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Guide to Allergies

OVERVIEW

Allergies are among the fastest growing chronic conditions in childhood. Allergic rhinitis (hay fever) alone is the third most common chronic disease in U.S. kids, affecting up to 40 percent of the population, according to the American College of Allergy, Asthma and Immunology (ACAAI).

Researchers don't fully understand why allergies are on the rise, but there are interesting theories. One likely culprit: our squeaky clean lifestyles. Most kids today aren't exposed to enough germs to help their immune systems learn the difference between harmless and harmful substances. Even global warming may play a role. Studies have linked climate change to longer pollen seasons. Some believe that improvements in medicine, ironically, contribute by decreasing the number of diseases children face. As a result of these factors, the immune system, which is designed to protect us, may overreact to otherwise harmless things like pollen, mold and pet dander.

Genetics play an important role, too. Kids who have one parent with allergies are 25 percent more likely to develop them than children whose parents don't have allergies. When both parents have allergies, kids are up to 70 percent more likely to experience them. According to the Centers for Disease Control and Prevention (CDC), white children are more likely to have hay fever, or allergic rhinitis, than black or Asian children. Black children are more likely to have food or skin allergies. And Hispanic children are the least likely to experience allergies overall.  Allergies can emerge in the first several years of a child's life. One of the first indications: eczema, or atopic dermatitis, which results in skin rash and itchiness, and can affect babies in the first few months of life. Children can show signs of airborne or food allergies by age two or three. 

SYMPTOMS

Allergic Rhinitis (airborne allergies, including seasonal and indoor)

This is the most common of allergy problems and can make children miserable. A constantly stuffy or runny nose, sneezing, and coughing are typical. Children with allergies may also have itchy, watery eyes, dark circles under the eyes, and chronic ear problems. Depending on the trigger, symptoms can occur seasonally or year-round.

When allergies are present, itching may also occur in places a child can't get to easily, such as the inside of the nose and ears or on the roof of the mouth. This is the kid that wrinkles or rubs her nose or grimaces to relieve the uncomfortable sensations. An allergic child may wake up tired and cranky. "Children with allergies can experience 'micro-arousals' during the night due to their stopped-up noses," says pediatric allergist Linda S. Cox, M.D., immediate past chair of the American College of Allergy, Asthma and Immunology's Immunotherapy and Diagnostic committee. "It interrupts the quality of their sleep and results in fatigue that carries over into the next day."

Is it a cold or allergies? Check for these symptoms.

Allergies

Mucus: Thin, clear
Duration: Two weeks+ duration
Fever: No
Itching: Yes
Sneezing: Repetitive

Cold

Mucus: Thick, yellow
Duration: No more than two weeks
Fever: Sometimes
Itching: No
Sneezing: Occasional

Food Allergies

Food allergies can start during the first year or even the first months of life. Major culprits include milk, egg and soy. To a lesser extent, small children may react to tree nuts and peanuts. Children who are allergic to foods may experience allergic symptoms when they come into contact with the offending food or often within minutes of eating even a trace of it. Reactions can include:

  • rashes

  • hives--itchy bug-bite-like welts on the body

  • stomach pain with vomiting

  • diarrhea

  • difficult breathing

  • swelling in the mouth and throat

When a child experiences severe symptoms in at least two body systems (say, skin and respiratory), it can signal anaphylaxis, which can be fatal if not treated immediately. The most serious symptoms are compromised breathing and blood circulation. 

CAUSES

Allergies are the result of an over-reaction in the immune system to substances that are normally harmless. When children who are allergic come into contact with these substances, called allergens--such as dust or pollen, peanuts or shellfish--their bodies produce an antibody to it. That sets off a process that triggers the allergic response.

For example, if your child is allergic to pollen, his immune system identifies pollen as an invader and over-reacts by producing antibodies called Immunoglobulin E (IgE). These antibodies trigger the release of chemicals, such as histamine, which set the allergic reaction in motion. The result: itching, stuffiness, and and/or swelling in the nose, lungs, throat, sinuses, ears, lining of the stomach or on the skin. Although allergies do not cause asthma, they can trigger it. In fact, allergic asthma is the most common type in the United States.

