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Your child has had a runny nose and cough for several weeks now. You realize that this is her third or fourth cold this winter. In fact, she never really seems to get completely well in between the colds. You are growing weary of the constant nose wiping and doses of cold medicine during the night just so she, and you, can sleep. When will these colds end? Or could it be allergies? How do you tell? Here is some information to walk you through the confusing world of allergies and help you prevent and treat these bothersome symptoms.

One quick note before we embark on this extensive discussion. This section deals mainly with NASAL ALLERGIES – symptoms that involve the nose, eyes, throat, ears and chest. This section does not discuss food allergies or skin allergies. It also does not deal specifically with asthma, although it does apply to allergy prevention issues for asthma. You may click on each of these words for more information on these other topics.

• Nasal congestion
• Clear runny nose
• Itchy nose
• Crease across the top of the nose from constant wiping
• Excessive sneezing
• Itchy, watery, red eyes
• Dark circles under eyes
• Wheezing
• Persistent cough, often rattling
• Recurrent ear infections
• Recurrent colds
• Nighttime cough and nasal congestion

Two important things to note regarding these symptoms:

• While all of these symptoms can be signs of allergies, they can also be signs of the simple, common cold.
• Your child will often have two or more of these symptoms if allergies are present. For example, dark circles under the eyes without any nasal symptoms are probably not allergies.

Allergies occur when a foreign substance, called an ALLERGEN, enters your body via the nose, lungs, intestines or skin. Examples of common allergens include pet dander, dust, pollen, mold, and food. For many people, the story stops here. The foreign substance does not cause any reaction and instead is simply eliminated from your body. However, if you are allergic to the particular allergen, your body has white blood cells that will recognize and attack the allergen. These special white blood cells are called MAST CELLS, and they are concentrated in the lining of our nasal passages, lungs, skin, and intestines.

It would be great if the mast cell could just swallow the allergen and be done with it. Well, unfortunately the mast cell's job doesn't stop here. When the mast cell attacks the allergen, a substance called HISTAMINE is released from the mast cell. Histamine is a chemical that causes swelling and mucus secretion. Thus, we experience the allergy symptoms in our eyes, nose, throat or intestines. This is where the term ANTI-HISTAMINE comes from – an allergy medication that blocks the effects of the histamine. Minimizing exposure to allergens is the key to allergy prevention.

Before embarking on extensive and expensive tests and allergy prevention measures, go though this checklist:

• Does your child have many of the above 12 allergy symptoms?
• Wait and see if symptoms persist longer than three months - this is perhaps the single most important indicator of allergies. Virtually all children go through normal coughs and colds. Some children may have several back-to-back colds during winter that make it seem like they may have allergies. However, before you delve into an all-out effort to prevent your child's allergies, we suggest you allow at least two or even three months to pass. Mild allergies or a string of colds will usually work themselves out within this time period, thus making allergy interventions unnecessary. You may alleviate your child's symptoms with over-the-counter allergy medications during this time if necessary. One exception to this three-month rule is for young infants where formula allergy or an allergy to food in mom's breastmilk should be investigated after perhaps one month of symptoms.
• How much do the symptoms bother your child - because investigating and preventing allergies can often be very time-consuming and costly, we suggest you consider the following questions to determine if allergies are worth exploring:
  • Are the symptoms significantly interfering with sleep?
  • Do the symptoms significantly interfere with normal day-to-day activities?
  • Do the symptoms significantly decrease quality of life?
  • Do the symptoms slow your child down or interfere with sports or active play?

Decide how significantly the symptoms are interfering with your child's well being. If your child coughs several times during the night, but in general gets a good night's rest, you may want to leave well enough alone. If the runny or stuffy nose comes and goes and requires an occasional nose-blow, but does not bother your child or slow her down, you may just decide to wait and see if she outgrows it. Very mild, non-bothersome allergies don't have to be extensively treated.

