When I lived and practiced in Kansas City, the seasons were better defined and, while over the years spring and fall seemed rather short, it was obvious when spring was starting based on flowers blooming and new leaves budding. For the past 5 years here in Florida, I have struggled alongside parents trying to tell whether a child has a runny nose, congestion, even a cough, from a virus or due to high pollen count. In Florida, environmental allergies seem to flare up multiple times throughout the year as various beautiful flowers and trees bloom. We don’t get snow and rarely ever have ice or freezing temperatures. I tell parents, nothing “dies,” so those with true environmental allergies never get a break!
As I discuss in A Healthier Wei, young preschool aged children today are almost always prescribed allergy medications (like Flonase and Claritin) for presumed allergies. Every time the nose runs, is congested or parents complain about something being wrong with a kid’s nose, they tell me that pediatricians treat them for a “sinus infection” or “allergies.”
I have met countless preschoolers who have been on daily medication for years, continuously, regardless of when they feel better while on them or when they don’t show symptoms. Most healthy children have NOT had formal allergy testing for a very good reason: allergy testing is not sensitive or definitive in young children. Children can be born allergic to food and animals, but really need a few years (with exposure to a variety of aeroallergens) to perhaps develop allergies to trees, grass, pollen, mold, dust mites, etc. Whenever I meet young children who come to see me for a runny nose, congestion, and a “stuffy” head, despite being on years of allergy medications and other over-the-counter medications, I help them get better by reviewing their eating and drinking habits and making dietary modifications.
Food allergies may show up in the first year of life, based on the development of hives, bloody stool, or other signs that parents notice and pediatricians are told about. In children younger than four, blood testing is typically used and can be ordered by pediatricians or allergy specialists to see if the child may show signs an allergy to food and or other common allergens. This test is called RAST, short for radioallergosorbent test. It is beyond the scope of this blog to get into how accurate and confusing such test results are, as there are many infants who may show positive test results indicating an “allergy” to milk, eggs, etc., and can still truly tolerate exposure to such foods without significant medical issues. True cow milk protein allergy is something children can outgrow.
By the way, nuts are an entirely different story and any allergies to tree nuts or peanuts must be discussed and worked up in detail with your child’s primary physician and allergy specialists.
Another test is a skin allergy test, which determines the presence and degree of allergy by the reaction of a person's skin to different substances introduced to it. Skin testing is further divided into a skin prick (scratch) test or an intradermal test. Skin testing is generally not ordered until a child is older than 4, as it would be difficult for younger children to tolerate being still while enduring many pokes on their back. More importantly, the test may not be sensitive or could be falsely negative.
What I share with parents as reasonable ways to guess whether their child has true allergies to the environment are the following:
If your child is constantly rubbing and itching his/her eyes and nose, then it is more likely that he/she is truly showing signs of being allergic to what’s in the air. I have had many parents tell me that after an outdoor soccer game their child has significant itching, congestion, and even “puffy” eyes (eyelids), and such may be clues to a child with true allergies.
Parental history of test-proven allergies.
If either parent has a history of allergies to the environment based on positive skin testing, not just hay fever symptoms, then the child has a 40-60% chance of developing allergies to aeroallergens sometime in their life. Anytime the child has been on medications and symptoms do not get better, then consider coming off of the medications.
During the office visit with me, (or any ENT specialist), I can perform a relatively simple office “scope” procedure, during which a fiber optic camera the size of a thin spaghetti noodle, is gently inserted into the nasal passage about 2 inches deep. I can then directly see if it’s an enlarged adenoid tissue that is causing blockage of nasal breathing. This is also helpful when I show the parents when I find this. If the adenoid is not enlarged, then of course we can rule out any need or indication for surgical intervention. I can’t tell you how many toddlers come to see me during which time I diagnose an enlarged adenoid, when all along they have been treated for allergies without improvement since allergies were not the problem. These are also children who likely snore nightly and often have a runny nose.
Finally, I always ask about eating habits and constipation. If your child has the "Milk and Cookie Disease" and goes to bed with a stomach full of food/liquids, then often they will experience pretty bad congestion in the morning, or even throughout the day.
Anytime a child has constipation, I ask the parents to treat them through diet by increasing their intake of water and fiber, because constipation may contribute to congestion.
Since there are many causes for why children have a runny nose, it can certainly be confusing when trying to figure out whether true allergies are the cause of your child’s nasal symptoms. Your young child could grow up and prove himself/herself to have test proven allergies to the beautiful trees and flowers around us, but during their preschool years it is much more likely that they have congestion and runny noses due to a cold, enlarged adenoid, and/or reflux related nasal congestion from excessive dairy and sugar intake.