Q & A on Children's Allergies

Prevention & Treatment

What kinds of allergy medications can young children take? What are other ways to control their allergies?

Not all adult allergy medicines are appropriate for children. Claritin, which is now available over the counter, is a very good antihistamine that may be used for children over 2. (For children under two consult your pediatrician.) Zyrtec is a prescription antihistamine that may be used from the age of 2. Benadryl also works to stop allergy symptoms but can make children sleepy or wired (before administering to your child, be sure to contact your doctor for safety and dosage information).

Other medications approved for children 2 and up include Nasonex, a nasal corticosteroid that is sprayed into the nose. This medicine relieves the inflammation in the nasal passages that causes congestion and a runny nose. Pulmicort Respules, an inhaled corticosteroid, is approved for bronchial asthma. This medicine relieves the swelling in baby's airways so he can breathe more easily.

Obviously, the best way to beat allergies is to avoid whatever is causing the reaction. But this can be tricky. A few years ago, I had a patient in pre-K who was worse on the weekdays while he was in school and better on the weekends. He was found to be very allergic to cats and dust mites, and we discovered that of the other 11 kids in his class, 7 had cats at home. In class, he napped on a rug on the floor where children with cat dander on their clothes also napped. The secondhand animal exposure and the dust mites in the rug were a disaster for him. The only solution was to switch schools.

Using a HEPA filter in your home, which filters the air of the tiny particles that cause allergies, can help. (Skip the cheap air purifiers found in department stores -- they don't work well.) Try using dust-mite covers on the bed and pillows if your child is sensitive to dust. Also store dust-collecting stuffed animals in a closet, rather than out on shelves, and use area rugs instead of wall-to-wall carpeting. In addition, it's important not to smoke at home, because cigarette smoke can aggravate allergies.

My pediatrician wants to refer my 2-year-old to an allergist for skin testing but I'm afraid of his skin being scratched. My doctor says he can also perform a blood test that detects allergies in his office. Is that just as good?

If your pediatrician feels that your child should be tested for allergies, either a blood test or skin testing is fine. The blood test involves taking blood from a vein, usually in the arm. It's a little stick and lasts a few moments.

Skin tests are slightly painful but are soon forgotten by the child -- and the parent. You will learn the results in about 20 minutes, but may have to wait a few days for the results of a blood test.

Skin Prick Test: The doctor places a drop of a solution that has the allergen on the skin, and a series of scratches or needle pricks allows the solution to enter the skin; if a wheal pops up then this is considered positive reaction.

Intradermal Test: A small amount of the allergen solution is injected into the skin. An intradermal allergy test may be done when a substance does not cause a reaction in the skin prick test but may still suspected as an allergen.

Skin Patch Test: The allergen solution is placed on a pad that is taped to the skin for 24 to 72 hours. This test is used to detect a skin allergy contact dermatitis.

Whichever you choose, it's best to go to an allergist for either test, because just as important as the test is the interpretation of the results. These tests are a backup to the complete medical history and physical exam taken by an allergist. Your allergist will ask questions about when, where, and how often the reaction occurred. He can often determine the likely cause of an allergy from these answers and from examining your child -- the test simply confirms what he may already know.

It seems that more and more kids have allergies these days. Why is that?

Part of the answer is that we are much more aware of what allergies are than in the past, so more people seek treatment for allergies and doctors are better at diagnosing them. We are also exposed to a greater variety of allergic substances -- for example, we eat many more foods today than in the past. A hundred years ago or so, for instance, you wouldn't have been able to get lobster if you grew up in the Midwest, so you would never have become sensitized to seafood. In addition, today we tend to seal ourselves into our homes for insulation from heat and cold, which means we get less fresh air flowing in and are exposed to greater concentrations of allergy-causing substances (called allergens), such as dust and animal dander.

Paul Ehrlich, MD, is a pediatric allergist in New York City, and coauthor of What Your Doctor May Not Tell You About Children's Allergies and Asthma (Warner).

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

Originally published in American Baby magazine, April 2004. Updated February 2010

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