• Continuous versus intermittent symptoms – allergies usually cause continuous daily, or nightly, symptoms, at least during certain seasons of the year. Your child will often experience symptoms five or more days a week for several months straight. Colds, on the other hand, will usually hit your child hard for a few days, and then slowly improve over the next week or two, followed by a period of complete wellness. If your child is experiencing two or more symptom-free weeks in between attacks, then it is more likely to be recurrent colds instead of allergies.
• Cold and flu season – children are much more likely to catch frequent colds during the late fall and winter months. If your child has been healthy all year, but seems to be sick all winter long, it may simply be the constant exposure to cold germs at school or childcare (although allergies could also play a role during wintertime). See if the symptoms continue into the spring, then consider allergies.
• Family history – studies have shown that if one parent suffers from nasal or skin allergies, your child has a 25% chance of having allergies as well. If both parents have allergies, your child may have up to a 75% chance. Therefore, if one or both parents have allergies, be more alert to the possibility of allergies. If you have lucky genes, and allergies are virtually non-existent in your family, you can be slower to worry about allergies.

The following are common situations that parents often feel are due to allergies, but may be due to other non-serious causes:

• "Doctor, my child had a bad cold with fevers 4 weeks ago, and STILL has a stuffy nose and a cough at night" – this is a very common occurrence after a bad cold. Kids can have leftover nasal symptoms and cough for 3 or 4 weeks after a cold. This is why we suggest waiting to see if symptoms persist for 2-3 months before you consider allergies.
• "Doctor, my child has dark circles under her eyes. Could she have allergies?" If there are no associated nasal symptoms, then dark circles alone are not due to allergies. Some children simply have dark circles under their eyes as part of their complexion.
• "Doctor, my child is having unusual temper tantrums and is waking up many times a night. I'm afraid he might have allergies" – Often times parents are quick to blame any unusual or unwanted behavior on allergies. While it is true that sensitivity to sugar or artificial additives in foods can contribute to unusual behavior, this isn't actually an allergy.
• "Doctor, my usually healthy child has had a runny nose and cough all winter long. Could this be allergies?" During cold and flu season it can often seem like our children are sick all winter long. Often times, however, if we look back, our kids do have several weeks of health in between illnesses. Frequent "colds" during the winter season are more likely to be caused by germs rather than allergies.
• "Doctor, my child has had 6 ear infections this year. Could this be due to allergies?" We know that nasal allergies can contribute to recurrent ear infections, but nasal symptoms are usually also present in this situation. If your child does not have chronic nasal congestion or runny nose, then the ear infections are probably not due to nasal allergies.

Now we're ready to really get down to business. The following 5 steps will help you determine what's causing the allergies and how to minimize exposure to the allergens.

STEP ONE – DETERMINE WHEN AND WHERE THE ALLERGY SYMPTOMS ARE OCCURING

• Nighttime and upon waking – if your child seems to be fine during the day, but has allergy symptoms during the night and wakes up with severe symptoms in the morning, then you can suspect that your child is allergic to something in the bedroom. The most common bedroom allergens are dust, mold and bedding. See below for prevention of dust, mold and other bedroom allergies.
• Seasonal allergies – if your child seems well all year, but suddenly develops allergy symptoms during a particular season (usually spring), or seems to have symptoms only on windy days, then your child probably has allergies to particular pollens or plants that are prevalent during that season. These can cause symptoms during the day or night or both. See below for prevention of seasonal allergies.
• School allergies – if your child only experiences symptoms at school or daycare, but is generally well at home and during the night, then the allergen is probably something at school. See below for school allergy prevention.
• Year-round allergies – if your child has allergies all year long, then the culprits could be any of the above as well as other common causes such as pets, smoking, foods, or dairy products.
• Friend's or relative's house – if you notice that your child only has symptoms at other people's house but not at school or your house, then he may be allergic to something unique to that house such as smoking, pets, plants or grass. The simple solution to this is either to not go there or give an antihistamine before going over.

STEP TWO – UNDERSTANDING THE DIFFERENT ALLERGENS AND WHERE THEY CAN BE FOUND

After tracking down the most likely suspected allergens in step one you hopefully have an idea what your child may be allergic too and where the allergens are found. Now you need to understand more about those specific allergens. Step three will teach you how to prevent exposure to these allergens.

