Allergies in Children

Spring is in the air — you are sneezing, your eyes are itchy and watery, you have sinus headaches. But are seasonal allergies hereditary? How can you tell if your baby/toddler has seasonal allergies too? On this episode, Dr. Melissa St. Germain, a pediatrician here at Children’s Hospital & Medical Center, discusses what you need to know about allergies.

Topic Breakdown

00:57 – Common Childhood Allergies
02:11 – Seasonal Allergies in Young Children
04:57 – Onset of Allergies with Age
06:18 – Food Allergies
08:57 – Allergy Shots and Treatments
10:39 – Differentiating between Allergies, Cold, and COVID-19

Transcript

Gina Melton: Well, spring is in the air and with that comes sneezing, and itching, and watery eyes. I suffer from allergies too. So, that’s what I’m going through right now, and so do both of my boys. I’ve always been curious — seasonal allergies — are those hereditary? Now, we’re gonna explore that topic and so much more, today.

I’m Gina Melton, with the Just Kids Health Podcast from Children’s Hospital & Medical Center. Join me, as I talk with the region’s pediatric experts about everything related to children’s health from medical issues to mental health — all to keep your children healthy, safe, and strong. And that’s what we all want.

So, just sit back and listen or you can do some multi-tasking like the super parent that you are.

Now today, we welcome pediatrician Dr. Melissa St. Germain, to discuss seasonal allergies in kids. Welcome, good to see you today.

Dr. Melissa St. Germain: Thanks. Thank you for having me.

Common Childhood Allergies

00:57 Gina: You bet. Now, what are some common childhood allergies that kids typically have? I know my kids have, you know, outdoor allergies, but I’m sure some kids have indoor allergies, too

Dr. St. Germain: Yes, so we can kind of split allergies up into a couple different categories. The outdoor allergies are what we usually consider seasonal allergies or, back in the day, hay fever, because a lot of the things that kids are allergic to, are found in hay.

So, mold, for example, and pollen. So, those tend to start in the spring when everything starts to bud — the trees and then the grass and then the weeds. So, depending on which of those pollens you are allergic to, that’s when you tend to see those symptoms start to pop up.

The indoor allergies are most commonly mold and dust, dust mites and cockroaches — which none of us like to think that might be living in our houses but they’re more than you think and those things really can cause symptoms year-round in kids.

And then food allergies — which the most common food allergies are peanuts, eggs, wheat, milk, and soy. As kids get older and into adulthood, then you start to see more tree nut, shellfish, and fish allergies. But really, those first five that I mentioned are kind of the ones that start early in childhood.

Seasonal Allergies in Young Children

Gina: And speaking of starting early in childhood, I know that my boys — I realize that they had allergies earlier, you know, when they were younger — but how can you tell if your, say, baby or toddler has seasonal allergies since they can’t really talk to you or you know.

Dr. St. Germain: Yeah. The outdoor allergies are more common as kids get older. So, it’s unusual to see pollen allergies before about the age of 3, for example. You know, the other category of allergens that I forgot to mention was pets. That’s an important one to think about. Especially, with the younger kids, if you’ve got a pet at home or a couple of pets at home — that might be something that you need to do a little more exploring to find out if they’re allergic to.

Gina: Now, how can you help a baby or toddler with seasonal allergies? What are the best things that you can do?

Dr. St. Germain: So, the seasonal ones that aren’t gonna start till they’re a little bit older — till they’re 3 or so. We can do some environmental things to help limit their exposure to those allergens. So, if they’re allergic to dust mites and the things that are inside, we can make sure that we’re vacuuming with a HEPA filter every week. We can put allergen covers — they have zip covers for mattresses and pillows and things like that, that help keep the dust mites from seeping out of the pillow and into our respiratory system.

So, really — just focusing on those sorts of basic hygiene. The kids that are allergic to the outside allergens like the molds or the pollens — when they come inside, having them shower off or at least wash off their hands and face. Or even a little saline nose spray to help flush out their nasal cavities, can go a long way towards cleaning out some of their respiratory system, as well.

Gina: I know when my son comes in — my older son comes in from baseball, I say, you know, “Go upstairs and take a shower.” And, he even goes as far as eye drops. I don’t know if that helps at all but, you know, and just the saline solution — all the things that you’re talking about.