Although any food can trigger an allergic reaction, certain ones top the list. These include:

  • Peanuts

  • Tree nuts (such as walnuts, pistachios, pecans and cashews)

  • Shellfish (such as shrimp and lobster)

  • Fish (such as tuna, salmon and cod)

  • Cow's milk

  • Wheat

  • Soy

  • Eggs

The good news for some kids is that food allergies can be outgrown. Up to 90 percent of egg, milk, wheat and soy allergies go away by age 5 years. But others are likely to continue as children grow up. Only about 1 in 5 young kids outgrow their allergy to peanuts and even fewer outgrow their allergies to tree nuts or seafood. Your pediatrician or allergist can test your child over time to see if food allergies are going away or getting worse.

Seasonal allergies are brought on by various types of pollen or mold. If your child is 4 or older and sniffles and sputters throughout the first few weeks of spring, an allergy to a specific pollen is probably to blame.  Children typically have a "hay fever" season that depends on where they live. The season tends to start in the spring and continue until the fall. Symptoms rise along with increasing levels of pollen from ragweed, grass, weeds, and trees as well as mold spores.  

But the indoor environment can just as easily be the culprit. Some children are bothered by dust mites, microscopic spider-like creatures that nestle where there is lots of food for them--flakes of human skin! Upholstered furniture, carpets, mattresses, stuffed animals, pillows and blankets are prime breeding grounds. Other kids react to molds and pet dander. Cats and dogs are tops on the list, but your child can also be allergic to guinea pigs, gerbils, rabbits and other pets.

DIAGNOSIS

If you suspect allergies are at the root of your child's health problems, talk to your pediatrician. You may be referred to an allergist who can conduct skin or blood tests to determine what your child is allergic to.

If you think your child has a food allergy, your doctor may also ask you to keep a food diary for a few weeks. In it, you'll record everything your child eats and any symptoms that emerge. You may also be advised to eliminate a suspected food for two weeks or so, then re-introduce it while at the doctor's office, in case your child experiences a serious reaction.

Is it a food allergy or food intolerance?

A food allergy can sometimes be confused with food intolerance. The difference: A true allergy involves the immune response. Having an intolerance for a food means the body lacks enzymes needed to help process certain compounds--such as the lactose in milk. When a child eats such foods, she experiences gas, bloating, stomachache, loose stools and, in some cases, vomiting. While symptoms associated with food allergies occur immediately after contact with the foods--and even trace amounts can cause problems--people with a food intolerance may not see symptoms until several hours after eating the foods and small amounts don't necessarily create problems.

PREVENTION

It's not always possible to prevent allergies but there are things you can try when your child is a baby to reduce his risk of developing them.  

For allergic rhinitis:

  • If it's right for you, breastfeed your infant. When you nurse your children, you pass along your immunities to allergens.

  • Don't smoke or allow others to smoke in your home or car.

 For food allergies:

  • Talk to your pediatrician about when to start your baby on solid food--starting solids before 4 months increases the risk of food allergies. (Waiting past 6 months, which was previously recommended for preventing food allergies, may actually increase your baby's risk of a wheat allergy.)

  • Introduce foods one at a time, and wait at least two to three days before starting another new food so you can identify potential problems.

  • Although doctors used to advise against introducing egg whites and wheat until your baby turns 1, and peanut butter and shellfish until age 2, they have recently scrapped those recommendations. "A baby's immune system is in a teaching state," says Cox. "You can teach tolerance to foods if there is exposure in the first year or two." Just be alert to problems that could be symptoms of an allergy, including stomach upset like recurrent colic or diarrhea.

 

TREATMENT

Your best bet in treating allergies is to avoid the substances that trigger symptoms in the first place. These strategies can make a big difference:

Pollen (seasonal allergies)

  • It's hard to keep your child inside, but try to keep him or her inside at least part of the time between 10 a.m. and 5 p.m., when  pollen is at its peak. (Check pollen counts in your area at the website of the American Academy of Allergy, Asthma and Immunology or at pollencount.com)

  • Have your child spend more time indoors when grass is being mowed, and on cloudy, still days when there is a threat of thunderstorms. There can be added mold or pollen spores right before a thunderstorm.

