TIPS + RESOURCES: Hot Topics
Allergies
Everyone knows the symptoms: itchy, watery eyes, stuffy, runny nose along
with sneezing and coughing. Unfortunately, in Austin there are pollens and
molds in the air year round, so many allergy sufferers never truly feel
relief. The medical term for these symptoms is “allergic rhinitis
and allergic conjunctivitis”. As pediatricians, we frequently are
asked “Doctor, do you think it could be just allergies?” This
question is often asked by parents of infants under two years of age who
attend day care or preschool. In general infants don’t experience
allergic rhinitis (also known as hay fever). Most allergists feel it takes
two years of exposure to an allergen to develop a reaction, so children
under two years of age aren’t often diagnosed with allergic rhinitis.
Due to their young immune symptoms and frequent exposure to viruses in a
day care environment, they unfortunately likely have what we refer to as
“day care syndrome”, which is a series of back to back colds
and respiratory viruses. In the first year of a child’s life, s/he
can have up to 6-8 respiratory infections per year, each of which will last
7-12 days. Children in day care usually have more, which leads to the chronic
runny nose and cough.
In older children, we see similar symptoms to that of an adult: nasal congestion and rhinorrhea (runny nose), cough, itchy, watery eyes and sore throat due to post – nasal drip. Children also often have dark circles under their eyes referred to as “allergic shiners”. They may also have increased numbers of skin folds under their eyes which we refer to as Morgan-Dennie’s lines. They may use the palm of their hand to wipe their nose by pushing their fingertips upward from below their nose. This is referred to as the “allergic salute” and if done chronically can result in a permanent crease horizontally across the bridge of the nose. The chronic congestion from allergies may lead to Eustachian tube dysfunction which can result in an ear infection. By the way, for those of us in central Texas, “cedar fever” is a term we all know. Cedar fever is caused when cedar trees bloom and begin to release their pollen into the air usually beginning in late December and lasting through January. While all that pollen may be making you feel miserable, it shouldn’t be giving you a fever. (There is no real fever in cedar fever.) If you develop a temperature greater than 100.4, you are dealing with an infection, possibly the flu (influenza), since this is also usually the middle of flu season in Austin. Don’t hesitate to call our office if you have symptoms which seem more severe than typical allergies.
Diagnosis of allergic rhinitis is often based on a patient’s history of symptoms, family history and the presence of other allergic type disorders in either the patient or the family. Asthma, eczema and allergic rhinitis are all allergic in nature, and the presence of one disorder in a family increases the risks that subsequent generations may develop any of the allergic disorders mentioned. In other words, if you have allergies, your child may not only develop allergies, but possibly asthma or eczema as well. When more specific testing is needed, there are generally two types of testing available. One form is a blood test, that is commonly used in young children who may not be able to sit still for traditional scratch testing, where an allergist scratches the patient’s back with multiple types of pollen then measures the area of redness which develops around the scratch to determine the presence of an allergy. There are two allergy panels available by blood testing, one of which is for common central Texas airborne allergens, the other for food allergies. These tests also test for common household allergens such as dust mites, cockroach (yuck!) and molds. We can draw these tests in our office. If a patient is older, or perhaps seems like they may need allergy immunotherapy (allergy shots), we will refer you to an allergist. Immunotherapy is usually considered when a patient has failed medical management of their allergies, or if they have a life threatening reaction such as to fire ants, or bees.
You don’t have to be miserable due to your allergies. There are many things you can do to help alleviate your symptoms. Following the weather report or looking in the paper for their daily pollen counts will help you figure out to which allergen your child is reacting. Avoiding the outdoors on days when those pollens are high or if the day is especially windy may help.
Simple things such as using saline nose spray to rinse the nose after being outside may provide some relief, as well as frequent vacuuming and bathing the family pet frequently. Keeping the pets from going into the child’s room may also help. There are also special air conditioner filters and mattress covers for people with household allergies such as dust mites. When these things don’t help, children will often benefit from anti-histamines. There are many over the counter as well as prescription anti histamines available, some of which are non-sedating. One thing we do not recommend is the use of over the counter medicated nasal sprays. The medicine in these products will cause a “rebound” congestion once the patient using them tries to stop. This will make the patient feel worse than before starting the spray, therefore making the patient crave the relief that the spray initially gave him/her. This leads to an “addiction” to the sprays. Normal saline nose sprays are fine to use, as they contain only salt water similar to tears. If these measures fail to help, we can prescribe nasal steroids which relieve the inflammation directly in the nasal passages.
Please schedule an appointment with your child’s doctor if you wish
to discuss their allergy symptoms.