• Pollens – these are tiny, dust-like, yellow seeds that are found in the middle of flowers. Wind picks up pollen and it floats around in the air, sticking to anything it touches such as hair, clothes, and inside your child's nose and lungs. Local weather organizations measure the concentration of pollens in the air on a daily basis, known as the pollen count. Daily pollen counts are available in newspapers and on-line. You can click here to go to the National Allergy Bureau (AAAAI) website for pollen counts.
• Dust – dust itself does not cause allergies. It is actually dust mites, microscopic organisms that live in dust, that cause the allergies. The dust mites excrete tiny pieces of feces that float around in the air just like pollen. It is the feces of the dust mites that get inhaled and cause the allergy symptoms. Dust mites live wherever you find dust, and they thrive especially in warm, humid environments.
• Mold – this is another source of allergies that can be found throughout the house. Molds thrive in dark, cool, damp places. Molds release spores into the air, which are then inhaled and can cause allergies.
• CIGARETTE SMOKE – exposure to second-hand smoke is one of the most ignored and preventable causes of allergy symptoms and asthma. The best way to prevent this is to stop smoking altogether. When this is not an option for the smoking family member, here are some precautions you can take:
  Back to top
  • Never, ever, ever, never, ever smoke around the child. This includes inside the house, in the car, and outside near the child.
  • Never smoke alone in the house or car – even when the child isn't home, the smoke can linger for hours to days, and the child will constantly be inhaling the residual smoke that can permeate the whole house when he is home. Smokers can't smell the residual smoke because they are used to it. But just ask any of your non-smoking friends – they will usually tell you your house has a very strong smoke odor.
  • Smoke outside away from any open windows so the smoke doesn't blow into the house.
  • Smoke where it is windy so that the smoke will cling less to your clothes and hair, which also can irritate your child.
  • If breastfeeding an infant, have a "smoking long-sleeved shirt" which you put on while smoking, then take off again so the smoke doesn't linger on your clothes.
  • Relatives – when smoking relatives come to visit, remember, this is YOUR house. You make the rules. Tell them to smoke outside.

    For an in depth discussion of the harmful effects of smoking around children click on smoking

• Pets – it is not actually the pet hair that causes allergies, it is the pet dander – tiny flakes of skin mixed with saliva that shed off animals and float around in the air. Cats, dogs, and birds all shed dander, even shorthaired pets. The urine of rodents can also be allergenic. Reptiles and fish don't shed dander.
• Grass – some children will be allergic to a specific type of grass. This is often caused by direct contact or playing around the freshly mowed grass.
• Cosmetics – perfume, hairspray, makeup powder, baby powder, and strong-smelling deodorants can be irritating to a baby and child. Avoid these.
• Dairy products – this is another easily identifiable and preventable cause of allergies. Two common situations often occur:
  • Your 15-month-old, who has never really been sick, has had nasal symptoms and coughing for the past few months. You can't think of any new foods she is eating that may be causing allergies. Yet, your infant recently began drinking cow's milk. Allergy to dairy products may be the culprit.
  • Your 5-year-old has had mild allergies all his life, and you've never really made any effort to investigate them. When asked if he likes milk, you answer, "Yes, he loves milk! He drinks a ton of it every day!" This may include yogurt and cheese as well. Click on milk allergies for more information.

    If you think this may be the cause of your child's allergies, try taking her off all dairy products for 2 to 4 weeks. Substitute with soymilk if you need to, although children can go without any milk-type product for a few weeks without compromising their health. Some kids may also be allergic to soy.

• Formula allergy – if you notice your infant developing allergy symptoms, and she is on formula, consider changing to another type.
  • If using a cow's milk formula, change to soy.
  • If using a soy formula, change to cow's milk formula.
  • Allow two weeks for symptoms to improve.
  • If this doesn't work, try changing to Carnation good start or a more specialized hypoallergenic formula such as Nutramigen, Allimentum, or Pregestimil. Click on here for more information on formula.

STEP THREE – PREVENTING EXPOSURE TO SPECIFIC ALLERGENS AND ALLERGY- PROOFING YOUR HOME

In steps one and two; hopefully you have narrowed down the cause of your child's allergies. Step three will help you focus on certain areas of your child's daily life to minimize the exposure to the suspected allergens.

Allergy prevention is a very tough job. As you study the following material, consider just how troublesome your child's symptoms are. For mild allergy symptoms that don't interfere with daily life, most of these preventative steps are not reasonable. If your child has year-round allergies that occur night and day, wherever he is, then you have a tougher job ahead of you. You may choose to consult with an allergist for skin testing that will help you determine specifically what your child is allergic to so that you can focus your attention on preventing those allergies. Try the following preventions in hopes of finding the allergens that affect your child.

