What Goes Around?

Most Common Springtime Illnesses

Spring is here, and so are allergies. In fact, the only things that "go around" this time of year are allergies and allergy-related problems. Here is a guide to understanding springtime allergic conditions, how to recognize them, how to treat them with over-the-counter medicines, how to prevent them, and when to seek the advice of your doctor.

The reason for the spike in allergy flare ups in spring is because all the trees and plants are blooming, and pollen from the flowers get carried by the wind, and end up in our nose, eyes, and lungs. Immune cells in these body tissues react to the pollen and release histamine, a chemical that causes fluids to leak out of our bloodstream and into the tissues. In the nose, this results in swelling and mucus production. In the eyes, this causes redness and tearing. In the lungs, this triggers swelling, wheezing, and mucus production. Histamine is also responsible for the itching that occurs in the eyes, nose and throat.

NASAL ALLERGIES
This is the most common manifestation of allergies. Typical symptoms include:

• Nasal congestion
• Clear runny nose
• Itchy nose
• Itchy throat and post-nasal drip
• Crease across the top of the nose from constant wiping
• Excessive sneezing
• Dark circles under eyes
• Persistent cough, often rattling

How do you tell if your child has allergies or just a simple cold?

You notice that your child's nose has been running for a few days. He begins sneezing, develops an occasional cough, and has to blow his nose frequently. You ask yourself, "Could this be allergies? Or is it just a common cold virus?"

Many parents bring their children to the doctor with this very question. In reality, during the early stages of these symptoms, it doesn't really matter if this is an allergy or a cold. Neither condition needs an antibiotic and the child doesn't need to be in the office. See below for how to approach treating allergies.

Now, if you really want to know whether your child is suffering from allergies or just a cold, you are going to have to wait and see if symptoms persist longer than one to 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 intervention 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 breast milk should be investigated after perhaps one month of symptoms.

How do you treat allergies?

Step one - no treatment at all.
If your child's symptoms are mild, and do not seem to interfere with his life very much, then you really do not need to give any medication at all.

Step two - nasal saline spray.
If the symptoms are mildly troubling, simply squirt this into your child's nose several times a day to flush out the allergens, and blow the nose periodically.

Step three - non-prescription nasal decongestant and/or antihistamine medications.
If the symptoms bother your child enough and are interfering with his daily life, and the saline spray doesn't seem to be enough, then you can try the following medications:

• Over-the-counter antihistamines - these work by blocking the action of histamine like I mentioned earlier. 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. Common brands include Benadryl(tm), Dimetapp (tm), and Chlortrimeton (tm). 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.

   

• Decongestants - drug name is pseudoephedrine. 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 over-the-counter antihistamines also come combined with a decongestant.

   

• Cromolyn nasal spray - this acts like an antihistamine directly in the nose. Side effects are transient stinging and sneezing. It is over-the-counter (Nasochrom [tm]).

   

Because nasal sprays 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.

• 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.

   

Step four - prescription medications.

• Prescription antihistamines - common brands include Claritin (tm), Zyrtec (tm), and Allegra (tm). Some of these are now approved for children as young as two years old. These prescription medications generally last 12 - 24 hours. We suggest you try over-the-counter medications first, 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.

   

• Antihistamine nasal spray - there is only one on the market right now, available only by prescription, called Astelin (tm). 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.

   

  Remember, nasal sprays 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.

   

• 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 two 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.

  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.

For a complete discussion on allergy and cold medications, click here to check out our medicine cabinet.

How can I prevent my child's allergies in the first place?

Some parents may be reluctant to use medication for a problem that they may be able to prevent from even occurring. Prevention is important, but don't knock yourself out trying to track down your child's allergies unless they truly are persistent and bothersome. Usually a few weeks of treatment is preferable to the painstaking task of allergy prevention.

If, on the other hand, you do wish to jump headfirst into the world of allergy prevention, here is how to do it.

The most common sources of allergies in children (and adults) are:

• Foods
• Pets
• Pollens
• Dust
• Mold
• Environmental irritants (cigarette smoke, perfumes, aerosols)

Now because this is springtime, we are not going to go into details on all the above allergens. Instead, we will focus on springtime seasonal allergies. To read our complete guide to allergies, click here.

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 during the pollen season and when the pollen counts are high. Local weather websites usually have pollen count information.

   

• 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.

   

• Keep car windows rolled up while driving.

   

ALLERGIC CONJUNCTIVITIS (red eyes)
Many children come through our office with red, irritated, itchy eyes because they have been kicked out of school because the school nurse is worried about "pink eye" spreading through the school.

Realize that at this time of year, most cases of "pink eye" are actually due to allergies, not infections, and are therefore not contagious.

How do I tell if it's allergies or infection?

• Bacteria - when the eyes are red with yellow or green drainage oozing or crusting in the eye throughout the day and night, then bacteria are usually the culprit. The eyelids may also be swollen. Affects one or both eyes.

