Many children and adults suffer from allergies, and they commonly run in the family, so if you have allergies your child may develop them as well. Because they're so common and many symptoms overlap with other conditions, it can be challenging to figure out if your child has allergies or something else, especially early on. Once we've had a chance to observe for a few seasons, it becomes much more obvious. For example, if your child catches a cold 2 or 3 seasons in a row around the same time in April, it might look like springtime allergies at first. But after they're 5 or 6 years old and you've observed multiple seasons, it becomes pretty obvious by that point what's going on.
How to tell if it's allergies or something else
The following go in favor of allergies:
- Itchy nose and eyes
- Congestion and/or runny nose that:
- are chronic
- consistently correlate with exposure (e.g. cat, grass, tree bloom)
- not accompanied by signs of infection (fever, vomiting, etc.)
- Family history of allergic diseases (allergies, asthma, eczema)
- Consistent seasonal symptoms (e.g. every spring, same symptoms for several years in a row)
The following go against allergies:
- Signs of infection (fever, vomiting, sinus pain, thick nasal discharge, ear ache, heavy cough, shortness of breath, etc.)
- No family history of allergies
- Young age (less than 3 years old)
- Varying time of year
- Winter illness, especially sudden/acute illnesses
How we diagnose allergies
We'll start with an appointment at my office to check for signs of allergies on exam and review your child's symptoms and family history. Often, we'll be able to get a good idea at that point if it may be allergies, and a trial of treatment can help us determine if allergies are the cause. Sometimes, if we can't tell based on your child's history and response to treatment measures, I might refer you for allergy testing. However, that is usually reserved for cases where we can't tell what's going on and are unable to get your child's symptoms under control easily. There are two types of allergy tests:
- Blood test - this test counts the antibodies in your child's blood stream against various allergens (e.g. grass, tree, etc). Upside: no consult or skin test needed, just go to the lab, quick and easy. Downside: cost, trauma of blood draw, less accurate.
- Skin test - this test involves taking a tiny amount of allergen and placing it on your child's skin under controlled conditions to see if they react. Upside: more accurate, interpreted by allergist for a more thorough assessment. Downside: cost, can be extremely itchy, time consuming. More accurate than blood draw, but still not 100%.
Keep in mind that with allergy testing, you're not testing for EVERY allergen in the world. Each specific allergen requires its own specific test, so when testing we are selecting a few possibilities that we think might be a culprit (e.g. specific trees, specific plants, specific molds, dog, cat, grass, etc). Anything not specifically tested for will not show up, so there's that limitation as well.
Most of treatment focuses on reducing allergen exposure. Keep in mind that a lot of allergen exposure occurs from the allergens that accumulate on your child's hair, hands and clothes throughout the day, as well as in your dust, on your dog, etc. So keeping things clean during allergy season can have a huge impact.
Here are my tips for managing allergies in children:
- Keep an ongoing allergy diary. Note when symptoms are better/worse year to year, which will help you identify and avoid triggers. Grass? Trees? Cats? etc. Using an online allergen index/forecast can help. Once your child's season and exposure is solidly identified, you will be able to target the following actions to hopefully the few weeks or months out of the year when your child needs it most.
- Dust frequently. Dust carries allergens (pollen, dander, etc.) which can make your child's symptoms worse. Try to avoid kicking up the dust while you clean. Using a damp rag or HEPA vacuum may help.
- Use dust mite covers and wash sheets in hot water at least weekly. These measures reduce the dust mite population in your child's bed and pillows, and keeps other allergen levels low in their bedding. Dust mite covers are a tightly knit fabric that covers the mattress and pillows, and are available at most bedding stores.
- Keep pets out of your child's room. Pets carry allergens within their fur even if your child isn't directly allergic to that specific pet.
- Identify and remove mold. Check that there are no water leaks in your home, where pipes are damaged or rainwater is leaking into your walls, such as around window sills or in bathrooms. Use the bathroom fan when showering, and clean any moldy spots regularly. Use a hygrometer (humidity meter, available online or at electronic/hardware stores) to ensure the house or basement is not too humid. Ideally, humidity should not be over 50%.
- Wash hands frequently. Hands collect allergens too, which kids then rub into their faces.
- Wash hair before bed every night. Hair can be a magnet for allergens. Use a fragrance-free, scent-free shampoo, which is less irritating to breathe in.
- Keep windows shut when allergen counts are high.
- Strictly avoid fragrance and smoke (candles, incense, cigarettes, etc). These things irritate an already irritated airway.
- An antihistamine may be given for itchy nose and eyes, sneezing and sniffling (see below for dosage). These work best when used regularly, and especially when given before the allergen exposure when possible.
- Prescription medications are available if these measures don't keep things under good control, so come in for an appointment if you think something stronger might be needed.
Over-the-counter treatment options:
Children's Zyrtec (cetirizine 5mg/5ml or 10mg dissolve tab) dosage:
- Age 6-12 months: 2.5 mL once daily
- Age 1-2 years: 2.5 mL 1-2 times daily
- Age 2-5 years: 2.5 mL to 5 mL once daily
- Age 6+ years: 5 to 10mL (or one 10mg dissolve tab) once daily
Children's Claritin (loratadine 5mg/5ml or 5mg chewable tabs) dosage:
- Age 2-5 years: 5ml or 1 chewable tablet once daily
- Age 6+ years: 10ml or 2 chewable tablets once daily
Allergy eye drops (ketotifen 0.025%, multiple different brands)
- Age 3 years and up: 1 drop to affected eye(s) twice daily
Signs to watch for
Call for an appointment if:
- symptoms are persistent or don't respond to simple measures within 2 weeks
- symptoms interfere with sleep or daytime functioning
- signs it might be something else (fever, heavy cough/shortness of breath, vomiting, heavy nose or eye discharge, etc.)
- stronger prescription might be needed
For urgent needs, same-day appointments are available Monday through Friday. Please call as early in the day as possible, the more notice we have the easier it is to fit everyone in.
Need help outside of office hours?
Firstly, if your child has an emergency, please call 911 or go directly to the ER - they will contact us if needed once your child has been evaluated.
Urgent Care centers can also be helpful when something needs to be seen outside of office hours but it's not an emergency.
For our list of preferred Urgent Cares and ERs, see our resources page.
And if you have something that might need urgent attention but you're not sure/don't know what to do, we can help: