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Environmental Allergies

Allergies are the body’s over-reaction to any outside material. Our immune system helps to protect us from dangerous outside materials like germs and chemicals. Sometimes the system overdoes it. Environmental allergies happen when the body over-reacts to things in the indoor or outdoor environment. Probably the best-know allergy in this group of problems is hay fever, also called “seasonal allergies.” People with seasonal allergies react to pollen from many different sources, or to molds and mildew. People with seasonal allergies usually have one time of year when their allergies are at their worst. Pet or animal allergies are reactions to animal hair or “dander,” the mixture of dried skin cells and saliva that animals shed. Many children are allergic to materials that are found indoors. Dust mites and roaches are common sources of allergic reactions.

Whatever the cause of an allergy in a particular child, the symptoms are usually fairly similar. Children with allergies develop itchy, red, and watery eyes, runny noses with sneezing and sometimes coughing. They may develop red itchy skin rashes. Severe allergic reactions with wheezing and difficulty breathing (anaphylaxis) are uncommon, but they do occur, especially with children who are allergic to animals.

Allergies are related to conditions such as asthma and eczema. Together doctors refer to these as the “atopic” conditions. Many children with one atopic condition have one or both of the others. Things that set off allergies, for example, may also trigger asthma attacks or worsening of eczema.

 

What is the biggest concern?

Our biggest concern in most cases is to make the child with environmental allergies comfortable. We want to stop the itchy eyes and skin, dry up the runny nose, and relieve the sneezing and coughing. Children often find the itchy eyes to be the biggest problem – many children simply cannot stop themselves from rubbing away at their swollen, red eyes. If they rub too hard, children can develop corneal abrasions, or scratches on the eye. These can become infected.

Children with more severe allergies may develop wheezing (noisy or whistling breathing sounds) or difficulty breathing. Children who also have asthma may develop an asthma attack triggered by the allergy. In rare cases, children with extremely severe allergies, usually to animals, can develop the most serious kind of allergic reaction, called “anaphylaxis” (ann-ah-fill-axis). This is a life-threatening reaction in which the throat and windpipe can swell nearly closed, and the heart stops pumping blood effectively. Anaphylaxis is rare, but children who have had severe allergic reactions must learn to avoid things that might trigger this kind of reaction.

 

Environmental Allergies treatment

There are a few simple things you can do to limit the severity of your child’s environmental allergies. You can wash your child’s face and hands several times a day in cool water with no soap. This will help to get pollen off the skin and away from the sensitive mucous membranes. You can bring your child into an air-conditioned building when possible. Air conditioners have filters that screen out many of the allergy-producing materials. High Efficiency Particulate Air (HEPA) filters are specially-designed machines to take even very tiny particles out of the air. You can buy one of these for use in your home if your child’s allergies are very severe.

Doctors can treat most children who have environmental allergies with anti-histamines. These medicines prevent a body chemical called “histamine” from triggering the immune reaction, or at least reduce the amount of the reaction. Antihistamines treat most of the symptoms of allergies all at once. Because they are preventive medicines, antihistamines work much better if we give them before a child gets exposed to a trigger. This is not always possible, of course. Often parents and doctors don’t realize a child has environmental allergies until the first symptoms appear. Once the child starts taking the antihistamine, it is best to continue taking it regularly until the season is over. Many of today’s antihistamines are so effective that the allergy can appear to be gone. If you stop giving the medication at that point, you may be unpleasantly surprised a few days later to find the symptoms coming back.

The oldest antihistamine in common use is diphenhydramine (dye-fen-hi-drah-meen; Benadryl® and many others. It is available as liquid and capsules that you give about every six hours. The main side effect of diphenhydramine is drowsiness, which is actually often helpful to a child whose itching is making him or her frantic and unable to sleep. Some parents prefer to use this medicine for that reason.

Many newer antihistamines are available that you can give only once or twice a day. These include loratadine (Claritin®), desloratidine (Clarinex®), and fexofenadine (Allegra®) and many others. Other newer drugs work in a different way to reduce the effects of histamine in the body. These drugs, such as montelukast (Singulair®) and zafirlukast (Accolate®), are currently licensed for use in asthma, but many doctors also recommend them for children with moderate to severe allergies. Like antihistamines, they work best if given before an allergy attack and on a regular basis. They do not produce drowsiness. Please discuss all of these options with your doctor to come up with a plan of medication that works well for your child and for you.

Treating the runny nose, itching, and sneezing

For children whose main symptoms are nasal congestion, many doctors prescribe steroid nasal sprays such as fluticasone (Flonase®) or mometasone (Nasonex®). These sprays work very well when used once or twice a day. It’s important to use them every day during the season when your child’s allergies are active. This is because these sprays take several days to start working, and several days to wear off. Steroid nasal sprays do not help in the midst of an allergy attack. These sprays do not interfere with antihistamines – it’s fine to use them together. Treating the runny nose can also help prevent to prevent an asthma attack in children with asthma.

