Dr. Pressman

Juvenile Allergies
from Treating Asthma, Allergies and Food Sensitivities
by Alan H. Pressman and Herbert D. Goodman, MD

For the majority of people, allergies begin in infancy or childhood. Parents raising an allergic child are faced with the difficulty of handling a child who can turn from delightful to cranky and teary-eyed in the blink of an eye. Add a runny nose, sneezing, itchy skin, and a rash, and you get a not-quite-so-pleasant picture.

All parents want their children to be happy and healthy. During times of impaired health, parental support is more important than ever to accomplish such goals. When children are suffering from allergies, not only are they physically ill, but they are probably angry and upset about it. After all, if life is fair, why can’t Susie or Jimmy: play in the grass and not break out in hives? Coping with your child’s allergies isn’t going to be easy, but there are enough treatment options to make it less difficult. Understanding the roots of allergies and why they affect your child in particular ways is a major step toward helping your child live comfortably with the condition. Since allergies affect infants and children in different ways than they affect adults, this chapter will offer solutions that are tailored exclusively for them. After reading this chapter you will feel more confident about having the necessary tools to help your child play, sleep, and generally spend the day more comfortably. There is no cure for allergies, but there are ways to make the symptoms almost disappear.

EXPLORING THE ROOTS OF JUVENILE ALLERGIES

Allergic disorders have the dubious distinction of ranking first among children’s chronic diseases. Allergies start early. Infants often develop allergic reactions to milk that result in bloody diarrhea, weight loss, and other symptoms. Cradle cap -the scaling of the skin on an infant’s scalp- is a form of allergy, often referred to as atopic dermatitis. Sniffles, coughs, and diaper rashes can all be caused by allergies.

Children have immune systems that are still developing and that are much more sensitive to illness and less effective than adult systems in fighting it off. Their skin is also more fragile than that of adults. It is important to recognize and treat the symptoms of allergy in order to minimize the damage from repeated assaults on the immune system and other body functions.

Although some of the following symptoms may have a variety of causes, your child may suffer from allergies if you notice:

• itchy, watery eyes
• dark circles under the eyes that resemble “shiners” • recurrent sinus or ear infections
• watery, clear nasal discharge
• breathing from the mouth and frequent clearing of the throat
• rashes on the skin, hives, eczema
• a chronic cough, wheezing, and/or chest congestion
• diarrhea, bloating, gas; nausea, vomiting
• symptoms that recur seasonally
• hyperactive behavior, temper tantrums, irritability

There are many types of allergies, and we are going to touch on the most common in this chapter. We suggest that you also read chapter l, “Introduction to Asthma, Allergies, and Food Sensitivities,” for a more comprehensive view of what allergies are about, as well as the chapters on juvenile asthma; food allergies; skin allergies and eczema; and hay fever and allergic rhinitis. The topic of allergies is very complex and requires a broad range of theories and factors to fully explain or explore it. What we have done in this chapter is to condense the vast amount of research, theory, and clinical insights on allergy as it applies particularly to infants and children and their unique treatment needs.

MILK ALLERGY AND LACTOSE INTOLERANCE

Milk is a common allergen in children and in infants. Symptoms are severe in infants, often taking the form of diarrhea, rashes, asthma, and a variety of infections worrisome enough to give parents some sleepless nights. Since milk allergies in infants are a serious problem, a physician should be consulted at once. A number of factors contribute to an infant’s developing an allergy to milk. They include: heredity; introduction to solid foods too early; and being fed cow’s milk rather than breast milk, which may prevent the infant from developing the necessary antibodies.

Sometimes what is thought to be a milk allergy is actually lactose intolerance, which can be determined by many tests. One test measures the pH level in a fresh stool sample to determine whether or not glucose is present and the stool is acidic. An acidic stool is an indicator of lactose intolerance.

For further information about lactose intolerance, refer to the chapter on food sensitivities in this book.

SKIN ALLERGIES

Skin rashes and irritations have a variety of causes. Ironically, some medications that are supposed to cure us-such as penicillin, sulfur, insulin, and antibiotics-may actually cause hives, the itchy, raised bumps that may appear suddenly and just as suddenly disappear. Other causes for this reaction may be allergens, such as food additives or foods, including berries, nuts, and chocolate, among others. Hives may also appear after exposure to certain plants, insect bites, pollen, injections, changes in temperature, and chemicals. In acute cases, hives may result in severe allergic reactions, such as anaphylaxis, which can interfere with breathing or swallowing. Get emergency help immediately.