  • Change your child's clothes and wash his hair after he has played outside for an entire morning or afternoon.

  • Close the windows and doors and turn on the fan setting of your air conditioner, which acts as an air purifier.

  • Clean the AC filters every week or two.

Dust

  • Wipe surfaces with a damp cloth; use a wet mop on floors.

  • If you use a forced-air heating system, replace filters frequently, or use an air purifier.

  • If possible, avoid wall-to-wall carpeting. If you have carpeting, vacuum it weekly with a HEPA-filter vacuum and keep your child out of the room for at least a half hour afterwards.

  • Use allergy casings on a child's mattress and pillow, and wash bedding weekly in hot water (at least 130 degrees); that can reduce dust mites by as much as 80 percent.

  • While some recommend stuffed animals be banned, naturally that's a tough position to carry out. A reasonable alternative is to keep the menagerie off the bed and away from your child's face wherever she's sleeping. You can also tumble them regularly in the dryer to remove dust, or seal them in a plastic bag for 24 hours to kill dust mites.

Pet dander

  • If you have a family history of allergies, you may decide to put off adopting a pet. But since there's no way to know when or if your child will develop an allergy to your fuzzy friend, you may also opt to go for it if your child shows no signs of being allergic. Trying to eliminate any and all sources of allergy triggers from your home is pretty much futile, and has been shown to sometimes actually backfire.

  • If you already have a pet, wash it regularly and keep it out of your child's bed or play room.

Mold

  • Use exhaust fans in bathrooms to remove moisture and put a dehumidifier in the basement.

  • Repair leaks promptly and dry water as soon as you see it.

  • If you smell a musty odor, it's mold. Remove damaged carpets, rugs or furniture.

  • Scrub any mold you see with a bleach-and-water (3/4 cup chlorine bleach to 1 gallon of water) or a commercial mold remover.

  • Keep your child from playing in piles of dead leaves in the fall--they can harbor mold.

Foods

  • Eliminate allergic foods from your child's diet. That's easier said than done if your child is allergic to a ubiquitous food like wheat, eggs, or nuts. You'll need to study food labels and seek out natural and health-food stores, which often stock foods free from common allergy-provoking foods. The Food Allergy Network has helpful information on how to identify problem ingredients on food labels.

  • If you are bottle-feeding, talk with your pediatrician or allergist about the best brand of formula.

MEDICATIONS

Commonly recommended drugs for allergic rhinitis include the following. Never give your child any medications, though, without a call to your doctor first.

 
  • Antihistamines. These medications block histamine, a protein involved in many allergic reactions, which causes itching and mucus production.  Newer generation antihistamines, such as Zyrtec and Clarinex, are less likely to cause drowsiness than older medicines like Benadryl. "They do not cross the blood-brain barrier as much as the older drugs, so they are do not have as sedating an effect," says Cox, Chair of the American College of Allergy, Asthma and Immunology's Immunotherapy and Diagnostic committee.

  • Nasal steroids. Drugs like Nasacort, Nasonex and Rhinocort reduce nasal stuffiness and are safe to use in children over long periods of time. They must be used daily, however.

  • Leukotriene antagonists, such as Singulair, block the action of leukotrienes, which increase inflammation and trigger asthma attacks in sensitive kids.

Allergy immunotherapy

Can your child's allergies be cured?  Symptoms can be drastically reduced and in some cases even eliminated with allergy shots. This type of treatment consists of getting shots on a weekly or bi-weekly basis over a period of months to years. Injections contain a diluted extract of the substance that causes your child to have allergic reactions--from pollen to mold spores. Doctors begin with small doses and gradually increase them until your child reaches a maintenance dose. Once your child has reached this stage, she may only need to get the shots every few months.  Over time, the body builds resistance to the effects of these substances, reducing the intensity of symptoms caused by exposure to them. The benefit may even last for your child's lifetime. Doctors base the decision to begin allergy shots on the length of your child's allergic season, how well medications and other measures control symptoms, your desire to avoid using medication indefinitely, and the cost and convenience of regular shots. The latest research shows allergy immunotherapy slashes health care costs in children with allergic rhinitis by a third. And it's the only allergy treatment that has been shown to reduce the risk of allergies turning into asthma.