• SEASONAL ALLERGIES AND POLLENS – if you suspect that your child has seasonal allergies due to pollens, here are the steps you can take to minimize the exposure:
  • Stay indoors on windy days of the pollen season and when the pollen counts are high.
  • Don't allow your child to play in fields with flowers and tall grass.
  • Keep all the windows and doors closed during your child's specific allergy season. This keeps the pollen out.
  • Wash hats and jackets more frequently during pollen season.
  • Give your child a bath and wash hair before bedtime to get the pollen out.
  • Don't hang-dry your child's laundry outside as it can pick up pollen.
  • Install a special filter into your central heating and cooling system that cleans the air as it comes in from outside. You can buy these from a hardware store.
  • Buy a portable HEPA filter – High Efficiency Particulate Accumulator filters can remove dust mite droppings, pollens, molds, spores, animal dander and many other irritants. They cost $100 – $200. Place it in the main living area of the house during the night to clean the air while you sleep. Then run it in the bedroom during the afternoon so the air will be clean while you sleep.
  • Pollen counts are usually highest during late morning and early afternoon. Limit outside playtime to early morning, late afternoon and evenings during allergy season.
  • Put window air conditioning units on recirculate to keep out the outside air.
  • Keep trees and bushes near the house well pruned to avoid heavy vegetation.

• DUST MITES – if you suspect your child may be allergic to dust mites, here are a number of steps you can take in the bedroom to minimize the exposure.

  Warning – eliminating sources of dust in your child's environment can be very costly and time consuming. The following steps are divided into several different categories based on convenience and cost. We suggest you start with the easiest and least expensive measures and then proceed to the more costly and difficult items.

  LEAST EXPENSIVE AND MOST CONVENIENT

  • Take all of the following dust-attracting items out of the bedroom:
  • Stuffed animals – you can wrap one or two favorites in a bag and place them overnight in a freezer once or twice a week to kill the dust mites
  • Books on bookshelves
  • Piles of clothes
  • Down comforters or feather pillows – pillows filled with synthetic stuffing collect much less dust
  • Upholstered furniture – plastic, wood, metal or vinyl furnishings don't collect dust
  • Stacks of boxes
  • Items stored under the bed
  • Wool blankets – synthetic or cotton blankets are less dusty
  • Heavy drapes and horizontal blinds – roll up or fold up shades or vertical blinds are preferable
  • Electric fans – these really collect dust
  • Large house plants
  • Wash blankets, sheets and pillowcases in hot water (at least 130 degrees) once a week to kill the mites. Use synthetic pillows that can be washed monthly and replaced yearly.
  • Place cheesecloth over vents in the bedroom (and throughout the house if able) to catch dust. Change the cloth every few months when using the central air or heating. You'll be surprised at how dirty it gets. Best is to keep the vents closed altogether and sealed with heavy gauge plastic.
  • Keep the bedroom closet doors closed and avoid storing toys, boxes, luggage or heavy coats in bedroom closets.
  • Damp dust when cleaning – don't forget lampshades, picture frames on the wall, the tops of tall dressers or wardrobes.
  • Vacuum the mattress every two weeks.

  MORE EXPENSIVE BUT STILL CONVENIENT

  • HEPA filter as discussed above under pollen control.
  • Encase mattresses, box springs, and pillow with dust mite-proof zippered covers. Seal the zippers with tape. This will keep the dust mites locked in.
  • Buy a special filter for your central air system that will trap dust and other allergens in the air ducts.
  • Use a vacuum cleaner with a HEPA or other specialized filtering system that will prevent dust and other particles from spreading around the room.