ALLERGIC RHINITIS AND HAY FEVER

Children suffering from allergic rhinitis or hay fever tend to develop a recognizable look; that is, they tend to have dark circles around their eyes; and, because they wipe their noses often and vigorously, there may be a crease between the tip and bridge of the nose. You’ll notice sneezing and sometimes a buck-toothed expression that comes from prying open their mouths with their fingers in order to breathe more easily.

There are two main inhalant allergies that could be making your child miserable. Allergic rhinitis can be seasonal (occurring in the spring and fall), due to exposure to pollens, grasses, or weeds; hay fever is caused by seasonal pollens such as the infamous ragweed plant. On the other hand, perennial allergic rhinitis occurs with exposure to indoor allergens such as pet dander, dust mites, and other offenders. These two allergies spring from different causes, but they are equally annoying.

Allergies should never be ignored in the hope that they will go away. Allergy symptoms such as mouth breathing have serious long-term implications. The continuous air pressure it causes can change the way that the soft bones of your child’s face grow, abnormally elongating the face and forcing the teeth to come in at incorrect angles. This will create dental problems, such as an overbite, and your child may need braces as a result. Chronic dental problems such as tooth decay are another side effect of untreated allergies. Ear infections that are chronic and untreated can lead to hearing loss, which can lead to poor grades, loss of confidence, and poor speech. Toddlers and small children with runny noses often stuff their noses with tissues, which can result in a discharge from the affected nostril. Untreated allergies can interfere with normal childhood activities and leave your child feeling a bit like a wallflower. These are just some of the reasons why it is so important to take your child to a physician or allergist as soon as allergies are suspected.

FOOD ALLERGY

You can’t fool Mother Nature, especially when it comes to feeding your newborn infant; mother’s milk is the perfect food for a newborn infant, and in the interest of protecting your child from allergies it is advisable to breast-feed for the first year if possible. Mothers who are breast-feeding should avoid foods that are likely to cause allergic reactions. Try not to eat milk, eggs, peanuts, fish, citrus fruits, wheat, beef, and chicken — or any food to which your other children may be allergic, since your infant may have the same allergies. As the infant grows, it is best to feed him foods such as carrots, pears, rice, and lamb, for example, that generally don’t cause allergic reactions in adults. Avoid foods -particularly wheat, eggs, corn products, citrus fruits, sugar, and chocolate- which are known to cause allergic reactions, until the infant’s system is more developed. Solid foods should be introduced slowly and in small quantities. Observe your child to see if there are any adverse reactions to foods as they are introduced into the diet. As the child becomes accustomed to a variety of foods that do not commonly cause allergies, foods such as wheat and eggs (after the child is about a year old) can be introduced.

Food allergies play a major role in childhood asthma and hay fever. Common allergens are milk, nuts, eggs, fish, shellfish, nuts, and peanuts, as well as food colorings. The sooner allergies are caught and treated, the better for your child’s general health and well-being. If you suspect allergies, take your child to a physician or allergist to be tested and treated. A severe reaction to a food allergen -peanuts, for example- can lead to anaphylactic shock, which is life threatening.

Infants and young children usually don’t miss the foods that they are allergic to, but older children who suffer from food allergies often feel deprived. The truth is that most people crave the foods they’re allergic to, and kids are no different. Try to make the new diet as much fun as possible, and offer substitute foods that taste good. Eventually your children will learn to love the foods that are good for them and will lose their taste for the food that they cannot tolerate. When you first withdraw problem foods, however, there will be a difficult period of physical and mental withdrawal that may include sulking and temper tantrums. Explain to your children that they will feel better and be able to play longer and harder if they stick to the foods you are giving them. Once they begin to feel healthier and their allergy symptoms are reduced, the children will realize that you are telling the truth. And after all, no one wants to return to a stuffy nose, headache, and other allergy symptoms.

