Figuring out whether sniffles and coughs are due to a cold or allergies can be a challenge, even for doctors. This is what you need to know -- and how to help your child get through the season.
At age 3, Cheyenne Madden seemed to be sick more than the average preschooler. For much of the year, she dealt with a constant dry cough, painful sinus congestion, and endless rounds of pediatrician visits and antibiotics. "We were always at the doctor," says her mother, Lynn, of Hartly, Delaware. "I thought, 'It can't be normal for a 3-year-old to cough all the time.'"
When one of Cheyenne's sinus infections persisted for weeks despite three rounds of antibiotics, her pediatrician started to suspect the little girl was not suffering from an illness, but allergies. It made sense: Lynn herself had seasonal allergies, and Cheyenne's symptoms seemed to worsen with the arrival of spring. Finally, after more than a year of symptoms, Cheyenne saw an allergist, who confirmed she was allergic to several types of trees and grasses, as well as certain pets. Now that she takes an antihistamine and a nasal steroid spray daily, and steers clear of freshly mown lawns and neighborhood dogs, Cheyenne is coughing less -- and enjoying the outdoors much more.
Solving a stubborn case of the sniffles has never been trickier, for parents or doctors. It's not unusual for kids to have six to eight upper-respiratory illnesses a year, especially in early childhood, when they're most vulnerable to infections. But more and more children get a stuffy nose, a nagging cough, and watery, itchy eyes just from breathing the outside air, particularly during the spring and fall. These seasonal allergies -- which docs call allergic rhinitis -- are caused by an overreaction of the immune system to certain things outdoors, like molds and pollens from grasses, trees, and other plants such as ragweed. "Up to 40 percent of kids now have allergic rhinitis -- a percentage that's doubled over the past two decades," explains Parents advisor William E. Berger, M.D., an allergist in Mission Viejo, California.
No one knows exactly what's behind the rise in seasonal allergies, but many scientists say that our increasingly sanitized environment is diminishing kids' exposure to everyday microbes that bolster their immune system. When it isn't busy fighting germs and viruses, a child's body may perceive harmless things in the environment as a threat, and cells release chemicals such as histamine -- which causes sniffling, sneezing, and itching -- in defense. A newer theory relates to global warming, which is leading to longer pollen seasons. Because people often develop allergies only after being exposed to a trigger for a couple of seasons, consistently higher pollen counts might be leading to earlier and peskier symptoms. (Kids don't typically develop seasonal allergies before age 4, though they may have "perennial allergies" to indoor irritants like dust, mites, and pets at an earlier age.)
Thankfully, as allergy rates grow, so has awareness, and doctors are getting better at diagnosing kids. Making the distinction between colds and allergies can be difficult; a clue is often the duration of symptoms. "A typical cold lasts only seven to ten days," says Fuad Baroody, M.D., director of pediatric otolaryngology at The University of Chicago Medical Center. "Children with allergies might suffer for weeks or months, with no break in their symptoms." Also, allergic kids often just look different from sick kids, says Dr. Berger. Many have "allergic shiners," dark circles that form under the eyes due to chronic congestion, or rub their drippy noses upward in what docs call an "allergic salute."
If you suspect an allergy, a pediatrician can start your child on a trial of an over-the-counter, non-sedating antihistamine like Children's Claritin (safe for children 2 and older), says Dr. Baroody. (Some oral non-sedating antihistamines contain a decongestant for stuffiness, but these make some children hyper or irritable, so it's best to avoid long-term use.) Pediatricians can also perform a blood test to help pinpoint what your child is allergic to, though you'd need to see an allergist to get a skin-prick test, in which tiny amounts of various triggers are placed just under the skin in order to see what produces a rash like response. "Skin tests tend to be slightly better than blood tests at showing what bothers your child the most and give you results right away," says Sakina Bajowala, M.D., an allergist in North Aurora, Illinois, and mom of two sons with seasonal allergies. (Because both tests can have false-positive results, an allergy diagnosis is usually made only when a child has obvious symptoms as well.)
Allergists can also fine-tune your child's treatment plan. "The most effective treatment is a nasal steroid spray, such as Flonase, approved for kids 4 and older," says Dr. Baroody. "The medication reduces the allergic inflammation that contributes to nasal tissue swelling. It also helps reduce the production of watery mucus, which contributes to chronic runny nose and postnasal drip." Allergists may need to recommend allergy shots, in which kids are injected with increasing amounts of an allergen until they become less sensitive to it. This regimen is typically reserved for children over 4 whose symptoms don't respond well to drugs. Although treatments are usually done through a series of shots in an allergist's office, the FDA may soon approve kid-friendlier, under-the-tongue drops, which are commonly used in Europe. "Research suggests that for patients with a limited number of allergic triggers, drops such as these are effective and safe enough to be given by parents at home," says Dr. Bajowala.
The most important point doctors want to make: Don't brush off a chronic runny nose or a nagging cough. "You may think it's not worth worrying about because it looks like a common cold," says Dr. Bajowala. But left unchecked, allergic rhinitis can make a child more vulnerable to sinus or ear infections, asthma, and even orthodontic problems (chronic open-mouth breathing can actually reshape the palate). Allergic kids are also prone to academic troubles, usually due to poor-quality sleep. "I see a lot of kids with symptoms similar to those of ADHD, when in fact they're just exhausted," says Dr. Berger. When their allergy symptoms improved, he adds, their behavior and focus did too. "Kids don't need to be miserable," Dr. Baroody adds. "Allergy treatments have come a long way. They're safe -- and they work."
Medication is just part of the solution for allergic kids. Reducing kids' exposure to triggers is key for controlling symptoms. Some doctors suggest running the air-conditioning at night or having an air purifier with a HEPA filter for your child's bedroom. Check out these parent-tested tips for limiting exposure to pollen and other seasonal allergens.
"I receive a daily e-mail alerting me about the airborne allergen counts on the website of the American Academy of Allergy, Asthma, & Immunology. You can get notifications of when pollen or mold from certain trees, grasses, or weeds in your area is present -- and then keep windows closed as a precaution."
Amanda Milani; Leander, TX
"Dress your kids in natural fibers. When most synthetic fabrics rub together, they produce static electricity, which attracts pollen. Pollen clings less to my boys' 100 percent cotton clothes."
Sakina Bajowala, M.D.; North Aurora, IL
"I dust and vacuum frequently and, once a month, spray Febreze Allergen Reducer on the carpet. My kids' coughs go away, and their runny noses aren't as bad."
Autumn Lewis; Fort Wayne, IN
"Every night before bed, we wash our son's hair to make sure that any allergens that may be clinging to his hair don't wind up on his pillowcase. We also use a saline spray or a neti pot to help clear out his nose."
Deanna Leigh Miller; Valencia, CA
Originally published in the April 2012 issue of Parents magazine.
All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. 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.