What are the most common allergy symptoms in children?
Here in Atlanta we see a lot of kids that come in with chronic nasal conditions. The parents just say: "We've tried all the cold medicines, we've tried everything over the counter, but this runny nose will not go away".
So chronic runny nose, chronic nasal obstruction is the number one symptom.
And then number two for kids is mouth breathing. Because kids, once they're congested can't breathe from their nose and have to open their mouths to start breathing. When you see these kids, they have very loud breathing, because they're breathing from their mouth.
The number three most common symptom in kids is snoring. The parents come in and ask: "Oh my gosh, my kid is snoring like an old man! What's going on?" And because they snore, they don't sleep well. It's very disturbed sleep, they also have sleep disturbance. Their nose is congested, they're snoring, they don't sleep well and they have daytime sleepiness.
This causes a vicious cycle of events: a lot of infections because they're congested, adenoidal enlargement, and then this can lead to chronic fluid in the ears. I can't count the number of kids that have had that cycle of events - congestion, fluid in the ears, recurrent ear infections, hearing disturbance and then speech disturbance, and then this affects their school performance. Those are the main ones.
And then, of course, there is coughing and sneezing, watery red eyes, puffy eyes and a groove on the nose because they are constantly wiping and scratching their nose, which is called the allergic salute.
The gastrointestinal symptoms for allergies are vomiting and diarrhea. Some of these kids have eczema, they have dry itchy skin, or they may get hives. And then wheezing is another symptom. There are a lot of symptoms kids have, and one symptom leads to more problems.
Anaphylaxis – a life-threatening very severe allergic reaction can also be the only symptom. If a patient develops hives, swollen eyes, shortness of breath, wheezing after coming into contact with an allergen, this could be anaphylaxis. Emergency services must be called immediately.
How do you diagnose allergies in kids?
The first thing is your clinical impression. You see a kid, you take a good history, a good physical examination. Before you carry out any tests, we can already tell from your history and physical examination that this kid has an allergy. In 80 percent of cases, we can be sure.
And then the remaining 20 percent if confirmation is needed, you can then do a skin prick test or you can do a blood test to test for the IgE level. The skin test is usually not done by the pediatrician, The patients are often referred to an allergist.
And speaking about treatment, what steps should parents take to make sure their kid avoids those allergens and how these kids with allergy can be medically treated?
The first step in treatment, once you know what an allergen is, you want to avoid the allergen. That's easy, right? But that's not always easy with pollen.
You can't avoid pollen because it's outside everywhere. Medications often have to be used for these. Or some simple actions like washing your child’s hands and face after they return from outside.
If it's household dust, there are many ways you can avoid it. Changing bed sheets at least once a week, avoiding carpet in your child’s bedroom, dusting often, and leaving soft, hairy toys out of the bedroom. If it's a food allergy, try to avoid that food.
Medications that can help are antihistamines, for example, Loratadine, Cetirizine.
The next group that is used very often is the Leukotriene modifiers. Montelukast is very helpful.
And then the third group are the corticosteroids. For example, Fluticasone nasal spray. A lot of the parents that I see are very scared of the word "steroid". Once they hear "steroid", they don't want to use it. You have to educate your patients very well, and inform them that it's just a steroid that acts locally in the nostrils. Steroid nasal sprays are very helpful if used correctly.
Medications that can help are antihistamines, for example, Loratadine, Cetirizine. The next group that is used very often is the Leukotriene modifiers. Montelukast is very helpful.
And then if these three medications still don't help, in those people who have very severe allergies, then they may need immunotherapy which can be given as an injection or as a sublingual tablet. But most of the time, by this stage you would have referred them to an allergist, most of the time the allergist will then proceed to do this.
Some kids could have anaphylaxis, a very severe allergic reaction, and this is a medical emergency. For these kids usually, the symptoms are very severe. These kids have to have epinephrine at home. They have to have an emergency epinephrine injection at home.
It's important for parents to know that allergy is not a simple disorder, it can lead to a very severe reaction and can be life-threatening.