Traditional Treatments

If you suspect that your child may suffer from allergies, go either to your primary health care provider or to a physician whose specialty is juvenile allergies. Once you have identified the offending allergens, you can take measures to remove or eliminate them from your child’s environment or diet. Skin testing for allergies is preferable to blood tests - although, in the case of food allergies, it is possible to have a positive test to food that is not causing symptoms. Changes in diet should not be based on skin tests alone, but on a combination of tests and other evaluations. If a skin test for food allergies is positive, the next diagnostic step should be a double-blind challenge to make sure that the diagnosis is correct. Many health care providers, both traditional and alternative, will prescribe some form of the elimination diet to test for food allergies. See chapter 6 for a detailed discussion of the elimination diet.

If environmental factors, such as dust mites, mold, or pet dander, are a problem, you should make sure that your child’s teacher and school nurse are aware of the situation. Some environmental allergies are easier to control than others. You simply take small and common-sense measures, such as having your child sit away from the blackboard if there is a sensitivity to chalk dust, or having your child take a bath before bedtime to avoid bringing allergens into bed. At home, you can remove feathers, down, carpets, heavy drapes, pets, and even stuffed animals from your child’s bedroom, since these are favored haunts of the dust mite.  Clean and vacuum closets regularly, disinfect your bathroom, and keep your home well ventilated in order to make it less hospitable to mold. Additional measures that you can take to rid your child’s environment of allergens are outlined in chapter 3, on juvenile asthma, of this book.

Medications

In the allopathic medical tradition, your child’s allergy symptoms will be treated with various medications. Children are somewhat more limited here than adults, since adult allergy medications are not suitable for use by children. However, there are certainly enough medications available, prescription and nonprescription, to treat symptoms such as chest congestion, skin rashes, hives, runny noses, and watery eyes. When taking any medication, your child should always be observed closely to see if an unusual reaction occurs. Nasal sprays can be addicting and are often overused, which results in a “rebound” effect that clogs the nose and puts you right back where you started. If your child uses a medicated nasal spray, you might buy a bottle of saline nasal mist for occasional use to soothe the delicate nasal membranes, which can get irritated from the overuse of nasal sprays and decongestants.

Following is a list of the most commonly used medications for children:

Corticosteroid Nasal Sprays Prescribed for children (age six or older) to reduce inflammation in the nasal passages caused by hay fever and allergic rhinitis, corticosteroid nasal sprays work to relieve the symptoms of congestion, sneezing, runny nose and itching. Beclomethasone products (Vancenase and Beconase AQ) are the only nasal sprays approved for children as young as six years of age. They can also be used by adults

Nasal Corticosteroids Not to be confused with anabolic steroids, the drugs used by some athletes to build muscle and bulls, nasal corticosteroids have been found to be safe and effective, although some patients do experience side effects, such as sneezing, irritation of the nose, dryness, and nosebleeds. In the case of hives that do not respond to treatment with antihistamines, many physicians will prescribe corticosteroid drugs to be used in conjunction with the antihistamines.

Antihistamines Antihistamines work to reduce the action of histamines, which are produced when your child inhales pollen, dust, mold, or other inhalants. They are most effective in treating such allergy symptoms as itchy, watery eyes, runny nose, sneezing, and other symptoms of hay fever and allergic rhinitis. Nonprescription antihistamines can have unpleasant side effects, however, such as drowsiness, dizziness, and dry mouth. If your child is using antihistamines, you should notify the child’s teacher and ask to be contacted if your child has trouble concentrating or participating in school activities. Non-sedating antihistamines are available by prescription for children age twelve and older, and they can be a good alternative medication for older children who wish to avoid the side effects of over-the-counter antihistamines.

Cromolyn Sodium Nasal Sprays A cromolyn sodium nasal spray, such as Nasalcrom®, is often used to prevent nasal inflammation that results in congestion. Although side effects are very rare, some people experience side effects that include sneezing, a burning sensation in the nose, nasal irritation, and headache. If your child shows any of these symptoms while using the spray, stop using it at once.

Hydrocortisone Applied topically for its anti-inflammatory qualities, hydrocortisone is used to treat skin allergies such as eczema

Decongestants Taken by, mouth or applied locally through nasal sprays or drops, decongestants are often prescribed to eliminate the nasal congestion caused by allergies.

lmmunotherapy (Allergy Shots) This process of allergy injection is a long-term commitment not generally advised for most people. If you feel that your child’s allergy symptoms cannot be controlled by changes in the environment or medication, then this might be a last-resort option. Refer to the discussion of immunotherapy in the adult asthma chapter for more details.