  MOST EXPENSIVE AND/OR LEAST CONVENIENT

  • Remove carpeting from the bedroom, and possibly the rest of the house. Hardwood, tile, and linoleum can be kept virtually dust-free. Use throw rugs that can be washed frequently.
  • Lower pile commercial carpeting can be used if needed. It is less likely to trap dust mites.
  • Humidity control – place a humidity gauge in the bedroom and in other rooms as needed. Molds and dust mites thrive in high humidity. Maintaining a humidity level of 25 – 40% is ideal. During hot, dry weather, run the air conditioner or humidifier, but be sure it doesn't get too humid. During humid weather, run a dehumidifier. Warning – humidifiers (cool mist) and vaporizers (hot mist) can harbor molds if not properly maintained. You can purchase a humidifier with a special filter to prevent mold and contaminants from the water from being blown into the air. They should also be cleaned at least weekly using the manufacturers recommended solution or approximately 3% bleach and water solution.
  • Clean out the central air ducts – this costs several hundred to over a thousand dollars to have done professionally. Do it at least every few years if not sooner.
• PET DANDER – if you suspect the family dog or cat is the source of your child's misery, little Rover or Fluffy don't necessarily have to leave home for good. There are a number of steps you can take to minimize pet dander around the house.
  • Possible allergenic pets include:
    • Dogs
    • Cats
    • Birds
    • Rodents
  • Before buying a pet, take a test drive for a few days while letting child and pet play frequently together. Emphasize that you are only "babysitting" the pet so your child isn't too sad if allergies begin and the pet has to go.
  • If you are unsuccessful at finding a non-allergenic pet, consider fish or reptiles. They're not as cuddly, but your child's nose will thank you.
  • If you already have a pet and you suspect your child is allergic, try either keeping the pet outside for a week or quarantined in a room in the corner of the house. Clean the whole house and observe your child. If allergies improve, test it by letting pet and child play together for several hours a day. If allergy symptoms start again, continue the quarantine for another week or so. If child gets better again, then your child is probably allergic. If you don't see any correlation, then it may not be a pet problem.
  • If you conclude your child is allergic to the pet, you can either keep the pet outside for good or find it a new home. If you absolutely must keep your pet inside, here are some suggestions to minimize your child's exposure:
    • Give the house a thorough cleaning to remove existing pet dander.
    • Keep the pet out of your child's bedroom at all times.
    • Keep the pet in one room as much as possible and keep this room well ventilated to the outside.
    • Keep the house well ventilated. Open the windows as much as possible and recirculate the air.
    • Use a HEPA filter as described above under pollen control.
    • Wash your pet frequently to minimize dander shedding.
    • Use a vacuum with a special filter to trap allergens.
    • Allergy control solutions can be purchased and sprayed onto the carpet to inactivate accumulated dander.
• MOLDS – Like dust mites, molds often cause allergy symptoms in the bedroom, as well as throughout the house. Molds thrive in dark, cool, camp places such as:
  • Cellars
  • Closets
  • Attics
  • Piles of damp clothing or towels
  • Old mattresses
  • Pillow and blankets
  • Damp carpet, especially the padding underneath
  • Water damaged wallpaper
  • Window frames
  • Garbage cans
  • Shower curtains
  • Shower stalls
  • Bathroom tiles
  • Houseplants
  • Humidifiers
  • Outdoor sites include piles of wet grass, leaves, or wood

  An environmental testing company can test your house to see if mold is a problem. In some cases, the mold is too extensive to clean up, and you may need to move. Usually, however, the company can assist you in cleaning up the mold enough to decrease your family's exposure.

  Here are some tips on how to limit your child's exposure to molds in the home.

  THROUGHOUT THE HOUSE

  • Clean the above-mentioned areas routinely with a mold-killing disinfectant such as a 10% bleach solution.
  • Regularly inspect the above-mentioned areas around the house for signs of mold growth.
  • Humidity control – hang a humidity gauge in the bedroom and elsewhere as needed. Try to keep the humidity between 25 – 40%. Run a dehumidifier if needed during humid seasons. Run the air conditioning or use a humidifier periodically if needed during hot, dry weather. Humidifiers and dehumidifiers should be emptied of water frequently. Mold-killing sprays can be sprayed into air conditioning intake vents if you detect a musty odor. See humidity control above under dust prevention.
  • Ventilate the house by opening all the windows several times a week.
  • Install filters in the central air and over vents in the house as discussed under dust control.

    Dr. Sears's advice: To remove the days pollen, wash your child's hair before going to bed.

  IN THE BEDROOM

  • Take the same precautions with mattresses and pillows as discussed under dust control above. Foam rubber pillows and mattresses are more likely to collect mold.
  • Humidity control as discussed above.
  • Keep a nightlight on in closets. This can decrease mold growth.
  • Regularly clean window frames with mold-killing solution.
  • Use a HEPA filter.
  • Wash wallpaper frequently with mold-killing solution if using a humidifier or vaporizer.
  • Replace damp carpeting.

  IN THE KITCHEN

  • Regularly clean the bottom of the refrigerator as well as around the rubber door gaskets.
  • Wash garbage cans frequently with bleach.
  • Run the exhaust fan when boiling water.

