Anne Kasaba should buy stock in a tissue company. Her family goes through a couple of boxes of the stuff every week. Like their mother, three of Kasaba’s five children battle seasonal allergies. Pollen in the spring and ragweed in the fall, among a slew of other triggers, keep the kids sneezing and rubbing their eyes for half the year.
Most of the time, antihistamines and nasal steroids keep the Kasaba kids’ symptoms under control, but sometimes, it’s just not enough. “When the medicine’s not working, that’s when we go to see a specialist,” she says.
Is it time to take your child to an allergist for help? Here’s how you’ll know and what you should expect.
Allergies or Just a Cold?
Seasonal allergy symptoms can look a lot like a cold, but there are some key differences.
A cold lasts a week or two. Seasonal allergies last an entire season. Colds come on gradually and can happen at any time. Allergy symptoms start quite suddenly near the time that the seasons change. Output from a runny nose is clear and watery -- not like the yellow or green mucus your kids have with a cold. Unlike a cold, seasonal allergies can make your child’s eyes itch and water, too. One final clue: Allergies never cause a fever, but colds can.
“Sometimes it takes looking back a year or two at the pattern of symptoms before you notice, for example, that every September your child has a runny nose, itchy red eyes, and sneezing,” says Elizabeth Matsui, MD, pediatric allergist and immunologist at the Johns Hopkins Children's Center in Baltimore.
What Have You Tried at Home?
“For many children, taking antihistamines as needed or every day during pollen season is very helpful and will help them get to the point where they’re not having sleep disruption or constantly sneezing or rubbing at their noses,” Matsui says.
- Have you tried over-the-counter antihistamines?
- Have you tried an over-the-counter nasal steroid spray? Did you give it enough time to work (up to 2 weeks)?
- Are you keeping allergens, like pollen, out of the house by taking off shoes when coming indoors and having allergic kids shower before bed?
If you’ve tried all of these and your child still isn’t getting enough relief, it’s probably time to see an allergist -- a doctor who specializes in allergies. You might call one directly or, like Kasaba, you might get there by way of your pediatrician. “Personally, I waited until the pediatrician said, ‘Let’s get somebody else in on this,” Kasaba says.
What Can a Doctor Do?
Kasaba appreciated the allergist’s approach. “He started out with the least invasive treatments, and said, ‘Let’s not go to allergy shots unless we have to,’” she recalls.
An allergist or a pediatrician might first do a skin test to confirm that your child is in fact allergic to seasonal allergens, says Bryan Martin, DO, an allergist and professor emeritus at Ohio State University. It could be something else or something in addition to those triggers. Then, even though you’re sure you’ve tried everything, your doctor will probably want to make sure that your child is using over-the-counter medications correctly. They’ll also want to know that you’ve done all you can to limit how much your kid is exposed to his allergens.
If the correct use of over-the-counter medications doesn’t bring relief, your child’s doctor can try prescription drugs. “Prescription eye drops can help with eye symptoms if that’s what’s really bothering the child most. Or sometimes we will increase the dose of the nasal corticosteroid above what the over-the-counter dose is,” Matsui says.
After that, the doctor might be ready to move on. “For kids who don’t do well on other medication, we can start to talk about allergy shots” or tablets that go under the tongue for ragweed and grass allergies, Martin says.
Allergy shots are similar to vaccines. They have small amounts of the allergen that’s causing the problem, such as pollen. Your child will get shots with gradually higher amounts of it to help his body build up a tolerance to it. Along the same lines, tablets that dissolve under the tongue have trace amounts of allergens.
As for the Kasaba kids, it’s not time for shots just yet. “He didn’t go full bore,” Kasaba says of the allergist. “He said to keep using the antihistamines, and he added [a nasal steroid.] I’m happy.”