What should I know about my child's allergies (allergic rhinitis and conjunctivitis)?

Allergies can show up many ways in children:

• a chronic runny nose
• a chronic stuffy/congested nose
• a cough that won't go away
• red, puffy eyes with dark circles underneath

Allergies can also be manifested as atopic dermatitis (sensitive skin) and asthma (sensitive lungs.) Some children are unfortunate enough to have all three!

Although they may be worse in some seasons and better in other seasons, allergies are a chronic problem. This means they may last years, even one's whole life.

The body's immune system is trained to tell the difference between bad germs (like bacteria, viruses, and parasites) and harmless things (like fruits, cloth, and plastic.) The body gears up to fight infections when it is exposed to harmful germs, but is supposed to ignore harmless exposures.

Sometimes, though, the body is too sensitive and overreacts to harmless material. These allergy-provoking items (called allergens) differ from child to child, but the most common are:

• Dust
• Fur and feathers
• Cigarette smoke
• Pollen
• Molds

For many children, environmental allergies aren't severe enough to warrant testing. We do recommend pinprick testing (at an allergist's office) or blood sample testing (performed in our office) for food allergies, chronic allergies which aren't responding to medication, or any allergy which has caused a severe reaction (wheezing or trouble breathing, for example.)

Not all children with allergies require medications. Sometimes the allergies are mild and brief, or can be controlled adequately by making environmental changes. (See our information page on reducing allergens in the home and .outside. Children with allergies severe enough to interfere with their lives should probably get some medication.

For young children, medications are occasionally helpful. Otherwise, the best policy is generally to eliminate allergens from the baby's environment.

In older children, there are several medications that work quite well:

• Nose sprays: Best for children with lots of congestion and nasal drainage. These help shrink swollen, boggy nasal tissue and dry up chronic drainage. There are both over-the-counter products (like Nasalcrom) and prescription products (like Flonase and Rhinocort.) We can recommend one specifically for your child.
• Antihistamines: These help block the over-reaction of the immune system and help nasal drainage, a scratchy throat, and cough. Over-the-counter antihistamines like Benadryl are inexpensive, but are sometimes sedating and make it difficult to stay awake in school. Newer antihistamines (like Claritin, and Zyrtec, which are now over the counter) are not sedating and are safe down to 6 months of age.
• Eye drops: Prescription allergy eye drops (like Patanol) work great for red, itchy, irritated eyes. Non-prescription eye drops like Visine do not help allergies: in fact, they can make itching worse.
• Leukotriene antagonists: Singulair (montelukast) is a prescription medication originally designed for asthma patients which also helps with allergies.

Allergy shots are designed to desensitize people to allergens. Allergy shots are customized for each individual, depending on what he or she is allergic to. They are painful and expensive, and sometimes don't work very well for children. We recommend them when allergy medications don't work, the allergen in question can't be avoided, or if the allergy is quite severe.