  IN THE BATHROOM

  • Run the vent fan in the bathroom during showers to prevent mold growth from the humidity.
  • Clean shower, bathroom tiles and toilets regularly with mold-killing solution.
  • Clean shower curtain regularly and replace periodically.
  • Regularly wash wallpaper and replace if water-damaged.

  OUTSIDE

  • Remove damp piles of debris from the yard.
  • Keep windows that are near moldy shrubbery closed.
  • Prune shrubbery and trees regularly to avoid shading the house too much. Sunlight helps kill mold.
  • Correct drainage problems. Pools of stagnant water or grass grow mold.

  ALLERGIES AT SCHOOL
  If your child only seems to have symptoms at school, here are several items to consider as possible sources:

  • Pets in the classroom – often there is a class gerbil, rabbit, or other rodent. You can test this by asking the teacher to let someone take the pet home for two weeks and see if your child improves.
  • Dust mites and mold – the classroom can contain all the same sources of dust and mold as your house. Talk to the school principle about how to correct any possible sources.
  • Plants and grass – there may be specific grass or pollens present only at school. This would be difficult to prevent exposure to.
  • Cockroaches in lockers or other areas – children can be allergic to the feces of these insects.

If you can't eliminate these sources you may need to treat your child with medication during flare-ups.

STEP FOUR – CONSULTING YOUR PEDIATRICIAN

After reading step 3, you're probably ready to just forget the whole thing and let your child suffer. Don't despair! Try some of the more simple suggestions and observe your child for improvement. If you don't see any significant improvement, then it's probably time to discuss the allergies with your pediatrician.

What can your pediatrician offer you? Although your child's doctor may not be able to offer any additional advice on allergy prevention and control, he or she may be able to help you narrow down what could be causing the allergies so that you can focus your prevention on specific areas. The pediatrician can also make recommendations on treating the allergies with medication and discuss the various forms of over-the-counter and prescription allergy medication.

STEP FIVE – CONSULTING AN ALLERGIST

Do you need to see a pediatric allergist specifically, or is a general allergist adequate? Pediatric allergists are often much more difficult to find these days, since most allergists need to practice with both adults and children. A general allergist is excellent for most allergy cases. If your child has very severe allergies, or an allergist is considering allergy shot therapy, we suggest you consult a pediatric allergist.

There are several services that an allergist can offer you that your pediatrician might not be able to:

• Time – an allergist often has more time to sit down with you and discuss your child's allergies. The allergist may be able to pinpoint the most likely allergens that are affecting your child specifically so you can focus your prevention more precisely. The doctor can also spend more time educating you on allergy prevention.
• Skin testing – an allergist's office can perform skin testing on your child to help identify specific allergens. A tiny needle is used to introduce a substance such as dairy protein or pet dander into the skin. The allergist can either do a small number of these at a time to test suspected allergens, or 30 to 40 different allergens (and skin pricks) at one visit to get a more complete allergy profile. A bump will form in the skin for each test that is positive.

  Note – your child should be off of any allergy medications taken by mouth for several weeks prior to testing. These can interfere with the test.

  Advantages of skin testing:

  • If your child tests positive to several things, you can more accurately focus your prevention efforts at home.
  • It can also help you identify any hidden food allergies.
  • Very useful for older, more corporative children.
  • For severely allergic children who have not improved with a variety of home preventative measures, skin testing can be very useful.
  • It is more accurate than the blood testing mentioned below.

  Disadvantages of skin testing:

  • For the items that your child shows no reaction to, this doesn't guarantee he isn't allergic to that item. A child can show no reaction, for example, to milk, but may still be severely allergic to it. The younger the child is, the more likely he will show no reaction on skin testing. Skin testing is more accurate for children over 5 years old.
  • It can hurt a little, and is very difficult to do on uncooperative children.

• Blood testing – A blood test, called a RAST test, gives similar information to skin testing, although it is not as accurate as skin testing. Antibody levels to a variety of allergens can be measured. This can be very helpful if several items come back showing high antibody levels. However, RAST testing has the same disadvantage as skin testing – a normal test can be present and your child could still be allergic to that substance. This is truer for younger children. RAST testing costs several hundred dollars or more, and is often not covered by insurance. It is useful for severely allergic children who are too young for skin testing. Your pediatrician or allergist can order this test for your child.
• Up to date treatments – an allergist is often more educated in the latest medications to alleviate allergy symptoms. He or she may also be more adept at using combinations of medications when needed.
• Allergy shots – this is a long term, time-consuming and expensive treatment plan that involves several shots each week for the first few weeks, then slows down to one shot a week, then once or twice a month for a year or more. The whole process can take almost a year sometimes. The shots slowly make your child less sensitive to his specific allergens. This is a very aggressive, but sometimes necessary, treatment.

