Environmental Allergies and Children

Allergies can affect anyone, including children, which can become a problem at home and school. We asked Dr. James Thompson, a board-certified asthma and allergy specialist in Chicago, to share his recommendations on how best to minimize and control environmental allergies in kids.

Q: What are the most common environmental allergens for kids?** A:** Generally, it depends on the age of the child. If we’re talking about infants and toddlers, there are a smaller number of allergy triggers. When you’re talking about older children, school-age and above, then it pretty much mimics adults. So for children ages one to five, the most common allergens are dust mites, pets, indoor and outdoor mold spores and outdoor pollens. And if we’re talking about inner-city children, cockroaches and mice can be a major factor too.

Q: What are the most common symptoms a parent should look for?** A:** They are pretty similar to what you find in adults. The children have runny noses, itching, sneezing, eyes itching and watering and some persistent coughs. In children, we are also very observant of rashes because sometimes they are the manifestation of allergies. Food allergies get a lot of the blame for eczema, but sometimes there are environmental factors. So for people who have eczema we usually do dust mite control and limit contact with pets.

Usually parents ask, “Is it a cold or is it allergies?” One thing we tell parents is that if their child has persistent symptoms that last more than two weeks, it likely is allergies because a cold doesn’t last that long. If a parent comes in and says their child has had a runny nose for three weeks or four months, then I know it’s not a cold. Now, I can’t be sure it’s allergies because other things can last several weeks, too. They may have an infection. That’s why the physical exam is important and asking if they have a fever. Even though people still refer to “hay fever” to describe allergies, fever is not a common component of allergies. But if you have several weeks of runny nose, itching or sneezing, we usually suspect an allergy trigger, particularly in children.

Q: How can you minimize allergy triggers in the home?** A:** Allergists first want to identify what a patient’s triggers are. This requires getting a thorough history and testing to determine if they have seasonal or year-round allergies. If we know a trigger is tree or grass pollen, it might not be a good idea for your child to hang out on the front porch when the neighbor cuts the grass. Also, there are certain times when tree pollens and grass pollens are more prevalent, and you’ll want your child to try to avoid those peak times of exposure.

For indoor triggers, the same environmental controls that are recommended for older children and adults would apply to young children. Dust mites are a big indoor trigger, and for children who have perennial allergic rhinitis, we focus heavily on dust mites, especially if their skin tests show they are allergic to them. Trying to reduce mold in the home is also crucial. All homes have some mold, but places that have water damage or leaks in their foundation or a history of flooding or moist crawl spaces tend to have more mold. To help eliminate mold, you can take such steps as putting a dehumidifier in the basement, making sure that pipes are fixed and that any leaks in the foundation are repaired so that mold doesn’t have humidity on which to feed.

If a child shows a hypersensitivity to a cat or dog, keep the pet out of the bedroom. We prefer wood floors because carpets are like sponges that hold allergy triggers for a long time, no matter how frequently you shampoo or clean them. Remove most stuffed animals from the child’s room and put the remaining ones in the dryer once a week to kill dust mites. Change filters on the heating and cooling systems once a month and keep windows closed during warm months. When you open windows, you invite the pollens and mold spores that are microscopic and can pass through screens.

Q: Are there ways to minimize allergens at school?** A:** School is a little trickier because you don’t really have control of the environment, but the key is to communicate with teachers and other officials at school about your child’s indoor and outdoor triggers. Certain things can be done if a child is allergic to grass. Sometimes, if they are very allergic, we will try to minimize their exposure at recess or outdoor gym class. Avoiding class pets may be necessary, too. I’ve written notes to schools asking that children be permitted to stay away from these animals or if the pets can be removed from the classroom. Generally, our first step is to treat patients so that they can withstand any triggers at school.

Q: What are the best treatments for kids with allergies?** A:** It makes sense to have them take medication that’s long-acting and can be a preventive for allergic inflammation. A common treatment is a combination of a long-acting non-drowsy antihistamine and a prescription nasal spray. Long-acting antihistamines are based on the child’s age. Some of the antihistamines now available can be taken at six months of age. Some nasal sprays can be given to children at age two. And some of the over-the-counter antihistamine and nasal sprays can be taken under a doctor’s guidance. But we are more cautious with young children. For instance, we don’t usually give young children decongestants because it can race their heart.

Q: Should a child with environmental allergies have an action plan?** A:** I think action plans are good in all phases of allergy management. Usually, parents come in with their children looking for problems to be solved, but even after we help them deal with those symptoms, it’s always good to stay prepared for setbacks. So it does help to look ahead and determine steps to take if they see symptoms.

This can be established between the parent and doctor. It might mean maximizing the medicine they are already on. I don’t generally start at the highest dosage, especially in children. We usually start at a modest to low dose. So I give parents a range of what they can do with the medicine. Perhaps their toddler is on a half teaspoon of an antihistamine. If the dose range allows it for that child at that age, I’ll tell parents to go to a half teaspoon at night and another quarter teaspoon in the morning if they see increased runny nose, itching and sneezing. If they frequently have to use maximum doses of their medication, I want to follow up with them to review what’s triggering it. If it’s something that’s happening every day, then I want to reassess the situation. Perhaps allergy shots should be a consideration. Allergy shots aren’t likely to cure the problem, but they can help.

Q: Do allergies run in families?** A:** We do see siblings more affected by allergies. If either parent has allergies, there is a greater chance the child has allergies. We can see whole families that have these problems. Generally, when we do environmental controls, we’re not just helping the child, we’re often helping other members of the family.