Darren T. Scoggin, MD
Children’s Medical Group
One of the challenges parents (and pediatricians!) face is determining if a child is experiencing symptoms consistent with allergies, or if an infectious process is to blame. There is considerable overlap between symptoms of allergies and a cold, and, as with most diagnostic processes in medicine, obtaining a good history is key.
When most people think of “allergies”, they are usually referring to runny nose, itchy or watery eyes, or sneezing. Allergic rhinitis is the most common allergic disorder and occurs in up to 25% of the population. Characteristic symptoms include sneezing, itchy nose, nasal drainage, congestion, post-nasal drip, or cough. Children may show signs of allergies by rubbing the nose or eyes, blowing the nose frequently, or clearing the throat (especially younger children). Allergic disorders can be present in certain seasons (intermittent or seasonal) or throughout the year (persistent or perennial). Allergic rhinitis may have complications such as recurrent sinus infections, ear infections, or flares of eczema or asthma. Diagnosing allergic disorders in children begins with the pediatrician obtaining a good history of the illness, understanding family history including parents or siblings with allergic disorders, and reviewing any medications that may have been tried in the past. Testing is available for many allergy triggers, and should be discussed with the child’s pediatrician. Some allergy testing is even available in the pediatrician’s office such as the finger prick allergy testing offered at Children’s Medical Group. The mainstay of treatment for allergic rhinitis is an antihistamine (Zyrtec, Claritin, Allegra, etc.). Nasal sprays are often used with success to help control symptoms of the nose or eyes. Allergy immunotherapy (“allergy shots”) is available for many allergy triggers and can be discussed with the child’s pediatrician for a referral to an allergist.
Upper respiratory infections are one of the most common causes of missed work or school and are responsible for a large portion of pediatric office visits. Most URIs are viral in nature and are self-resolving. They can occur throughout the year, though winter months have the highest prevalence. Infants and young children average around eight new and distinct viral upper respiratory infections each year, but some children (especially those in daycare) may experience one new infection each month. Common symptoms of a cold include nasal congestion, runny nose, scratchy throat, cough, and sometimes fever. Most colds last around 7-10 days, though they are often prolonged in younger children. Color of the nasal drainage may change from clear to yellow or green, but this does not necessarily indicate a bacterial infection or the need for antibiotics. In fact, antibiotic therapy may cause harm if used to treat colds by disrupting the natural bacteria in the body or by leading to antibiotic resistance. Complications of colds include ear infections, sinus infections, asthma flares, or pneumonia. Treatment of common cold symptoms is mostly supportive in infants and young children and consists of cool mist humidifier, nasal saline with bulb suctioning, hydration, and rest. Older children may benefit from a trial of decongestant therapy to help relieve symptoms if severe. There is inconsistent data on the use of vitamins and herbal therapies in the treatment of colds.
Allergic rhinitis and viral upper respiratory infections both share many of the same symptoms and can be difficult to distinguish. It can be helpful to examine the length of symptoms, recurrence, family history, and exposure to sick contacts to help determine the cause. Evaluation by a pediatrician who is familiar with the child’s history is important in discerning whether a child is having symptoms consistent with allergies or a viral upper respiratory infection.
Pediatric Allergy: Principles and Practice
Zitelli and Davis’ Atlas of Pediatric Physical Diagnosis
Nelson Essentials of Pediatrics