Monday Medical: Allergies in children
Allergies, especially as the seasons change, can be more than bothersome for children.
Between 10% and 30% of children in the U.S. are affected by allergic rhinitis, with symptoms including nasal congestion, runny nose, sneezing and itching. But what can parents do to provide comfort for their children?
Dr. Patrick Grathwohl, a pediatrician in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center, discusses risk factors, symptoms and diagnosis of allergies to help parents comfort their children.
There are a few factors that can put children at an increased risk for allergies.
“Risk factors for allergic rhinitis, also known as swelling and inflammation inside the nose, include a family history of allergies, being male, a firstborn child, birth in the spring, maternal smoking in the first year of life and early use of antibiotics,” said Grathwohl.
Allergic rhinitis typically requires a few years of allergen exposure to fully develop; therefore, it is very uncommon in children under the age of two. Often, allergic rhinitis occurs with a number of other conditions including asthma, allergic conjunctivitis and eczema.
Symptoms include sneezing, runny nose, nasal obstruction and nasal itching. Postnasal drip, cough, irritability and fatigue are other common symptoms. Those with allergic conjunctivitis, or eye inflammation caused by allergies, have itching, tearing and/or burning of the eyes. Sleep-disturbed breathing is one of the most common issues for untreated allergic rhinitis.
It can be classified by temporal pattern, which can be intermittent or seasonal versus persistent, and by severity.
“Seasonal allergic rhinitis is often caused by pollen from trees, grass, and weeds. Persistent symptoms, however, are often triggered by an indoor allergen such as dust mites, cockroaches, mold or common animal dander,” said Grathwohl. “It can be difficult to distinguish allergic rhinitis from nonallergic forms of rhinitis, and sometimes diagnostic testing may be needed for an accurate diagnosis.”
Typical physical findings include:
- Swelling and darkening under the eyes, which are often called allergic shiners.
- Allergic salute, or a transverse nasal crease due to repeated upwards rubbing of the tip of the nose.
- Swollen nasal mucosa with a pale blue color and clear discharge, and the back of the oral cavity, or posterior pharynx, having the appearance of “cobblestoning’’ due to hyperplastic lymphoid tissue and chronic post nasal drip.
Diagnosis and treatment
A diagnosis is often made on clinical grounds based on the presence of symptoms and history, and is supported by a physical exam.
“Allergy skin testing by an allergist or blood tests are available, but not often necessary for initial diagnosis,” said Grathwohl said. “A response to antihistamines and/or nasal steroids also can help make the diagnosis.”
Blood tests looking for allergen-specific IgE, or Immunoglobulin E, are often useful. If an allergy is present, the immune system will overreact to it by producing the IgE antibodies. These antibodies are different depending on what they react to, and the IgE test can show what the body is reacting to. By identifying the specific allergen, patients may be able to avoid the allergen. This step can also help tailor allergen immunotherapy, which may be allergy shots or sublingual drops, which are given under the tongue.
“Other treatment for allergic rhinitis often includes a 24-hour antihistamine, plus or minus nasal steroid or nasal antihistamine,” said Grathwohl. “With any medical symptoms, be sure to talk to your doctor if you have any questions or concerns.’’
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