Q: How can I tell if I have allergies or just a common cold?
A: With older children or adults I would think about these questions: Is there a lot of itching of the eyes, nose or ears? Are symptoms worse when you are outside or around a pet? Do symptoms happen at particular times of year? Do you also have other allergic diseases like asthma or eczema that would put you at increased risk for allergies? If antihistamines have ever been tried, do they help? These would point toward an allergic cause. If there is a fever, body aches, and multiple family members or classmates with similar symptoms at the same time, that would suggest a viral cause.
Q: My hay fever has been pretty bad this year. I’ve been taking an Allegra 24hr in the morning, and a Claritin 24hr at night and also Nasonex nasal spray in between, just to get the slightest bit of relief. Safe, or not safe to be taking that much?
A: The nasal spray is going to work in a different way than the antihistamine pills, so taking those together is not a problem. That said, most studies show that there is little benefit gained by adding antihistamines to a nasal steroid like Nasonex. So if the Nasonex is not getting the job done, taking one, two, or even more antihistamines probably won't help all that much, and does have some risks depending on your age and whatever other medical problems you may have. If you're not getting enough relief from those medications you should probably consider immunotherapy (aka allergy shots) which is the most effective treatment option we have. The sooner you visit an allergist to get tested and started on treatment, the sooner you will feel better.
Q: I have a two month old baby and a lot of my friend kids have food allergies. Is there a way to avoid food allergies with my child or is it just genetic?
A: Great question and one we are learning more about every year. There is a definite interaction of genetics and environment that is increasing the rate of allergic disease. Current research is starting to show that early introduction of foods may actually decrease the risk of becoming allergic to those foods. If there are known risk factors for food allergy (eczema, existing food allergies to other foods, strong family history, etc.) you should talk with an allergist or your pediatrician before deciding to introduce foods. However if there are no risk factors, foods can be introduced when developmentally appropriate.
Q: How do I know for sure if my child has allergies? What medications can I give young kids for allergies?
A: The only way to know for sure if you or your child has allergies is to come in and get allergy testing. This is most commonly known as a scratch test, where we scratch an extract of the allergen in question into the skin. If a hive develops under where we scratched, we know that histamine was released because there are allergic antibodies against whatever we scratched with. The test only takes about 15 minutes and doesn't break the skin or draw blood. It’s a little uncomfortable but not painful and you will get answers right away.
It depends on the age of the child but liquid cetirizine or loratadine are good antihistamine choices that shouldn't make kids sleepy. Diphenhydramine (Benadryl) can be an okay choice as well, but will make kids sleepy. For older children we may recommend a nasal spray.
Q: My husband is allergic to all nuts except peanuts, and I gave my son cashews once when he was about 1 and he was throwing up. Now I'm afraid to give him any other nuts! I'm also afraid to give my younger child any either. My son is now 3 and my daughter is 1. Should I get them allergy tested and what age is appropriate to do that?
A: The genetics of allergies are not fully understood, but there is definitely an effect of genetics as well as our environment that play a role in developing allergies. I think you should have your son tested, as vomiting can be part of an allergic reaction. There isn't a straight forward answer as to what to do with your daughter since she has never been exposed. I would recommend you either bring her into an allergist, or at least talk about your concern when you bring your son in.
Q: My child seems to cough excessively any time he gets sick and sometimes when he plays really hard. Should I be concerned about asthma or is this just normal?
A: I would definitely look into asthma with those symptoms and possible other allergic diseases.
Q: My son is 16 months old and has a chronic runny nose (I don't remember the last time it was dry). At what point should I be concerned about allergies versus always having a viral infection?
A: The earlier nasal symptoms start, the less likely they are to be due to typical allergies (think pollen) as the child's immune system just hasn't seen those pollens enough. Indoor allergies like pets are a possibility, and less likely food allergies are also a possibility. A child in daycare or preschool will have significantly more viral infections (especially in their first year in daycare) than one who isn't. But if there is never a break in the runny nose, even for a couple of weeks, infections sound less likely and I suggest they get evaluated for allergies.
Q: I'm 37 weeks pregnant and having been dealing with really bad allergies all week. Is there something safe I can take and what a safe dose?
A: Diphenhydramine, loratadine, and cetirizine are all category B medications (meaning that there are no studies in pregnant women, but there are animal studies showing no problems, and no reports of problems in people) that you could take in their recommended doses. Some nasal steroids could be a good option too, but you should discuss the possible risks of those with your OB/GYN or midwife (fairly small, but warrant a more detailed discussion than is feasible here). Mothertobaby.org is a great resource for questions about medications and their safety in pregnancy.
Dr. Silge works at Intermountain Memorial Clinic in Sugar House and is board certified in Allergy and Immunology.