Dr. St. Germain: Yeah. And then for the kids that have more symptoms that we can’t get rid off with just the, sort of, basic washing off, rinsing off stuff — that’s when we start to use things like antihistamines, and there’s a couple good ones over the counter. Claritin and Zyrtec and their generics which work equally well, but basically, those help decrease the body’s inflammatory response to the allergens. You should always talk to your doctor before starting a medicine like that, but a lot of those are safe to take every day as needed for those seasonal symptoms.

Gina: Do they have one for kids and then ones for adults, too?

Dr. St. Germain: They do. Both of those have cetirizine, which is the generic name for Zyrtec, and loratadine, which the generic name for Claritin. Both come as a liquid or as a chewable.

Onset of Allergies with Age

Gina: Now I know, like as an adult, I got adult onset allergies which is interesting but do allergies change with age and kids?

Dr. St. Germain: Absolutely. So, in really young kids under a year, we’re more likely to see those food allergies start. So, again, milk. I mean, that’s something that most babies are exposed to, from a pretty early age and that is one of the more common allergens.

So, the symptoms that we typically see with food allergies are a little bit different than what we see with the outdoor allergies. You know, when you’ve got seasonal allergies, you’re usually talking about runny nose, congestion, itchy watery eyes, things like that.

Food allergies are more likely to cause more of a systemic response and so, we’re more likely to see things like rash and with more severe allergies — things like swelling around the airway, swelling of the lips and mouth, and the face. Sometimes, vomiting and diarrhea with those food allergens — and those are all things that you would need to see your doctor for right away.

Food Allergies

Gina: I think it’s interesting because sometimes when my kids were in elementary school and I would bring things to school, I never included peanuts but then — now there’s other things that kids are allergic to, too. So, I always like to be sensitive because I feel like, you know, it’s hard for kids who have those allergies and they don’t wanna be, you know, separated or different from the other kids.

Dr. St. Germain: Yeah and most kids from the time they can read, if they’ve got food allergies, they’re pretty good at reading labels. So, prepackaged snacks are generally a safer bet because then at least the child can look and see what’s in it and know whether it’s safe for them to take.

The interesting thing about food allergies is — there was a really good study in 2015 called the LEAP study, where they looked at what the optimal time to introduce those potential allergens into kids was. So, they took a group of 6 month olds and gave them peanut crackers and then they took a group of 6 month olds and didn’t give them any peanut exposure until they were a year. And they found that the kids who were introduced to the peanut protein around 6 months were much less likely to develop allergies later on.

So, from that has come a recommendation from the American Academy of Allergy and Immunology and the American Academy of Pediatrics that kids should be exposed to potential allergens, like peanuts, starting around 6 months. So, that’s something to talk with your doctor about if you’ve got a little one.

But, for most kids, we recommend trying peanut butter with them, trying eggs with them, trying milk with them when they’re around 6 months. Because the immune system in the intestines, in the gut, kind of needs its operating system upgrade. I kind of think of it like, when your phone starts getting really slow, it’s not working well — you gotta do that system upgrade.

Well, by introducing those foods around 6 months, we’re priming the intestines and the immune system to know how to handle those proteins as opposed to waiting until it’s way later and then your immune system tends to overreact and that’s where we see these allergies come in.

Gina: Does that work with other things like introducing dogs or cats or —?

Dr. St. Germain: There haven’t been any great studies with pets. Although, one of the hypothesis on why we’re seeing so many more allergies now because we are absolutely seeing increased rates of allergy, both food and seasonal allergy as time goes on, is that we’ve kind of made our kids too clean — that they’re not getting exposed to a lot of those normal proteins that their bodies are prepared for.

So then, when they do get exposed to those later on, it’s overwhelming for the immune system and it’s not sure what to do with that. So, yes, it could be — let your kid roll around in the pig pen and they’ll have less allergies.

Allergy Shots and Treatments

Gina: So many kids out there are going, “Yes, Mom! Yes, Dad! Absolutely.” So, I’m curious — because I’ve had allergy shots before as an adult — are allergy shots for kids safe and are they effective at the same time?

Dr. St. Germain: Yeah. So, it’s a pretty big commitment. You’re talking about usually 2 to 5 years worth of injections that are on weekly basis for a while but they work really well. Especially, if you’ve got allergens that you can’t avoid, right? So, like, in Nebraska, you can’t really avoid pollen. It’s everywhere. So, if you’ve got those kinds of allergies, they can be really effective for that.

