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Does Your Child Have Allergies?

allergies

This is a particularly interesting post to me. Birch has been diagnosed as “possibly having allergies”. It started with his constant blinking. At first, we thought it was an attention-getting measure, but he did it even when we weren’t looking. Then his eyes started watering all the time. We took him to an opthamologist who diagnosed it as “possible allergies” and prescribed Patanol. (See Dr. Gilgoff’s reference to it below). I was interested to read Dr. Gilgoff ‘s advice to use Patanol “as needed”. I am so relieved that we don’t have to pin Birch down every night for his drops. It has been torture for all of us! If Birch’s symptoms don’t disappear in 3 months, we are supposed to go back and consider his far-sightedness as the possible cause. Honestly, I hope it isn’t allergies. I have had them all my life, and can’t seem to make it through a season without Claritin, nasal spray and eye drops. Ugh!

Allergy Season is Here!

by Dr. Gilgoff
Achoo!!! Indeed, it’s that time of the year once again. The flowers are blooming and the pollen count is rising. Every year around this time we have a flood of “sick visits” – kids who are sincerely suffering with seasonal allergy symptoms.
Allergies can actually present at a young age although usually not before 6 months. Why they don’t start earlier is interesting, but it often takes repeated exposure to an allergen before you see a reaction. In addition, the mechanisms of inflammation in the body are not fully developed in a newborn.
Allergies often run in a family, and sometimes they are signs of a “sensitive” or atopic child in general. Quite often a child may have sensitive skin, or eczema and some allergic kids have asthma as well.

Symptoms and Signs of Allergies
The severity of allergies can be anywhere from mild to severe, and they can indeed mimic other disease processes. The eyes are usually itchy and mildly red, but there is usually NOT a yellow or green discharge. I have had to write many a letter to the school nurse explaining that the red eye in little Johnny isn’t contagious and he is free to go back to school. The nose is running constantly, and yet it’s usually clear water-like discharge. And the throat can be itchy and dry. Kids have that nervous throat clearing cough for many reasons, but during these few months, don’t forget about allergies as a possible cause of mild cough or itchy throat.
The first few days of an upper respiratory infection, or common cold, can seem a lot like allergies, but the mucous is often more yellow or green in infectious processes. Fever is also a great way to decipher a cold versus allergies – as allergies would never start with a fever. Swollen glands are another way to differentiate colds from allergies, as they are enlarged when fighting an infection, but are normal in allergies.
The physical signs of allergies can be puffy eyes, an allergic crease on the nose (from all the rubbing) and upon examination of the nasal turbinates, your doctor may see inflamed mucosa. The throat may also show signs of allergy, as the classic cobblestoning of the posterior pharynx often indicates allergies. The lungs should be clear in pure allergies, so if there is a wheeze this may be mild asthma (possibly triggered by the allergies) which requires treatment as well.

Child Allergy Medicines – When to use, and are they safe?

Our treatments for allergies luckily are quite safe and usually very effective. If the main problem is the eyes, we can prescribe drops such as Patanol or Zaditor, and use them only as needed every 12 hours. For a constant runny nose we prescribe a nasal spray, and there are many good choices – Nasonex, Flonase, Veramyst, and Rhinocort are the most common. These are inhaled steroids, but the data is very clear that there is almost no systemic absorption, and therefore no risk of long term effects. In other words, the steroids act locally and are not absorbed in any significant manner into the blood.
If the allergies are stronger, or all over (not just the eye or nose), we would use an oral medication such as Claritin, Zyrtec, or Allegra. These medicines are so safe that they are now over the counter (Allegra is the last one to keep their patent, but that will be OTC soon as well), and the generic versions are just as good and a lot cheaper. For Claritin and Zyrtec, the dose is 2.5 ml, or half a teaspoon once a night if your child is 6 months to 2 years, and then 5 ml, or a full teaspoon if they are 2-6yrs old. After that, the normal dose is 10 ml, or two teaspoons. Good old fashion Benadryl will work, but it is sedating, so I prefer to use it only when nothing else works, and not every night.
Singulair is a nice safe medicine (and not a steroid at all) that is mainly used for mild persistent asthma, but is proven to help with allergies as well. I wouldn’t use at as a first line allergy treatment unless there was mild asthma as well, but you’ll see lot’s of commercials telling you otherwise!
Once we see that the Claritin or Zyrtec is working, I would continue that for a good month or so, and then try weaning off and watch for the return of symptoms. The other medicines (for the eyes and nose) you can feel free to use only on an as needed basis. Some people have allergy symptoms all year round, and for those the medicines are safe and necessary all the time. But the vast majority of allergies will fade by the end of the summer.

When to see a specialist for child allergies?

We actually have amazing doctors who specialize in pediatric allergies – so when should we meet them? When I have a young child who has hives, or any chance of a severe anaphylactic (throat swelling, low blood pressure etc) reaction, I refer to the specialist. These reactions are almost always a food allergy, and not a seasonal allergy. Yes, allergy testing is sometimes important, but if you know your child is allergic to the pollen I don’t think skin or blood tests are necessary – they won’t change our management. And although allergen avoidance is an excellent treatment, I wouldn’t stop taking your little one to the park – that is important for their overall health.
On the other hand, there are certain kids whose allergies are so severe that they fail to respond to the normal safe medicines. For those kids, referral to an allergist is crucial, as they will go over the risks and benefits of allergy shots. These shots (not at all related to the vaccine shots of course) are given weekly in most cases and involve a true commitment to follow up with the doctor. But when appropriate they can really make a true difference, and allow a child to function normally. For the vast majority of children suffering from allergies, you and your pediatrician should be able to diagnose and treat your child effectively

Dr. Gilgoff is a pediatrician relatively new to the Brooklyn community. He has a balanced approach to medicine, combining a western training at top institutions with an alternative outlook shaped by a mom who is both a midwife and creator of Mother Nurture Inc. – a Doula company since 1987. Dr. Gilgoff worked in Manhattan for 11 years, and now practices on 185 Montague Street. Dr. Gilgoff is available for free prenatal consults, second opinions, and accepts new patients with all types of insurance plans.

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