Alternative Treatments

Selecting alternative treatments for your child’s allergies is a difficult task. You want to do the best thing for your child, and you’re pulled in many directions. The allopathic medical world will tell you that without proper treatment and medication -cortisone, antihistamines, and decongestants- your child’s allergies will not only fail to get better but they will eventually get worse. On the other hand the natural, chemical-free appeal of alternative remedies may seem like a “kinder, gentler” approach. What should you do?

First and foremost, your child should see an allopathic physician for the initial allergy treatment. There are many reasons for this recommendation, not least of which is the necessity of diagnosing the presence of life-threatening allergic reactions known as anaphylactic shock. Once you have a prescribed (medically approved) diagnosis and treatment plan in hand, you may begin to discuss alternative options with your primary health care provider. Your pediatrician or allergist can help you choose treatments that will not react or interfere with the basic therapies he or she is administering. Most people don’t realize it, but even the seemingly benign practice of adding vitamins to your diet can interfere with prescribed medications or other medical treatment. However, you probably will find a way to integrate natural and allopathic treatments if you and your doctor work together toward that goal. Having witnessed the long-term futility of over-prescribing antibiotics and other medications for colds and infections, more and more allopathic health care providers are open to discussing natural therapies in an overall allergy treatment plan.

Herbal Treatments

Herbs can be used to relieve various conditions - for instance, nasal congestion, nausea, and diarrhea - stemming from food allergies; they can also ease the itch and irritation resulting from hives and other skin allergies. Children need to take special precautions when being treated with herbs because their other organs and skin are more fragile than adults’, and remedies must be tailored to their special needs. Following are some general guidelines:

Ginger * Ginger is a warm herb that has been used as a tonic for centuries. It can safely reduce the symptoms of food allergy, such as indigestion, nausea, and gas. To make the perfect cup of ginger tea, put cold tap water into a kettle and bring it to a boil. Measure one teaspoon of commercially prepared dried ginger root into one cup of water, let steep for five minutes, and then strain into a mug. Serve several times a day or until symptoms are relieved.

*Ginger is not recommended for use by children under three years of age

Calendula (Pot Marigold) Often sold in creams for external use on skin allergies such as eczema, Calendula (also known as pot marigold) has anti-inflammatory effects.

Comfrey Comfrey can be used in salve form to cover skin inflammations such as eczema. You can find Comfrey salves ready-made in health food stores.

Burdock The leaves, roots, and seeds of the burdock are used for various treatments, including topical applications that heal skin eruptions, psoriasis, and eczema.

Diet and Nutrition

Alternative health care providers believe that the causes of systemic allergies almost always result from the diet. Allergies may be linked to pollens and other allergens in the environment, but they would never develop if foods that offend the immune system were not eaten. In other words, the problem dates back to the initial feeding process, usually with the introduction of cow’s milk, formula, and solid foods before the digestive system has matured. Food allergens are thus introduced into fragile systems that are simply not equipped to handle these substances, and allergic reactions may develop in response.

Alternative health care providers base their treatment of allergies on their suspicion of food allergy as the underlying cause. Given this basic premise, the alternative practitioner diagnoses and treats juvenile allergies with special diets, nutritional and vitamin supplements, and herbs. An elimination diet is based on foods not likely to cause an allergic reaction in the child (see the discussion of food allergies in chapter 6 for step-by-step instructions). As toxins are removed from the child’s system by adherence to this diet, additional foods are reintroduced after a week or more. If an allergic reaction occurs, the new food is quickly withdrawn.

An alternative health care provider may also prescribe a rotation, or “rotary,” diet (see chapter 6 for details) to treat food allergies. The theory behind such a diet is that lessening exposure to known allergies will prevent new allergies from forming. Foods that are tolerated are eaten once every four to seven days, giving the body time to clear out antibodies that may create symptoms. Foods that have been eliminated for a period of time can gradually be reintroduced. This diet involves a great deal of planning, and you may even require a nutritionist to help design it. Although once a rotation pattern has been established, it becomes easier to plan a menu around the diet, it does take time and effort to make it work. Additional dietary measures may be necessary to clear up skin allergies, and the consumption of essential fatty acids found in salmon, tuna, and other fatty fish are often recommended.

