A Child’s Allergies Are Serious but Can Be Treated Effectively

IT starts with a telltale sniffle, itchy eyes and an occasional cough. You think your little one is getting a cold, but the cold never comes while the runny nose seems never to leave.

“That could be a sign of allergies,” says Dr. Kevin Weiss, an expert on allergies and president of the American Board of Medical Specialties. Not a surprising diagnosis when you consider that more than 40 percent of children (and 20 to 30 percent of adults) suffer from allergic rhinitis, often simply called allergies. With spring pollen season just around the corner, parents are bound to hear more of those telltale sniffles.

Allergies are no trivial matter. Each year, allergic rhinitis accounts for two million missed school days and $2.3 million in health care costs for children younger than 12. It’s not unusual for allergy sufferers to spend thousands of dollars each year on doctor visits, medications and other products, says Dr. Linda Cox, an allergist practicing in Ft. Lauderdale, Fla., and a former committee chairwoman for the American College of Allergy, Asthma and Immunology

What’s more, Dr. Cox said, allergies left untreated in children can often lead to asthma, a chronic and debilitating pulmonary disease.

For the purposes of this article I’ll focus on allergic rhinitis, particularly among children. (The subject of food allergies may warrant a separate, future column.) The condition can be set off by outside elements like pollen from ragweed, grasses and trees and indoor allergens like dust mites and pet dander.

Combating allergies often requires a multipronged and sometimes costly approach. Here’s what you can do to make sure your child gets the best results.

THE RIGHT DOCTOR Most allergies can be identified and treated by a pediatrician or family doctor. The doctor will use blood tests and your child’s symptoms to come up with an educated guess on what is causing the problem.

“Mild allergies can be treated without a lot of testing,” Dr. Weiss said. New nondrowsy prescription and over-the-counter medications make it easier to treat symptoms, he added. Your child’s doctor should know which drugs are appropriate for children.

That’s good news, because allergists aren’t always part of an insurer’s network or covered under high-deductible plans.

Nevertheless, an allergist can best treat your child if symptoms become moderate to severe. If your child is extremely uncomfortable, losing sleep or missing a lot of school, and the current medications he or she is using aren’t working, you may need to take the next step. An allergist will most likely do a skin test to pinpoint exactly what your child is allergic to. This is often more precise than the blood tests and is usually covered by insurance.

To find an allergist, ask your pediatrician or family doctor for a recommendation or log onto the doctor locator sponsored by the American College of Allergy, Asthma and Immunology. If you’re covered by an H.M.O. or other health network, you’ll need to ask your primary physician for a referral.

ELIMINATE THE SOURCE After you and your child’s doctor have narrowed down the possible culprits, it’s time to reduce or remove the troublemakers. Many of the most effective ways to do this are labor-intensive but low in cost, said Dr. James Sublett, an allergist in Louisville, Ky., and professor of pediatric allergy and immunology at the University of Louisville School of Medicine.

Keep your pet away from carpeted rooms, sleeping areas, upholstered furniture and other places where it becomes difficult or impossible to remove dander. Cats are the animals that cause the most allergy problems, and cat allergen can remain in a house for an average of 20 weeks after an animal is removed.

If you and your doctor suspect dust mites are a problem, remove drapes, stuffed animals, pet bedding, upholstered furniture and even carpeting from the bedroom. Wash linens frequently. Dust with a moist cloth or an electrostatic fabric duster. Both do a better job of actually collecting dust rather than just stirring it around. Remember: dust takes a couple of hours to settle after cleaning and vacuuming.

Tumble-drying stuffed animals on high heat for 20 minutes will also kill dust mites.

Get rid of any pest problems, like roaches or mice. Both can be huge allergy triggers. In addition, keep windows closed during peak allergy season.

CONSIDER IMMUNOTHERAPY Even after you’ve identified and tried to eliminate the source of your child’s allergies, he or she may still be suffering. If that happens, you may have to go for the shots.

Allergy shots have come in for criticism over the years because, well, they are shots and require repeat visits to the doctor’s office — two things children really don’t like.

And many parents may wonder — in some cases, rightfully, alas — whether the allergy doctor is overdiagnosing allergies and overtreating their children. Dr. Cox argues that allergists get to the root of the cause instead of just treating symptoms. General practitioners can prescribe medicines to treat symptoms without easing the condition, she says. In any case, it is important to get a referral from a pediatrician or family doctor whom you trust to do what’s right for your child.

A new study published last month in the peer-reviewed Annals of Allergy, Asthma and Immunology found that allergy shots, also known as immunotherapy, could actually help eliminate allergy symptoms after only 18 months. What’s more, shots may help save you money in the long run. Among the children with allergic rhinitis studied, shots helped to reduce total health care costs by a third, and prescription drug costs by 16 percent, said Dr. Cox, who was a co-author of the study.

In immunotherapy, an allergist injects a small amount of the allergen into a patient. This prompts the body to make natural antibodies, which naturally increase one’s immunity to the culprit. “It is the only therapy that doesn’t just treat allergy symptoms but tries to get at the cause,” Dr. Cox said.

But because the allergist personally mixes the allergens according to a patient’s needs, the shots are not considered pharmaceuticals and are sometimes not covered by insurance.

The first year of allergy shots, which includes a three-month build-up period during which a child receives injections as often as twice a week until the proper dosage is found, would cost a bit less than $1,000 for the year, according to Dr. Cox. The next year, with twice-a-month injections, would total an estimated $350.

For parents who are uninsured and cannot afford shots for their children, Dr. Cox suggests contacting the state allergy society for a list of allergists and clinics that may offer low or no-cost treatments. (Because there is no clearinghouse for such information, you’ll probably have to do your own Web sleuthing.)

AVOID THE UNNECESSARY There’s no end to the number of products marketed to allergy sufferers, including air filters, humidifiers, dehumidifiers, ozone machines, mattress and pillow encasements, special breathing masks and more. Many of these products are expensive and some are ineffective. Ozone, for instance, can be a pollutant and actually worsen allergies, Dr. Sublett said.

Several studies show that there are no significant improvements from using mattress and pillow encasements and other allergy-fighting products. The best thing to do is to take the necessary steps to remove allergens like the ones discussed above.

source: nytimes