Interview has been edited for clarity.
Dr. Webzell says that in her location, Atlanta, they see a lot of kids with chronic nasal conditions. The parents say that they’ve tried over-the-counter cold medicines, but the runny nose will not go away.
- A chronic runny nose and nasal obstruction is the number one symptom of an allergy. The symptoms from allergies can also set off a vicious cycle. Congestion can lead to infections, adenoidal enlargement, and chronic fluid in the ears. Many kids with allergies experience congestion, fluid in the ears, recurrent ear infections, and hearing and speech disturbances, even affecting their school performance.
- Another common allergy symptom in kids is mouth breathing. “Once they’re congested, kids can’t breathe from their nose and have to open their mouths to breathe. These kids have very loud breathing because they’re breathing from their mouth,” Dr. Webzell explains.
- The next most common symptom of allergies in kids is snoring.
Dr. Webzell says that parents often tell her their children are snoring like old men. Because they snore, they often don’t sleep well. And then if they don’t get a good night’s sleep, they may experience daytime sleepiness.
- Coughing, sneezing, watery red eyes, puffy eyes, and a groove on the nose from constant wiping and scratching (sometimes called the allergic salute) are other symptoms of allergies in kids.
- Some gastrointestinal symptoms of allergies include vomiting and diarrhea.
- Some kids with allergies also have eczema, dry itchy skin, or hives.
- Wheezing is another symptom of allergies in children.
- Anaphylaxis is a life-threatening allergic reaction that can sometimes be the only symptom, according to Dr. Webzell. “If a patient develops hives, swollen eyes, shortness of breath, and wheezing after coming into contact with an allergen, this could be anaphylaxis. Emergency services must be called immediately,” she advises.
Dr. Webzell says that health care providers first use their clinical impression to diagnose allergies in children: “You take a good history and physical examination. Before carrying out any tests, health care providers can often already tell from the history and physical examination that a kid has an allergy.”
If the health care provider needs further confirmation, they may do a skin prick test or a blood test to check the IgE levels. Skin tests are usually done by an allergist rather than a family doctor or pediatrician.
According to Dr. Webzell, once you have identified an allergen, the first step in treating an allergy is avoiding that allergen. That’s not always easy when the allergen is pollen.
“You can’t avoid pollen because it’s outside everywhere. Medications often have to be used for these cases. You can also try simple actions like washing your child’s hands and face after they return from outside,” Dr. Webzell says.
If it’s household dust that your child is allergic to, there are many ways you can avoid it. Dr. Webzell suggests changing bed sheets at least once a week, avoiding carpet in your child’s bedroom, dusting often, and leaving soft toys out of the bedroom.
According to Dr. Webzell, there are three groups of medications that can help treat symptoms of an allergy:
- Antihistamines (e.g., loratadine and cetirizine)
- Leukotriene modifiers (e.g., montelukast)
- Corticosteroids (e.g., fluticasone nasal spray)
“A lot of parents are very scared of the word ‘steroid’ and 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,” Dr. Webzell explains.
Medications that can help are antihistamines (e.g., loratadine and cetirizine) and leukotriene modifiers (e.g., montelukast).
“If these medications still don’t help, people with very severe allergies may need immunotherapy, which can be given as an injection or as a sublingual tablet. Most of the time, by this stage, you would have referred them to an allergist and the allergist would do this,” Dr. Webzell says.
“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 an emergency epinephrine injection at home,” she advises.
Dr. Webzell says it’s important for parents to know that having an allergy is not a simple disorder. It can lead to a very severe reaction and can be life threatening.
According to Dr. Webzell, if you suspect your child has a rash from an allergy, then make sure to request an allergy test when they see their health care provider.
“Not every doctor will think of it. If your doctor hasn’t thought about doing an allergy test, you should ask for it,” Dr. Webzell says.
Once you know what your child is allergic to, the next step is to avoid these allergens. “Many kids in Georgia are allergic to household dust mites. I tell the parents not to have carpets in the room, make sure they clean the room frequently, and change the bed sheets every week. There are many steps you can take to reduce a household dust mite infestation,” Dr. Webzell says.
“Some kids are allergic to cockroaches. I have a lot of patients who have severe eczema, and they are allergic to cockroaches. I tell them to call pest control and keep their home as clean and clutter free as possible,” says Dr. Webzell.
If your child is allergic to food, then make sure you read every food label and avoid those foods.
As for skin care, Dr. Webzell suggests simply making sure that your child doesn’t scratch too much.
She also says that some children need medication to reduce itching. Antihistamines are good for that, according to Dr. Webzell.
“And then moisturize, moisturize, moisturize. And make sure that the cream you put on the skin is fragrance free and thick. It has to be a thick moisturizer. The thicker, the better,” Dr. Webzell says.
“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, topical steroids can be very effective,” she concludes.
Most kids who have eczema also often have seasonal allergies, asthma, and food allergies. Allergies can present a complex problem for parents, but your health care provider should be able to offer help.
- Shortness of breath. “If a kid has just had a peanut butter sandwich or a wasp sting, and they are saying they can’t breathe, holding their throats, and cannot talk to you, those are major symptoms indicating an emergency,” Dr. Webzell says.
- If they are breaking out in hives or their face, eyes, or lips start to swell, that’s also an emergency, according to Dr. Webzell.
- Wheezing is another sign of an emergency allergic reaction.
- Lightheadedness, when the child cannot stand properly, indicates an emergency.
- Some kids start to vomit after being exposed to an allergen.
“These are all symptoms that indicate you should call emergency services. If you have an EpiPen on you for emergency use, you must give it immediately and then call emergency services,” Dr. Webzell warns.
Severe shortness of breath and inability to talk are symptoms that indicate it’s time to call emergency services.
Dr. Webzell shares a story about her own daughter who had a severe allergic reaction to a bee sting.
“We went to a restaurant for lunch to celebrate my birthday. My birthday is in April, the beginning of allergy season in Atlanta. The pollen count is really high at this time, and the flowers are blooming.
“We sat outside 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 killed the bee or the wasp. When I looked at her back, I could see the sting area. It was kind of bumpy and red.
“Within five minutes, I saw her eyes getting puffy. When I asked if she was okay, she said she felt fine so we continued eating. In a couple of minutes, she told me she couldn’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. I ran to the restaurant reception and asked them to call emergency services immediately.
“By the time the ambulance came, her eyes were so swollen she couldn’t open them, and she was saying she couldn’t breathe properly. They gave her benadryl, and we spent the rest of the evening in the emergency room. 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, it could be a severe episode, and you have to know what to do. If your child is telling you they cannot breathe or their face is swelling, please call emergency services. Don’t wait until they collapse,” Dr. Webzell says.
Dr. Webzell says that she’ll remember this day for years. “Every time we drive by this restaurant, I think to myself, ‘I’m glad that I saved my child’s life.’”