"My two-year-old is sneezing every morning. Do you think she’s allergic?"
I’m frequently asked questions like this, particularly during the warmer months of the year. Often, the parent has an older child already under my care for environmental or food allergy. Allergic symptoms can be difficult to detect in young children because they are often unable to communicate the presence of nose, throat or eye itching. Parents are forced to recognize external signs of allergic problems.
Signs of allergic nasal problems include:
- Repetitive sneezing
- Frequent nose rubbing or frowning
- Frequent sounds of sucking the throat
- Prolonged coughing
- Persistent runny nose, often clear mucus
- Watery eyes associated with darkening of the lower eyelids
- Daytime tiredness or easy fatigue
The follow-up questions is: “When should I bring my child in for allergy testing?”
Many parents are uncertain about when to seek allergy testing. My advice to them is to consider getting an allergy workup if their child:
- Seems to always have a cold
- Has colds that last for more than 2 weeks
- Has frequent ear or sinus infections
- Sneezes repetitively several times a day, or most days of the week
- Has unexplained fatigue in association with nasal symptoms
- Has frequent cough or any wheezing
- Eczema that has been difficult to control or keeps coming back.
- Has unexplained hives or swelling.
- Has stomach problems associated with meals
- Has a family history of allergy and the child has any of the above symptoms.
What age is best for allergy testing?
Allergy testing can be considered at any age, after a full evaluation. The most accepted means of testing are blood tests and skin tests. Any doctor can order an allergy blood test panel to look for environmental and/or food allergy triggers. Blood test analysis is often first considered by primary doctors when infants or toddlers show signs of allergy. Blood testing for allergic triggers can be done at any age. You have to wait for the results to come back, but children are spared the annoyance of multiple pricking of the skin (and the itching that follows when positive results are found).
Skin tests are best carried out by board-certified allergists. Allergy skin testing is considered in children over six months of age but the skin becomes testable after three months of age. Children under five usually have fewer environmental triggers, and therefore require less testing. Skin tests are a little more sensitive (more accurate) than blood tests. There are more available allergy extracts (compared to blood test) for skin testing. The advantage to skin testing is that you get your results right away, before leaving the office or clinic.
What are common allergy triggers in infants and toddlers?
Infants and toddlers may have respiratory problems (hay fever or asthma) associated with exposure to dust mites, pets, molds spores and, in some cases, cockroaches and mice. Indoor triggers are more of a problem in young children because outdoor exposure is often limited compared to older children and adults. Furthermore, the allergic immune response is often delayed a few years with respect to time from initial response to seasonal allergy triggers (pollen and outdoor mold spores). Of course, there are exceptions.
Food allergy triggers are prevalent in infants and toddlers with skin rashes (dermatitis) and stomach problems. We often look for allergic hypersensitivity to milk, egg, soybean, wheat, peanut, tree nuts, shellfish and fin fish. Milk is the main suspect in infants, since it is the anchor of their diet. Although food allergy has been on the rise in young children, hay fever and asthma are rarely triggered by food. More often, environmental triggers are the reason for recurring or chronic respiratory symptoms.
What are treatment options?
Avoidance of established triggers may greatly reduce the need for medication. This is why allergy testing is important. Environmental controls are based on the results of the allergy tests.
Medications for allergy treatment in young children are limited and approached with caution because of concerns about adverse effects. For environmental allergies, your doctor may recommend an over-the-counter antihistamine and/or prescription nasal steroid spray (if age two or older). Nasal saline drops or sprays are considered more appropriate for infants and toddlers. Treatment should always be under the guidance of your healthcare provider.
Allergy shots** **(immunotherapy) for hay fever or asthma are considered once a child has reached school age, if medications and environmental controls have failed.
For reason that are unclear, childhood allergies have increased over the last two decades. The good news is that the availability of information on allergen avoidance and medications has also grown. This site is loaded with articles that further address similar allergy topics. Browse through and read other postings to learn more about what you can do to improve your health or the health of your loved ones.
acaai.org/allergist/allergies/children-allergies/Pages/default.aspx - 63k - 2014-04-10
acaai.org/allergist/news/New/Pages/End_Your_Childs_Allergy_Suffering_Within_Three_Years.aspx - 57k - 2014-04-08