Treating Food Allergies 

If your child has a mild reaction to a food, an antihistamine like liquid Benadryl or Zyrtec can help quell the allergic response. Even if the incident quickly passes, make an appointment for the pediatrician. If the doctor determines that you child could potentially have a severe reaction or anaphylaxis, she'll prescribe injectable epinephrine, or EpiPen, which reverses the effect of the reaction. The EpiPen should accompany your child wherever she goes, and anyone whose care your child is in--relatives, teachers, babysitters--should be shown how and when to use it.

If your child is having an allergic reaction, follow these steps:

  • If your child is having trouble breathing or otherwise seems to be having a severe reaction, call 911 and give an EpiPen injection if you have one.

  • If the reaction is mild to moderate with symptoms limited to itching and hives, administer a dose of liquid antihistamine like Benadryl. Over the next 15 to 30 minutes, monitor your child's condition. Watch for signs that airways could become blocked: swelling in the tongue and lips, wheezing, drooling or difficult breathing. Don't give your child the food that may have caused the reaction again until you can see a doctor.

Currently the best advice for parents of children with food allergies is to help children avoid coming into contact with foods they are allergic to and keep medication handy in case they accidentally ingest them. But someday doctors may be able to offer a new treatment--oral immunotherapy. Still experimental, the treatment involves eating minute portions of an allergic food and then gradually increasing the amount consumed in order to build up tolerance to it. Preliminary studies in children with peanut and other food allergies look promising. But whatever you do, do not try this at home. Talk to your allergist about his take on how soon he may offer this treatment in his practice and its suitability for your child.

COMPLEMENTARY/ALTERNATIVE TREATMENT

If your child has severe allergies, you may be tempted to try anything. That includes alternative or complementary treatments like herbal supplements or acupuncture. But there's no definitive evidence that these methods can relieve allergies. Although some studies show that certain herbs may be helpful, these supplements are not tested or regulated by the FDA, so you never know what's in the bottle you're buying. Herbal formulas can also cause side effects and may even trigger an allergic reaction or anaphylaxis.  

There are some healing approaches that can help tame the stress and anxiety that often accompany a chronic condition. Massage, relaxation, and yoga may make your child feel better while he gets established treatments. But don't substitute them for medical care. If you decide to try an alternative approach, consult the doctor first.

AT THE DOCTOR

Although some pediatricians treat allergies, you'll likely be referred to an allergist for treatment. (Go to the AAAAI, to find a doctor in your area.)

Be prepared to give a history of your child's symptoms and medical treatment. She will want to know whether there were symptoms in early childhood, such as in the first and second year of life, whether the symptoms are on-going or episodic, whether they correspond with the season and whether they are getting worse over time. Also bring a list of any allergy or asthma medications your child has been prescribed.

The process will include skin or blood tests, or both, to determine what your child is reacting to. So if your child is sneezing at home, it may be dust she's allergic to--not the family cat!

How the skin test works: the doctor will gently scratch your child's skin and place a small amount of the suspected allergen onto the surface. If your child is allergic, antibodies will trigger a reaction in the skin, causing red patches.

If your child is prescribed immunotherapy, the allergists' office will become quite familiar. During the "build-up" phase, your child will receive injections once or twice a week for about three to six months. (After each shot, you'll be asked to wait for 30 minutes before leaving to be sure she does not experience a bad allergic reaction. In very rare instances, shots themselves cause anaphylaxis.) When an effective dose has been reached, your child will get "maintenance" doses with longer periods between shots--every two to four weeks.  Symptoms may drop during the build-up phase, but it can take as long as 12 months on the maintenance dose to see good results.If the treatment is working, your child will probably stay on a maintenance shot for three to five years.

