Children and Allergies
By Dr. Mark Pashayan
When the sycamores, the pecans and the pine trees have about finished blooming, it's time for the new crop of grass pollen.
With North Carolina’s long growing season, the hay fever season runs from late February when the first trees bloom through the end of November when the last of the ragweed goes to seed.
But the truth is there is no such thing as allergy season in North Carolina, especially in children. That’s because children can be allergic to so many things, from pollen to dust to the chocolate glaze on a donut.
Allergy vs. Allergic Reaction
An allergy is essentially an overreaction by the immune system to a foreign agent. Our immune systems are supposed to fight off infection. That’s why we get a runny nose when we catch a cold. It’s the body fighting off that nasty virus.
But the immune system isn’t supposed to fight off dust and dander, peanuts and shrimp. And when it does, we call that an allergic reaction.
As many as a quarter of patients in my pediatric practice at Wake Forest Baptist Medical Center suffer from allergies. Many can be managed with an over-the-counter allergy medicine.
But as any parent of a child with an allergy to peanuts knows, some allergies can be life threatening and require immediate medical treatment and prevention. Let’s review the most common.
Allergies: Hay Fever
In North Carolina, with the long growing season, there’s something almost always in bloom. Usually a child is allergic to one kind of pollen and not the others. So just because your car is covered with heavy green tree pollen, that doesn’t mean your child is in for an attack of hay fever. Your child’s runny nose and itchy eyes may not come until September when the ragweed blooms.
Hay fever typically presents with a runny nose, itchy eyes, a sore throat and sneezing. Some children also feel nauseated from swallowing so much phlegm. All that congestion can lead to a secondary infection in the ears or sinuses.
About half of my patients respond to over-the-counter allergy medicines. These include name brands and and their generic versions loratadine, cetirizine and fexofenadine, all slow-release medications that last a full day and seldom cause drowsiness. When these don’t work, I try my patients on a prescription nasal steroid spray which helps suppress the immune response.
Some children require a different medicine (montelukast) that was developed to control asthma as well as hay fever.
Allergies: Mold and Dust
Many children are allergic to ordinary household dust and mold. Treatment for these children starts with prevention.
- Vacuuming more frequently
- Replacing carpeting with hard wood or vinyl floors
- Changing the air filters in the heating and air conditioning systems monthly
- Using freestanding air filters
- Covering mattresses and pillows with specialized covers
But finally there’s a limit to prevention and some children require allergy medicines all year long.
Children with pet allergies do best when they’re not exposed to pet dander. So if your child is allergic to dogs, don’t keep one as a family pet. The same goes for cats. But what happens when the child came after the pet? Many families are reluctant to part with their dog and opt instead for allergy medicine for their child.
I encourage parents to avoid a long list of foods that often cause allergies in children during their child’s first year of life. Peanuts get all the attention, partly because of peanut butter’s popularity. But children can also be allergic to almonds, walnuts, egg whites, milk, chocolate, seafood and many other foods.
These allergies can be mild, with a rash or upset stomach, or life threatening. A child who’s having trouble breathing from a food allergy requires emergency medical attention. Once a food allergy is detected the child needs to avoid that food. As with any severe allergy you might need to carry emergency medication (epinephrine) for injection in case of life-threatening allergy.
Some allergies, including many food allergies, are hard to diagnose and may require care by an allergy specialist. But most childhood allergies can be treated by a pediatrician or family medicine doctor.
Sometimes, allergies are mistaken for some other condition. A child with a chronic stuffy nose may not sleep well, and when he gets to school he may have trouble paying attention. Instead of thinking that he may be allergic to mold or dust, his teachers and parents think he’s suffering from ADHD. A visit to the doctor can help sort that out.
There’s been a lot written about the rise in allergies. I’ve been impressed by studies that suggest our environments are almost too clean. The immune system is designed to fight off infection.
In theory, a young immune system never exposed to bacteria or viruses, starts fighting off everything else, from the dust bunnies under the bed to the pollen falling from the back yard oak.
In theory, if kids play outside and get dirty they’ll develop fewer allergies. But that’s only a theory. In the meantime, if your child has mild allergies, try an over–the-counter medicine. If the allergies are interfering with your child’s daily life, see your doctor.
Dr. Mark A. Pashayan is a pediatrician with Wake Forest Baptist Health, Pediatrics-Clemmons. Request an appointment online or by calling 888-716-WAKE.
Learn about pediatric allergy and immunology services at Brenner Children's Hospital.
Visit our Allergies Learning Center to learn more.