctor may also suggest an antihistamine such as Claritin or Zyrtec liquid, medications which help cut down on the allergic symptoms.

My 7-month-old had a cold and was wheezing overnight. We took him to the emergency room and he was given albuterol, an asthma medication. Does this mean he has asthma?

Not necessarily. Wheezing is a high-pitched sound that occurs when the millions of tiny airways in the lungs narrow, sort of like what happens when you blow into a narrow instrument like a flute. Babies already have tiny airways that narrow even further when they swell up due to a cold or other infection, making children wheeze as they breathe with difficulty. So wheezing is common in babies and may not be a sign of asthma. (The medicine albuterol is a bronchodilator that relaxes the muscles of the airways and increases air flow to the lungs so your child can breathe.)

However, children who frequently wheeze when they get a cold may have asthma or develop asthma. (If you're concerned at all about your child, you should be sure to speak with your pediatrician for more information.) Asthma is more likely if there is a family history of allergies or asthma, or if your child has already shown signs of a food or other allergy, such as eczema or hives. Although some episodes of wheezing occur once and never again, if the problem recurs, it's more likely that your child does have asthma. Asthma is a chronic respiratory disease in which a person's airways become inflamed, the muscles around them tighten and this causes the airways to narrow and cut down on the air flow to the lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways may make more mucus than normal. Mucus is a sticky, thick liquid that can further narrow your airways. Asthma attacks also referred to as flareups or exacerbations can occur when exposed to common triggers such as dust, mold, and animal dander, as well as cold viruses. As the inflamed airways spasm, Baby coughs and/or wheezes as he struggles to breathe. To be safe, have your child evaluated by a pediatric allergist or pulmonologist.

Also, asthma is more likely if there is a family history of allergies or asthma, or if your child has already shown signs of a food or other allergy, such as eczema or hives. Some episodes of wheezing occur once and never again; if the problem recurs, it's more likely that your child does have asthma.

Asthma is a chronic respiratory disease in which a person's airways become inflamed, the muscles around them tighten and this causes the airways to narrow and cut down on the air flow to the lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways may make more mucus than normal. Mucus is a sticky, thick liquid that can further narrow your airways. Asthma attacks also referred to as flareups or exacerbations can occur when exposed to common triggers such as dust, mold, and animal dander, as well as cold viruses. As the inflamed airways spasm, Baby coughs and/or wheezes as he struggles to breathe. To be safe, have your child evaluated by a pediatric allergist or pulmonologist.

My pediatrician says my 5-month-old baby has eczema on her cheeks, but we can't figure out what's causing it. What should we do?

Eczema, which usually appears in baby's first year, is a red, rough, itchy patch of rashes usually found on an infant's cheeks, scalp, and forehead. It may spread to other parts of the body, such as behind the knees, chest, and in the bend of the arm. It is often caused by allergies to foods, but you're right that the culprit is often not apparent. The rash can also be aggravated by heat, irritants that come in contact with your baby's skin such as wool or the chemicals in some soaps, lotions, and detergents, changes in temperature, and dry skin. Think about whether your baby ate any new food recently or, if you're breastfeeding, whether you ate anything new. In the meantime, to treat the skin, keep it moist with a cream such as Eucerin. If the inflammation is severe, your doctor can prescribe a non-steroidal cream for short or intermittent-term treatment, which is preferable to the older, steroid-based creams used to treat eczema -- they can cause discoloration and thickening of the skin if used for too long.

Does having a pet make allergies worse or better?

Having a pet in the home, particularly a cat or a dog, may contribute to problems with allergies and asthma if there is a family history of allergies. Cats are very allergenic animals, as they leave their fur (containing the offending dander) everywhere. If a parent has an allergy to animals, the child is more likely to develop one.

You're probably confused because some recent studies have suggested that having a cat or dog in the house at an early age may be beneficial to your child, not only allowing him to tolerate the animal, but also offering protection against his developing allergies. However, these studies need to be repeated to confirm the findings. As of right now we recommend not having pets in the home if there's a family history of allergies.

Can babies and toddlers have seasonal allergies to grass and pollens?

The general rule is that it takes at least one season for the immune system to "learn" to be allergic. So subsequent seasons may be a problem. For example, a June baby may not react to ragweed at 3 months of age when he's exposed to it for the first time, usually in late summer and early fall, but the next time -- when he's around 15 months old -- he may develop allergic symptoms. Exposure to other allergens such as cat dander or mold may be constant, so in those cases, a child is likely to develop allergies to them at any time.

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