Risks to the treatment are unusual, but in some cases there is redness and swelling at the site of the injection.

THE CHILD'S EXPERIENCE

Allergies affect children in innumerable ways, large and small.  While some kids deal mostly with unpleasant symptoms or frequent doctor visits, others live with the fear of having a life-threatening reaction.   

  • "He asks me questions when I offer him things to eat--he wants to make sure it is safe," says Kim Peters, 46, in Beverly Hills, MI about her son, Zachary, now 5, who was diagnosed at 18 months with allergies to tree nuts, peanuts, dairy products, eggs and chocolate.

  • "The biggest thing he has to cope with is the coughing attacks and the lack of sleep," says Elizabeth Mooney, 30, of Massapequa, NY. Her son, John, 2, has seasonal allergies, and is also allergic to dog saliva. "At two, he doesn't really know he has allergies, but he does know when he's not feeling good!"

  Children may also resent the limitations they face due to their allergies, such as staying inside on a day when pollen counts are high or not being able to eat things other kids take for granted. And they may feel embarrassed about their condition or worry about not fitting in.

  • "If you ask him, he would shrug and tell you that it stinks, but that's the way it is for him," says Jessica Cohen, 37, of Bucks County, PA, about her son Shane, 6, who has multiple food allergies. "It typically depends on the day, but I don't think he ever forgets that he is different. Every once in a while he comes home sad and just cries, which is completely understandable. Now that he is in elementary school he is worried about kids making fun of him because of his allergies."

  • "He might show some frustration because he is not able to have what everyone else is having," Peters says. "But by in large he is very accepting and smart about it."

  • It's hardest for her around other kids' birthdays, when they are eating pretty bakery-decorated cupcakes and cakes," says Sharlene Breakey, 46, of New York City, whose daughter, Edie Fine, 7, is allergic to eggs. "The ones I make at home just don't look the same!"

  • "When Aviv went to a sleep-away, three-week summer camp, they did not allow him to administer his own medications. He had to go to the nurse or medic every morning and evening which took time away from fun and didn't allow him to do the normal routine that the other kids had," says Marcia Delgadillo, 47, of Richmond, CA. Aviv, 14, has asthma triggered by seasonal allergies. "When he gets hives during the summer swimming season, it embarrasses him for others to see it," she adds.

 

THE PARENT'S EXPERIENCE

Like any chronic condition, allergies are stressful for everyone. And when allergies are severe, parents live with constant fear. It's no wonder they feel frustrated and angry when other people minimize or completely disregard the challenges they face. 

  • "Whether it's camp or just a play date, we always have a nagging worry even though we always make sure her environment is as safe as possible," says Breakey. "Of course we train babysitters and everyone around her how to deal, but we never feel quite safe if it's not one of us with her."

  • "Devastated. Helpless. Angry. Overwhelmed." That's how Jennifer Grenz, 29, of Vancouver, British Columbia, felt when one of her twin daughters had a life-threatening allergic reaction and then both girls, Alicia and Madelyn, 2 1/2, tested positive for peanut allergy. "Alicia is so sensitive that she could react to 1/70,000 of a piece of a peanut," Grenz says. "I knew that it meant their childhoods would not be normal, that I would always be fearful for their lives. I feel like we live out lives watching out for a giant peanut monster that is out to get us. We were recently at the aquarium watching the whales and my husband suddenly smelled peanut butter. It was the little girl beside us eating her peanut butter sandwich, leaning up against the same glass our girls were, peanut butter all over her hands. I cried all the way home, because I feel like we aren't safe anywhere."

  • Before her son, John, got treatment for his allergies, Mooney endured dirty looks from other parents when her son started coughing in public. "I heard nasty comments, such as 'Stay away from that kid,'" she says. "It breaks your heart to hear someone say that about a one-year-old!"