If your child’s nasal congestion is very severe at the beginning of treatment with a steroid spray, your doctor may recommend using a pure decongestant spray, such as oxymetazoline (Afrin® and others). These sprays work very well within a few minutes of use. They can help dry and shrink mucous membranes so that the steroid spray can reach its target. Do not use nasal decongestant sprays for more than 3 days in a row – they can cause a “rebound” effect that can make the congestion worse.

Treating the itchy and watery eyes

For children who are especially troubled by eye itching and watering, doctors often prescribe eye drops. Some of these are steroids, such as prednisolone (OcuPred® and others), some are anti-inflammatory drugs such as ketorolac (Acular®), and some are antihistamines, such as epinastine (Elestat®). Like the nasal sprays, these eye medicines only work well if you use them consistently every day. They will not help relieve a sudden allergy attack. All eye drops are irritating to inflamed eyes so if itchy eyes are the main symptom, you will need to use oral medications until the worst of the inflammation goes away. Many children get great relief from simple cool compresses over the swollen, itchy eyes. Just be sure to change the washcloth frequently to prevent infection.

Allergy Shots

Most people have heard of “allergy shots.” These are actually a long series of injections aimed at “desensitizing” a child to the particular material that s/he is allergic to. Before getting allergy shots, your child must have testing done to determine what s/he is allergic to. Both the testing and the shots are uncomfortable and prolonged, and most doctors only recommend them for children who cannot get through the season using the other treatments. Some doctors also recommend them for children with very severe allergic reactions. Allergy shots can sometimes actually trigger a serious reaction.

Serious or Life-Threatening (Anaphylactic) Reactions.

Only a very small number of children have dangerous reactions to environmental triggers. Those who do, however, must take steps to prevent or shut down a dangerous reaction. The first step is to identify the cause – most often it is an animal allergy. Next of course is prevention. A child with a life-threatening reaction to an animal cannot live in the same house with that kind of animal. Children with these kinds of reactions often take allergy medicines year round.

The EpiPen®

If your doctor was concerned that your child may have a serious environmental or pet allergy, s/he may have given you a prescription for an “EpiPen®,” a device to inject epinephrine (adrenalin). Epinephrine is life-saving if you give it in the first few minutes of a reaction, in a child who is known to have a moderate or severe allergy. The EpiPen Jr. is for children who weigh less than 60 pounds, and the adult EpiPen is for larger children and teens. Please be sure to fill the prescription right away. Keep the EpiPen someplace where you can get at it right away. Older children should keep their EpiPen with them all the time. The side effects of using the Epi-Pen are a rapid heart rate, dry mouth, and mild trembling.

The EpiPen can be life-saving, but your child must use it within the first few minutes of a reaction starting. Many people keep several different EpiPens in places the child often visits (one at home, one at school, one at camp, etc). Check the expiration date when you fill the prescription, and mark your calendar for the date it needs to be replaced. Your doctor can provide a practice EpiPen that does not contain a needle or medicine. You and your child should practice using it regularly. Then, if your child needs to use it for real, s/he will know what s/he needs to do, how much pressure it takes to trigger the injection, and so forth. When an EpiPen expires, don’t throw it away immediately! Use it to practice giving the injection into an orange. This will provide more regular practice for your child, and will prevent the EpiPen from accidentally injuring someone else.

 

 

 

 

When should I be worried?

Most children with environmental allergies do quite well with the treatment we’ve discussed. Here are a few things to look out for that might suggest a more serious problem developing:

  • Fever
  • Cloudy green or yellow nasal mucous
  • Cough that lasts more than a few days after starting treatment
  • Eye pain or a feeling of something in the eye
  • Headache
  • Foul-smelling breath

Your doctor sent your child home because s/he is not having a serious allergic reaction. Still, it is good to watch your child for the first 48 hours after an allergic reaction to be sure that more serious signs do not develop. Here are some signs of a serious reaction:

  • Difficulty breathing or speaking
  • A feeling of swelling or tightness in the throat or chest
  • A hoarse voice
  • Wheezing (whistling breath sounds)
  • Increasing puffiness or swelling of the face or arms and legs
  • Increasing numbers of red wheals or hives
  • Extreme irritability in a toddler or infant
  • Lethargy (inappropriate sleepiness)

If any of these occur, please be sure to call your doctor’s office right away. If your child or infant is difficult to awaken or seems unconscious, go directly to the emergency room.

 

Other points of concern

The allergy season happens just at the time of year when kids love to be outside. This can make it challenging keep your child’s exposure to a minimum without destroying his or her summer fun. Water is your friend in this regard! Swimming or playing in water is a great way to keep your child cool while rinsing off as much of the airborne pollen as possible. The humidity from the water also helps to keep mucous membranes moist. Please do try to avoid heavily chlorinated water if your child has very sore eyes or has asthma. The chlorine itself can be irritating.

 

Other Conditions that Might Be Present

The symptoms of environmental allergies can mimic those of many viral illnesses like colds and upper respiratory infections. It can sometimes be hard to tell the difference, but these infections are much more common in fall and winter, which is when allergies are at their least common. Allergies don’t cause significant fever.

Children whose nasal congestion is very severe or lasts a long time can develop sinus infections. If your child develops a headache around the front of the face, foul breath, or cloudy nasal mucous, please check with your doctor.