Homeopathy

Most homeopathic physicians will recommend finding the source of an allergy and then avoiding it or removing it until symptoms clear up. However, there are times when they will provide custom remedies to combat the symptoms and treat the underlying systemic imbalances. A homeopath who mixes a combination remedy to relieve a broad range of symptoms - sneezing, headaches, watery eyes - assumes that the body will assimilate what it needs to heal and reject what it doesn’t. Because homeopaths treat each case as unique, remedies are usually based on extensive evaluation of factors such as symptoms, lifestyle, stress levels, and environment. Standard formulas are not simply doled out as a matter of course, but rather are carefully concocted to treat individual needs.

Some typical homeopathic allergy remedies that may be given to children include the following:

• Pulsitilla: used for treating allergies and ear infections when the child is tearful and upset

• Sabadilla: a common remedy for symptoms of allergic rhinitis and hay fever, such as runny nose, sneezing, and itchy, watery eyes

• Wyethia: used to treat a runny nose, and dryness in the throat and nasal passages

• Arsenicum album: used to treat allergic symptoms such as a runny nose, headaches, and coughing as well as asthma

• Chamomila: used to calm irritable, fussy children

• Apis: demonstrating quite clearly that what can kill you can also cure you, this remedy contains a substance derived from bee venom - effective on very itchy hives worsened by exposure to warmth or changes in the weather

• Anacardium: used for symptoms such as blisters filled with yellow fluid

TREATMENTS FOR JUVENILE ALLERGIES

Combined Treatments

As we have mentioned, juvenile allergies should always be treated by a medical doctor. There is no question that allopathic treatment plays a vital role in treating allergies, particularly in severe and acute cases. First, allergies must be identified through medical tests. Then, it is best to avoid or eliminate allergens from your child’s environment and life. After those two vital steps have been taken, however, alternative therapies can be implemented to assist in healing.

The best way to treat allergies in the first place is to begin a program of allergy prevention in the infant’s early years. When pregnant, try to avoid eating large amounts of foods that can be passed on to the child as allergens, such as chocolate or peanuts. Breast-feed your baby to boost the fragile immune system, which is so susceptible to allergens. Don’t introduce solid foods into the diet before your infant is mature enough for them.

Your child’s allopathic program can include prescription or nonprescription medication to relieve symptoms, avoidance of the allergen and, if everything else has failed, allergy shots. You can turn to alternative medicine to complement such treatments. For example, your child may have been using a nonprescription nasal spray to relieve congestion. In order to avoid the “rebound” effect that is caused by overuse and over-sensitivity to the medication itself, you might want to alternate it with use of an herbal tea suited for relieving congestion.

Here are some other suggestions for adding allopathic or alternative therapies to your child’s treatment program:

• In place of hydrocortisone, which can thin the skin if overused, use herbal skin creams such as comfrey, burdock, and marigold for external treatment of skin irritations.

• To complement an allopathic treatment program, meet with a homeopath to discuss homeopathic remedies for treating allergy symptoms such as runny noses and itching.

• Work with a nutritionist to design a healthy, allergen-free diet for your child.

• Use bodywork to relieve your child’s allergic symptoms and reduce the stress of living with allergies.

• Alternate commercially prepared herbal teas with antacids to relieve upset stomach and gas that accompany food allergies. For allergies such as hay fever, consider using homeopathic nasal sprays (such as Similasan Nasal Spray) sold in health-food stores as an alternative to chemical sprays, thus avoiding the “rebound” effect.

• Supplement your child’s diet with nutritional supplements, such as evening primrose capsules, to treat skin allergies. Good nutrition is a firm foundation for any medical plan.

• Learn more about alternative therapies that may be beneficial for your child. If one treatment does not work, don’t be afraid to explore related options. For example, if you take your child for an acupressure massage and your child doesn’t like it, you might try a Swedish massage the next time, or ask the practitioner to recommend another type of bodywork that will suit your child’s needs.

• Enjoy learning more about health care and make it fun for your child too. A good attitude is an essential part of any medical program, so don’t let anxiety about your child’s condition rub off on your child. Smile.

Note: The information on this website is not a substitute for diagnosis and treatment by a qualified healthcare provider.