And what advice can you give to moms who suspect that their kid has allergy? What steps can they take to avoid allergies?
If you suspect your child has a rash that is due to allergy, then, of course, the first thing is to make sure you request to have an allergy test when they go to their doctor. It's not every doctor that thinks of it. If your doctor hasn't thought about doing an allergy test, you should ask for it. You should say: "You know what, can you do an allergy test? Can you do a blood test or send me to an allergist?"
So once you know what your child is allergic to, the next step is how do I start to avoid these allergens. Many kids in Georgia are allergic to household dust mite. And you can tell the parents not to have carpets in the room, to make sure they clean the room frequently, change the bed sheets every week. There are many steps you can take to reduce household dust mite infestation.
Some kids are allergic to cockroaches. I have a lot of patients who have severe eczema and they are allergic to cockroaches. I just tell them to ask pest control to come in to see what they can do, as well as keeping their home as clean and clutter free as possible.
If your child is allergic to food, then make sure you read every food label and avoid those foods.
As for skincare, it's really easy. Just make sure that your child doesn't scratch so much.
You have to put them on some medications to reduce itching. The antihistamines are good for those.
And then moisturize, moisturize, moisturize. And make sure that the cream you put on the skin is fragrance-free. It has to be a thick moisturizer. The thicker - the better, like Vaseline or Aveeno.
You may also have to use topical steroids in moderate to severe cases. Many parents are scared of steroids. But if a child has severe eczema, you really have no choice but to use topical steroids. As you can see, all these allergies are related.
Most kids who have eczema, also have seasonal allergies, and often also have asthma. And they have food allergies. It's a complex problem for parents, but if you go to the right doctor, they'll be able to help you.
What is an emergency situation for allergy? What symptoms show that it's a time to call an emergency?
Again shortness of breath is number one. If you have a kid who's just had a peanut sandwich, or he had just had a wasp sting, and they are saying: "I can't breathe!", or they're holding their throats and they cannot talk to you. That's one major symptom. Severe shortness of breath and inability to talk. If their face starts to get swollen, or their eyes or lips are getting swollen, that's an emergency. Or you look at their skin and they are breaking out in hives. Wheezing is another one. And the most severe one is lightheadedness. The child starts saying: "Mommy, I feel dizzy". And you look at them and they feel like they can not stand properly. Some kids start to vomit. These are all symptoms for you to call 911. And if you have an EpiPen on you for emergency use, you must give it immediately and then call 911
Severe shortness of breath and inability to talk are the main symptoms that indicate it's time to call 911.
I can give you a story about my own daughter who had a bee sting. This was on my birthday about seven years ago. We went out to a restaurant for lunch to celebrate my birthday. My birthday is in April, the beginning of allergy season in Atlanta and the pollen count is really high at this time, and the flowers are blooming.
We sat outside - myself and my two daughters, and we're having lunch and all of a sudden my older daughter said: "What's that on my back? It seems like something just bit me". She slapped her back and she killed the bee or the wasp. And then I looked at her back and I could see the sting area, it was kind of bumpy and it was red. And I said: "Okay, that's fine". We continued eating.
And within five minutes I saw her eyes getting puffy. I asked if she was ok. She said she felt fine. And we continued eating. And in a couple of minutes she said: "Mom, I can't breathe". We didn't have an EpiPen on us because she'd never had a bee sting and I didn't know she was allergic to bee stings. I ran to the restaurant reception and asked them to call 911 immediately.
The ambulance arrived shortly, and by the time they came, her eyes were more swollen, she couldn't open them and she was saying she couldn't breathe properly. They gave her IV Benadryl, and we spent the rest of my birthday evening in the ER. Since then, she's been carrying the EpiPen on her. This is good advice for parents. The first time you find out about your child’s allergies could be a severe episode, and you have to know what to do. Just make sure, if your child is telling you they cannot breathe, or their face is getting swollen, please call emergency services. Don’t wait until they collapse.
That day I'll remember for years. Every time we drive by this restaurant I'm like: "I'm glad that I saved my child's life".