Patient education: Environmental allergies in children (The Basics)

What are environmental allergies? — Environmental allergies are a group of conditions that can cause sneezing, stuffy nose, or runny nose. They are caused by allergies to things in our surroundings, such as in the home and outdoors. Normally, people breathe in these substances without a problem. But when a person has an environmental allergy, their immune system acts as if the substance is harmful to the body. This causes symptoms.

Some people have allergy symptoms all year long. Year-round symptoms are usually caused by allergies to:

●Insects, such as dust mites and cockroaches

●Animals, such as cats and dogs

●Mold spores

Other people have symptoms only during certain times of the year, when the thing that they are allergic to is around. These allergies might be called "seasonal allergies." Some people also use the term "hay fever." Seasonal allergy symptoms are caused by:

●Pollens from trees, grasses, or weeds (figure 1)

●Mold spores, which are in the air when the weather is humid, or after rain

Many people first get environmental allergies when they are children. Environmental allergies are lifelong, but symptoms can get better or worse over time. Environmental allergies sometimes run in families.

Many children with environmental allergies also have asthma. (Asthma is a condition that can make it hard to breathe.)

What are the symptoms of environmental allergies? — Symptoms of environmental allergies can include:

●Stuffy nose, runny nose, or sneezing

●Itchy or red eyes

●Sore throat, or itchy throat or ears

●Waking up at night or trouble sleeping, which can lead to feeling tired or having trouble concentrating during the day

Young children often do not blow their nose but instead sniff, cough, or clear their throat a lot. If a child's throat is itchy, they might make clicking noises as they try to scratch their throat with their tongue. They might also get into the habit of breathing through their mouth because their nose is stuffy.

Because children do not always understand what allergies are or how they affect people, they sometimes put up with severe symptoms. This can really affect their life. Children with allergies can have trouble concentrating or doing schoolwork. They can also have trouble with sports. Your child might not be able to tell you what is wrong, but you can look for symptoms that show up at the same time each year or last a long time. You might also be able to tell that a child has allergies by the way they look (figure 2).

Environmental allergy symptoms usually don't show up in children until after age 2 years. If your child is younger than 2 years and has these symptoms, talk to their doctor about what might be causing them.

Is there a test for environmental allergies? — Yes. Your child's doctor will ask about their symptoms and do an exam. They might order other tests, such as allergy skin testing. Skin testing can help the doctor figure out what your child is allergic to. During a skin test, a doctor will put a drop of the substance that your child might be allergic to on their skin, and make a tiny prick in their skin. Then, they will watch your child's skin to see if it turns red and bumpy where it was pricked.

How are environmental allergies treated? — Children with environmental allergies might get 1 or more of the following treatments to help reduce their symptoms:

●Nose rinses – Older children can try nose rinses. Rinsing out the nose with salt water cleans the inside of the nose and gets rid of pollen in the nose. This can also help to clear things out if the nose is very stuffed up. Different devices can be used to rinse the nose.

●Steroid nose sprays – Steroid nose sprays are the single best treatment for nose symptoms. Doctors often prescribe these sprays first, but it can take days to a week before they work. Your child's doctor will prescribe the safest dose for their age. In the US and many other countries, you can also get some steroid nose sprays without a prescription.

If you decide to use a steroid nose spray for your child, ask the doctor if your child needs it for more than 2 months of the year. Using it for longer than 2 months is safe, but it's best if your doctor or nurse is aware. There might be better treatments for your child's allergies.

●Antihistamines – These medicines help stop itching, sneezing, and runny nose symptoms. Some antihistamines can make people feel tired, and should not be given to young children. Talk to your child's doctor before trying any new medicines.

Antihistamine nose sprays are also available for children 6 years and older without a prescription. If the medicine is swallowed, it can make your child feel tired. If your child uses a nose spray, tell them to spit the medicine out if it drains down the back of their nose into their throat.

●Allergy shots – Your child's doctor might suggest that they get allergy shots. Usually, allergy shots are given every week or month by an allergy doctor. These shots can help with eye and nose symptoms. They can also lower your child's risk of getting asthma later in life.

●Allergy pills (under the tongue) – For some types of pollen allergies, there are pills that work much like allergy shots. The pills are made to dissolve under the tongue. They are taken every day for several months of the year.

If you want to try over-the-counter (non-prescription) medicines for your child, read the directions carefully. Some are not safe for young children.

Talk with your child's doctor or nurse about the benefits and downsides of the different treatments. The right treatment for your child will depend a lot on their symptoms and other health problems. It is also important to talk with your child's doctor or nurse about when and how your child should take certain medicines.

Can environmental allergy symptoms be prevented? — Yes. If your child gets symptoms at the same time every year, talk with their doctor or nurse. Some people can prevent seasonal allergy symptoms by starting their medicine a week or 2 before that time of the year.

You can also help prevent symptoms by having your child avoid the things that they are allergic to. For example, if your child is allergic to pollen, you can:

●Keep your child inside during the times of the year when they have symptoms.

●Keep car and house windows closed, and use air conditioning instead.

●Have your child take a bath or shower before bed to rinse pollen off of their hair and skin.

●Use a vacuum with a special filter (called a "HEPA filter") to keep indoor air as clean as possible.

For children who are allergic to dust, dust mites, mold, or pets, you can:

●Wash bedding every week in hot water with detergent, or dry it in a dryer on the hot setting. If possible, use a comforter or a blanket that can be washed.

●Cover pillows and mattresses with vinyl covers to protect yourself from dust mites.

●Use fewer items that collect dust, especially in the bedroom – These include curtains, bed skirts, carpet or rugs, and stuffed animals.

●Clean air conditioner and furnace filters regularly.

●Vacuum every week using a vacuum with a HEPA filter.

●Keep pets out of the home, if you can – Keeping pets only out of certain rooms might help a bit, but does not remove animal allergens from your home.

●Bathe dogs each week – This might help reduce your child's symptoms. Bathing cats will probably not reduce your child's symptoms.

When should I call the doctor? — Call the doctor or nurse for advice if your child:

●Has a fever of 100.4°F (38°C) or higher, or chills

●Has green or yellow mucus

These symptoms could mean that your child has an infection and not just allergies.

More on this topic

Patient education: Environmental allergies in adults (The Basics)
Patient education: How to rinse out your nose with salt water (The Basics)
Patient education: How to use eye medicines (The Basics)
Patient education: Giving your child over-the-counter medicines (The Basics)
Patient education: Allergy shots (The Basics)
Patient education: Allergy skin testing (The Basics)
Patient education: Asthma in children (The Basics)

Patient education: Allergic rhinitis (Beyond the Basics)
Patient education: Trigger avoidance in allergic rhinitis (Beyond the Basics)
Patient education: Allergic conjunctivitis (Beyond the Basics)