Is It a Cold or Allergies?

Diagnosis: Respiratory Allergies

It started with a runny nose and a couple of itchy patches that the pediatrician diagnosed as eczema. But by the time he was 10 months old, our son, Parker, was suffering from a seemingly endless run of colds, coughs, and ear infections. Testing confirmed the doctor’s suspicions: Parker was a baby with respiratory allergies.

Respiratory allergies are allergic reactions to airborne allergens such as dust or mold. Although a baby’s very first allergic symptoms tend to show up as eczema or colic, respiratory symptoms may appear starting at around 6 months.

“Initially it’s in the form of asthmatic or chest type symptoms,” says Dr. Sherwin Gillman, clinical professor of pediatrics and allergy at the University of California, Irvine. “Then, later on, they develop more upper respiratory nasal symptoms, like what we call rhinitis or hay fever.” According to Dr. Gillman, as the respiratory symptoms start, children with allergies also seem to be more prone to recurring respiratory infections.

Just the Sniffles?

How can you tell the difference between an allergy and a cold? If you think your baby may be suffering from respiratory allergies, look at the time course of her symptoms, says Dr. Alan Greene, a primary care pediatrician and author of From First Kicks to First Steps: Nurturing Your Baby’s Development from Pregnancy Through the First Year of Life.

Dr. Greene says colds “tend to last for seven to 10 days, and at some point along the way the mucous turns cloudy or a different color. If a child has a runny nose that lasts longer than about 14 days without getting better, then you need to start thinking this isn’t a cold.” This is especially true if the discharge is thin and watery and doesn’t change color or consistency, he adds.

A child’s eyes also can reveal symptoms of airborne allergies. Allergic eyes tend to be itchy, watery, and irritated. “About 60 percent of people with allergies will have dark circles under their eyes,” says Dr. Greene. While these “allergic shiners” aren’t present in all allergy sufferers (and can be present in people who don’t have allergies), they can be another clue that allergies are lurking.

A family history of allergies of any kind raises the odds that your baby could have respiratory allergies. “If one of the parents has a clear-cut history of allergies, then about half of their kids will, and if both parents do, about two-thirds of their kids will,” says Dr. Greene.

Becky Bergman’s son, Matthew, began showing allergy symptoms at 12 weeks of age. Now 16 months old, Matthew has been diagnosed with asthma and several allergies, including an allergy to dust. Bergman, from Antioch, California, says allergy problems run in her husband’s family. “His father and one of his brothers had similar—but not as severe—problems as Matthew,” she says. Their allergies became less severe with age, and Bergman hopes that Matthew’s will, too.

Allergy Tests and Treatments

If your pediatrician suspects allergies, he or she will probably begin treatment by taking a detailed history of your baby’s symptoms and a physical examination. It’s sometimes possible to identify allergy triggers simply from the history and exam. Depending on the age of the child and severity of the symptoms, Dr. Greene says the first step in treatment is often simply avoiding whatever triggers your baby’s allergic response.

Will your baby be referred to an allergy specialist? Not always, says Dr. Greene, but in some cases you can usually expect a referral. He refers patients to an allergist if there are severe allergies (such as a nut allergy), if the allergy is causing other kinds of chronic problems (such as frequent ear infections) or if the allergy diagnosis is unclear and additional testing is needed.

The two most common methods of testing children are the skin prick test and the RAST (radioallergosorbent) test. During the skin prick test, tiny drops of common allergens are placed on your baby’s back, which is then lightly pricked or scratched. The area is then observed for a reaction. Results are available in about 15 minutes. The RAST is a blood test, which checks for antibodies against suspected allergens. It typically takes a few weeks to obtain results from the RAST.

There’s no age limit on allergy testing, says Dr. Gillman. “The definition of when testing should be done is really a definition of when the symptoms are present,” he says. A baby can be tested as soon as it becomes necessary.

Your doctor may prescribe allergy medication to ease your baby’s symptoms. The most commonly used medications are antihistamines, which neutralize or modify the allergic reaction. Topical anti-inflammatories are sometimes offered in the form of nasal sprays or inhalers and are used to control inflammation in the respiratory tract.

Helping Baby Breathe Easier

The airborne substances that cause the most trouble for babies are “the ones that they are exposed to soonest and on a more continual basis,” says Dr. Gillman. Dust mites top the list of offenders, followed by indoor molds, outdoor molds, and pets. Although allergies to pollens are possible in babies, they usually don’t appear until the fifth or sixth year. It takes living through several seasons to become sensitized.

Some suggestions for creating a more hypoallergenic environment for your baby include:

  • Reduce dust, especially where your baby sleeps. If you can, choose wood or tile flooring instead of carpeting for the nursery. Try to stay away from stuffed animals and upholstered surfaces, which collect dust. Once your baby is old enough to trade in her crib for a bed, invest in dust mite proof covers for the mattress, box springs, and pillows.
  • Never allow smoking in your home or around your baby.
  • Keep things clean. Cut down on household clutter, dust surfaces with a wet or oiled cloth, and vacuum with a HEPA filter once a week. Wash linens once a week in hot water.
  • Avoid indoor pets and plants.

Dr. Gillman says keeping the air as free as possible from airborne allergens is key to controlling baby allergies. “In general, if the parent knows what triggers off the problem, and they can avoid these so-called triggers, then that’s the rule to follow,” he says.

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