Gina: That is the hay fever. And what are the best allergy treatments for kids besides maybe doing the, you know, the Claritin — things like that, that you’ve already talked about?

Dr. St. Germain: Yeah, so, that would be considered an oral antihistamine — and like I said, there are some of those that are safe to use every day. We’ll also sometimes use — especially if kids just have nasal allergy symptoms — nasal steroids. We can use those in kids, as well, and those are really effective. And then again, just the saline. I can’t talk about nasal saline enough because it just works so well, and even the sinus rinses. Just to mechanically clear all of those allergens out of the nasal passages really helps.

Gina: Maybe this is a silly question but are there salines for kids and then for parents too? Like different or —?

Dr. St. Germain: There are sinus rinse kits that come in a smaller size for little kids. The saline spray is really just salt water and it’s the same, no matter which bottle you’re buying. It might have a different sized tip on it but it’s all the same stuff.

Differentiating between Allergies, Cold, and COVID-19

Gina: Now, this question is specifically about the pandemic and how can you tell if it’s seasonal allergies or if it’s a cold or if it’s actually COVID-19? What’s the best way to do that?

Dr. St. Germain: That is the million dollar question because it can sometimes be really hard to tell. Viral respiratory infections, including COVID-19, are more likely to have things like fever and general fatigue. These kids just really don’t feel good. And, it typically is more of a sudden onset and more of a sudden resolution. So, you know, colds are gonna last about 10 to 14 days. COVID’s gonna last, in general, in kids about 10 to 14 days — that’s not always the case but, in general, and then they get better.

So, with kids with allergies what you’re generally gonna see is — it’s weeks. And it’s just that, sort of, clear drip and it’s just, kind of, the itchy eyes and it just lasts for weeks if it’s untreated. So, a lot of times, in the first two weeks of a start of a runny nose, we’ll treat it like a cold and if it doesn’t get better then we’re more likely to try an allergy treatment with it. But certainly, fever is only gonna, generally, be found with a respiratory infection — not with allergies.

Gina: Well, my whole family had COVID-19 actually, and my kids. We all kind of had different symptoms but my kids had the respiratory and so, I didn’t know if they both had gotten a cold. So, that’s the time when you really wanna go into Children’s and see your favorite doctor there, right?

Dr. St. Germain: Exactly, and we do have — we’re doing a lot of telemedicine or telehealth and so, if you’re not sure — call. And we can walk you through that process because a lot of times we can do a virtual visit and determine whether you need COVID-19 testing or whether we think it’s more likely to be allergies and go from there. And we’ve been able to do COVID-19 testing from the car if we think that’s what you need and everything’s otherwise okay. So, yup. You can always call us.

Learn about COVID-19 testing at Children’s.

Gina: And, one of the things I like best about Children’s is the fact that it’s really geared towards children. So, I feel like when my kids have been in, they just feel more comfortable in the environment, you know. It feels good to be where there’s fun stuff on the walls and the pediatricians, you know, are all so nice to kids. They get that.

Dr. St. Germain: Yeah and I’m happy to say that most — not all — but most kids who have to be tested for COVID-19, feel like it wasn’t as bad as they were expecting it to be, because we’re pediatric based so we’ve got smaller swabs and we’re more used to having to do procedures with children and how to make them comfortable with it.

Gina: That’s great. Well, I love the fact that you started as a volunteer at Children’s and now you’re fully at Children as a doctor. That’s a pretty neat story.

Dr. St. Germain: I love being here. It’s a great group of people to work with.

Gina: Well, thank you so much. Thanks so much for coming in today. Thank you for sharing your knowledge about this. I know parents are going to be interested in hearing this topic because I think a lot of kids have allergies, you know, and just to know how to navigate all that.

Dr. St. Germain: Absolutely.

Gina: If they only had a manual, right? If they only had a manual.

Dr. St. Germain: It’s called your pediatrician’s office. We’re here for you.

Gina: Exactly, exactly. Well, thank you so much for listening to the Just Kids Health podcast and please remember to rate, review and subscribe. And for more information on how we can help your child, visit http://childrensomaha.org. Make sure to follow us on social media and also share our social media posts.

Learn about treatment for allergies at Children’s.

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