  • "When Elle was first diagnosed, at 18 months, grocery shopping took two or three hours because I had to read every label, and had no idea what was safe and what wasn't. It's shocking how much American food is processed with peanuts," says Lisa Daily, of Sarasota, FL, about her peanut-allergic daughter, Elle, 6. "Now that she's in kindergarten, I have to worry that about whether or not one of her classmates has brought a contaminated snack. One mom brought peanut butter cookies to our nut-free classroom. If she is accidentally exposed, I worry that no one will notice in time to give her the EpiPen. Kids with peanut allergies can die within a few minutes of exposure. Halloween is a nightmare, eating in restaurants is a challenge, and even birthday parties pose a threat."

 

AGE-BY-AGE GUIDE

Infants

The best food for your newborn is your own milk. It's a way to reduce the odds of your child having allergies. Still, some babies have allergic reactions to foods that their nursing moms eat. If that seems like a possibility, have your baby tested for allergies and drop the offending foods from your diet.

Of course, formula is a perfectly-healthy option too, if that's your choice. Doing what's right for you is always what's best for your baby.

When your child turns one, he may have cow's milk--an excellent source of calcium and protein. But if he gets hives after drinking milk or eating other dairy products, he could be allergic to dairy. Talk to your doctor about testing him for milk allergy.

Toddlers

In recent years, more and more prescription allergy medications have been shown to be safe and effective for children--some as early as age 2. Talk to your doctor about what medications are best for your child's allergy symptoms. In fact, some over-the-counter cough and cold medications have recently been shown to be ineffective against symptoms.

If your child has food allergies, you'll need an action plan, which lays out the steps to take when your child has a reaction to a food.  (Download the fill-in chart at: www.foodallergy.org/files/FAAP.pdf.Copies should be given to anyone--relatives, babysitters, day care providers--who cares for your child.)

School-age Kids

Have a frank conversation with the teacher(s) about your child's allergies and brainstorm ways to avoid allergens. For instance, you can encourage your pollen-allergic child to wash his hands well when he comes in from the playground. When your child is five, he is eligible for immunotherapy. Also typically by age 5, children are able to give themselves medications or self-administer an Epi-Pen.

Middle School and Up

By the time your child reaches middle school, she should be starting to take responsibility for her health. That can be a frightening time for parents of children with food allergies. Teens are famous for taking risks on the journey to adulthood, but when it comes to food allergies, the results could be tragic. Teens are more likely than younger children to eat unsafe foods. They may forget to carry their EpiPen, brush off symptoms or delay seeking treatment.  In fact more than 50 percent of deaths from severe allergic reactions occur in teenagers.

How can you keep them safe?

Start by having your tween practice asking food servers about how foods are prepared.  The Food Allergy & Anaphylaxis Network (FAAN) has a "chef card" kids can download and fill out to give to a waiter to make sure what's on their plate is safe to eat. Studies show that many tweens find the social isolation common with food allergies to be one of the condition's worst side effects.You can help your teen learn to discuss their allergies with friends and even enlist them in providing support when they're out with others. It can also help to have child practice making simple statements when social outings are being planned, as in, "I can't eat seafood" or "I'm allergic to peanuts." With time, that habit will become automatic.

SUPPORT

The American Academy of Allergy, Asthma and Immunology

This professional medical organization has a wealth of resources for people with allergies, children included.

The Asthma and Allergy Foundation of America

The foundation offers educational programs and tools for patients, caregivers, and health professionals. The organization can put you in touch with parent support groups in your region: www.aafa.org/esg_search.cfm.

It's asthma and allergy friendly Certification Program independently tests consumer products aimed at reducing allergens, such as air filters, vacuum cleaners, bedding and flooring.

The American Academy of Pediatricians

The AAP's Healthy Children site provides information on all kinds of allergies.

Kids with Food Allergies

This national nonprofit food allergy organization provides education and a support community for families and caregivers.

The Food Allergy and Anaphylaxis Network

This network of families, physicians, families, school nurses and nutritionists that work to build public awareness of food allergy. Provides food allergy information and sends e-mail alerts about mislabeled foods.

Medic Alert

These bracelets allow doctors to access your child's allergy history quickly in an emergency.

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