One of the most common questions in the pediatric office:
"How soon can you diagnose respiratory allergies in children?"
Although allergies can occur during the first year of life, it is unusual. Typically, allergies develop over the second year of life and are seen with increasing frequency as the child grows. This is due to the fact that you need to be repeatedly exposed to a potential allergen to develop a sensitivity.

It is very difficult to tell whether a child has a simple cold or whether its an allergic runny nose. We think of the common cold as lasting anywhere between 7-10 days. Anytime there is a fever, that suggests the likelihood of infection.

The typical course of a common cold usually is two to three days of clear nasal discharge followed by 3-4 days of a colored thicker discharge, then resolving with a clear discharge. Allergy symptoms usually are more chronic in nature and last longer than ten days. They include repetitive sneezing, nasal congestion, and eye itching. Persistent coughing is a very common symptom of postnasal drip caused by allergies.

Two signs in a child that can be suggestive of allergies are a crease on the nasal bridge caused by persistent rubbing of an itchy nose. Also blackening under the eye are termed allergic shiners. These can be suggestive of allergies, but a child can have allergic shiners without having allergies.

Allergies are very common in the United States. Anywhere between 20-25% of children can have allergies. The unfortunate thing about allergies is only about 10% of children truly outgrow their allergies entirely. There are two types of allergies--one is seasonal, such as pollen allergies to grass, trees, and ragweed; and the other is perennial, usually caused by continual exposure to indoor allergens such as pets or dust mites.

After the pediatrician determines that the symptoms are more likely due to allergies, the question becomes how do we treat. In uncomplicated cases, the pediatrician usually resorts to an over-the-counter antihistamine-decongestant combination. However, there are some common side effects associated with the over-the-counter antihistamines; the most common being drowsiness. Also with children, the question of whether or not it affects their behavior and/or their attention at school is very important.

The non-sedating antihistamines are now available for children between 6-12 years of age. These do not cause any symptoms with behavior. Some pediatricians are using these nonsedating antihistamines before FDA approval in children between 2-6 years of age. We also have new medicines that are used in a nasal spray. These are anti-inflammatory medications, those that contain cromalyn sodium which prevents inflammation of the nose. And we also use intranasal steroids that have a strong anti-inflammatory effect. The advantages of using nasal sprays means there is very little body absorption, only acting on the nasal passage. Parents are often concerned about using steroids in children. There is very little systemic absorption eliminating any of the drawbacks of using a liquid form of steroids.

I think it is important for a pediatrician to refer to an allergy specialist when, despite treatment, the child is still suffering; or, we have no good idea of what is causing the child's allergies. The referral to an allergist is not just so a child can go to receive allergy shots. In fact, the most important reason is to use the allergist's expertise and experience in skin testing to diagnose specifically what is causing the allergy in order to decrease the exposure of the child to that allergen.

It must be mentioned that allergies do run in families, and that is an important clue as to whether or not the child's condition is an allergy. Allergies must also be thought of in children who have other co-existing diseases such as frequent recurrent upper respiratory infections, repeated bouts of sinusitis, chronic ear infections, persistent cough, and asthma. Any child with the above conditions is a strong candidate to have allergy testing. There can be great improvement in those illnesses if their allergies are well controlled.

The parents can help the pediatrician make the diagnosis of allergies. It is important for the parents to keep a detailed diary of the child's symptoms: how long they last, what medicines were helpful in lessening the symptoms, what time of year the symptoms happen, and what exposures the child had. For example, a dog exposure that set off a sneezing attack and a runny nose, or the time of day of the worsening allergy symptoms are important, as dust mite allergies will be worse during the night time.

In summary, with the parents and the pediatrician working as a team, in most cases, the source of the allergen can be found by history. If not, then skin testing may be needed. Today we have numerous choices in antihistamines and nasal medications that can help lessen a child's suffering from allergies.

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