Dr. Sears advises: a daily "nose hose" and "steam clean" is a must for clearing stuffy nasal passages.

• A "nose hose" and "steam clean" – flushing the nose two or three times a day with nasal saline spray and gently blow the nose. Facial steamers are a good alternative to the spray. Steam your child's nose and gently blow for ten minutes twice a day. Nasal washing clears the allergens out of the nose and relieves congestion. If using a medicated nasal spray as discussed below, be sure to do nasal washing prior to using the medication. This increases the effectiveness of the medicine. (For detailed instructions click on Nose Hose and Steam Clean)
• Medications – allergy medications can be useful for temporarily relieving symptoms during flare-ups or for continuous use during allergy season. Your child may need an allergy medication every night for a week or two. Or, your child may need a medication every morning for two or three months only during allergy season. These are common situations where allergy medications can be used safely and effectively. We do not recommend they be used continuously for several months or more without the supervision of a doctor.
• Antihistamines – these work by blocking the action of histamine as described in the beginning of this discussion. They treat the itchy, sneezy, runny nose, itchy watery eyes, and itchy throat. They can also help with nasal congestion. Antihistamines are available in liquid, chewables, and pills.
  • Over-the-counter antihistamines – common brands include Benadryl, Dimetapp, and Chlortrimeton. Try several different brands to see which one works best for your child. They are generally safe for children 6 months and older. They last 6 – 12 hours.
  • Prescription antihistamines – common brands include Claritin, Zyrtec, and Allegra. Some of these are now approved for children as young as two years old. These prescription medications generally last 24 hours. We suggest you try over-the-counter medications first and then talk to your doctor about these prescription medicines if needed.
  • Side effects – include headache, dry mouth, drowsiness, and upset stomach. A few children can act hyperactive from these medications. In general, the new prescription medications (also known as "non-sedating" antihistamines) seem to have fewer side effects than the over-the-counter ones, but this varies from person to person. If drowsiness is the only side effect, try taking it only before bed. Often the drowsy effect wears off by morning, but the antihistamine action can last 24 hours.

• Decongestants – while these drugs do nothing to fight the histamine effects of allergies, they can improve nasal congestion associated with allergies. They are especially helpful in conjunction with an antihistamine when the major allergy symptom is nasal congestion. Decongestants come as a separate medication or in combination with an antihistamine. Over-the-counter decongestants are virtually the same as prescription ones. Side effects are rare but include jitteriness and hyperactivity.
• Combination antihistamine/decongestants – the above prescription antihistamines also come combined with a decongestant. You can also purchase over-the-counter combinations as well.
• Nasal sprays – These are sprayed directly into the nose and help prevent the immune cells in the nasal lining from reacting with the allergens. Because they usually take one or two weeks to start working, they shouldn't be used only one day here and there as this isn't effective. Three types of nasal sprays are:
  • Antihistamine nasal spray – there is only one on the market right now, available only by prescription, called Astelin. In 2000, it became approved for use in children as young as 5 years. It works well, and has the benefit of acting directly in the nose, compared to oral antihistamines. It can be used safely for many months at a time with very few side effects.
  • Steroid nasal sprays – the word "steroid" commonly makes a parent shudder at the thought of giving it to their child. But these steroids are different than the "body building" ones taken by weightlifters. This steroid also stays in the nasal lining. Very little of it is absorbed into the body. They are currently approved for children as young as four years, but this age gets younger every year. Available only by prescription, they come either as wet sprays or dry aerosols. If your child hates one kind, switch to the other. Some common brand names include Flonase and Beconase.
    • Side effects – include nasal irritation and dryness, nosebleeds, sore throat, cough, and headache.
    • An additional side effect has been noted over the past few years. Very rarely some children have been found to slow their rate of growth while taking steroid nasal sprays. Generally their growth speeds up again when taken off the medication. Studies have shown that the steroid has no effect on eventual adult height. While this side effect is very rare, it needs to be considered when deciding to use a steroid nasal spray. For moderate to severe allergies that don't improve with other measures, using a steroid nasal spray probably is worth this tiny risk.