   

• Virus - when the eyes are very red, but there is no drainage, or only a small amount of drainage or crusting upon waking up, then it is probably viral conjunctivitis. Usually affects both eyes.

   

• Allergy - allergic conjunctivitis is usually seasonal, mostly in the spring. The eyes are usually red with increased tears, perhaps a small amount of white drainage, and unusually itchy. Usually affects both eyes.

   

• Foreign body - a piece of sand or dirt stuck under the eyelid can cause redness, tearing, pain and drainage. Usually affects one eye.

   

How do I treat allergic conjunctivitis?

• Cool compress - hold a cool, wet washcloth against the eye and gently wipe away any drainage.

   

• Saline eye drops - or artificial tears can sooth the eye, whatever the cause. These can also be used to flush out any pollen that accumulates in the eye.

   

• Medication

   

  • Allergy eye drops - there are several prescription drops that can help alleviate eye allergies. There is also an over-the-counter antihistamine eye drop called Naphcon A (tm) that can help.

     

  • Visine (tm) - can help with eye allergies or red, irritated eyes.

     

Do I need to see the doctor for this?

If the symptoms are mild and controlled with the above treatments, then you may not need to see your doctor. If the symptoms are severe, or not improving with these treatments, then see your doctor.

For a complete discussion on all causes of "pink eye" or conjunctivitis, click here.

SINUS INFECTIONS
Although winter is usually considered more of a sinus infection season, many people with nasal allergies experience worsened sinus symptoms during the spring. Some may have a difficult time distinguishing an allergy flare-up from a true sinus infection. Here is how:

Symptoms of a sinus infection:

• Sinus infection - this occurs when the bacteria in the nose build up enough to take over and cause an infection. It usually takes around 10 days of sinus allergy symptoms in order for bacteria to build up enough for a sinus infection to occur. Sinus infections rarely just occur out of the blue. Signs of a sinus infection include:

   

  • Green nasal discharge for more than 10 days. Any green drainage before this may just due to the cold virus or allergies.

     

  • Sinus headaches - pain or severe pressure behind and around the eyes, forehead, and upper cheeks can be a sign of sinus infection. Remember, it is normal to have some headache at the beginning of a cold or with allergies, or during the worst part of a cold.

     

  • Tooth pain - pain in the upper teeth or gums can indicate a sinus infection, since the sinuses are right above this area.

     

  • Green discharge from the eyes - eye drainage accompanied with all these other symptoms can mean sinus infection.

     

  • Cough - the thick mucus produced during a sinus infection will drip down into the upper chest, thus causing a cough. A cough will almost always be present during a sinus infection. If your child does not have a cough, then it is less likely to be sinus infection.

     

  • Fever - infants and young children will usually have a fever during a sinus infection. Children older than 6 and adults may not have fever. Remember, fever can be normal for up to five days during a cold.

     

  • Fatigue - older children and adults will usually feel very worn out during a sinus infection. This fatigue can be part of a normal cold as well, but if it persists or is extreme, it could be the sinuses.

     

  • If your child has the first symptom above (green nose for more than 10 days), plus three or more of the remaining five symptoms, than it may be a sinus infection. Consult your doctor. If, on the other hand, you only have one or two symptoms, especially if there is no green discharge from the nose, then an infection is less likely.

     

• Nasal allergies - symptoms include nasal congestion, clear runny nose, mild sinus headache, itchy nose, mild cough, and sneezing. In simple allergies, there is no fever and no severe junky cough. If there is fatigue, it is usually mild. If there is green nasal drainage, it is usually intermittent and mild.

   

How do I know when I need antibiotics for a sinus infection?

Your doctor will help you decide this. New guidelines have been developed by the Centers for Disease Control and the American Academy of Pediatrics regarding antibiotic use for sinus infections. It is now recommended to consider NOT using antibiotics for mild sinus infections, or even for early moderate sinus infections. It has been found that these infections often subside on their own with appropriate non-antibiotic therapies (such as frequent nose blowing, nasal saline flushes, decongestants, and steam baths). If an infection persists, or becomes severe, then an antibiotic may be warranted.

For a complete discussion on colds, coughs and sinus infections, click here.

ALLERGIC ASTHMA
While winter is when asthma sufferers may experience asthma attacks during colds or flus, those whose asthma has more of an allergic trigger may suffer flare-ups during the spring allergy season. If your child begins to experience more frequent chest tightness, wheezing, nighttime coughing, or decreased exercise tolerance during these months, you should talk to your doctor about using a preventative inhaler and/or allergy medication to make this season easier. Remember, such medications can be stopped, with your doctor's advice, come summertime, if your child is doing well.

If spring is an allergic season for your kids, help minimize their exposure to pollens by following the recommendations for seasonal nasal allergy prevention I talked about above.