  • Cromolyn nasal spray – this acts like antihistamine spray. They are less effective than nasal steroids and Astelin, yet unlike steroids, they can be used daily for many months without harm. Side effects are transient stinging and sneezing.
  • Decongestant nasal spray – this isn't actually an allergy spray. It is very effective at temporarily relieving severe nasal congestion, but does not prevent allergy symptoms. It is available over-the-counter as neo-synephrine. Warning – do not use more than 3 days at a time or your nose may become dependent on it to stay clear, or a "rebound" effect may occur whereby the nasal membranes become more swollen.

Allergy prevention is usually the best long-term treatment for allergies. But when the above preventative measures aren't enough, or if your child's allergies are only occasional and not worth tearing the house apart trying to prevent them, then allergy medications can be a great benefit.

There are essentially two different ways to use allergy medications – preventative treatment and as-needed treatment.

• Preventative medications are used even when your child is well in order to prevent flare-ups.
• As needed medications are used only when your child is having symptoms.

Deciding which medications to use and when to use them can be confusing. The following are several different allergy scenarios. Decide which one fits you child best, and consider following that suggestion. Of course, be sure to do the nasal washings twice a day.

• Occasional symptoms – your child is generally well most days out of the month, but seems to have 3 or 4 random days where her allergies flare up. Try an over-the-counter antihistamine that works with minimal side effects. Have this handy to use only on those few days when it is really needed. If several different over-the-counter medications haven't worked well for your child, ask your doctor for a prescription antihistamine.
• Symptoms lasting several weeks, but only every few months – your child seems well most of the year, but has flare-ups every few months that last for several weeks. This generally doesn't warrant any preventative medications. What works well is when you notice one of these long flare-ups starting; give your child a daily dose of an antihistamine that works well for her. After 2 or 3 weeks when you see the symptoms subsiding, take her off the medication.
• Seasonal symptoms only – your child is well all year around, except for every spring (or other season) it hits – three long months of allergy symptoms that affect her almost every day. This is the time to use daily preventative therapy. You have three options:
  • Daily antihistamine
  • Daily nasal spray with an antihistamine as needed on worse days
  • Both antihistamine and nasal spray daily

  We suggest trying the first two options. If the symptoms don't subside after two weeks, then try the third option. Remember, it often takes the nasal spray one or two weeks to start working. Use the antihistamine as well until the nasal spray kicks in, then try coming off of the antihistamine.

• Persistent symptoms that never end – if this describes your child, and you've tried many of the allergy prevention steps but they don't seem to work, your child may need daily preventative therapy. Try the options as discussed immediately above under seasonal symptoms. Once you've found a combination that effectively alleviates your child's symptoms, leave her on this regimen for 2 or 3 months. Then try to wean her off the medications. You may find she stays well for some time afterwards.

Using the information in this discussion, you can follow these five general steps in evaluating and treating your child's allergies.

1. Decide if your child really has allergies and if so, whether or not they are interfering with his life enough to warrant evaluation and treatment.

2. Identify what the probable allergens are that may be causing the allergies.

3. Using the above prevention guidelines, take some simple, convenient measures to try to eliminate the possible allergens (such as allergy- proofing the bedroom, eliminate suspected foods, buy an air filter). Observe your child for two weeks to watch for improvement.

4. If no improvement within two weeks, try some additional preventative measures as discussed above. Begin doing nasal washes twice a day. Before you try any of the more drastic preventative measures, we suggest you talk to your pediatrician about blood RAST testing or see an allergist for skin testing to help you identify specific allergens.

5. It is best not to use any allergy medication during this time because if your child's symptoms improve, you won't know it this is due to medications or your preventative measures. However, if your child is experiencing moderate to severe symptoms that are dramatically interfering with his life, you can give him an antihistamine for some relief.

6. If you still don't see any improvement after several more weeks, you have two choices:

• Get the blood tests done or consult with an allergist for skin testing.
• Try just treating the symptoms with your pediatrician's help for 1 to 3 months, then come off the medication. The allergies may not come back.

If the symptoms do come back, or they persist despite medication, then consult an allergist if you have not yet done so for skin testing or try the blood tests with your pediatrician.

For related topics see: Asthma, Food Allergies, Milk Allergies