Allergies

How can I tell if my toddler has allergies or just a cold?

Because the symptoms of nasal allergies (also known as allergic rhinitis) are much like cold symptoms — runny nose, watery eyes, cough, nasal congestion, sneezing — it can be tough to tell the difference. There are some telltale signs of allergies, though. Ask yourself the following questions:

• Does it seem like your toddler always has a cold? (Colds usually wind themselves down in a week to ten days; allergies don't.)

• Is your toddler's nose always stuffy or running?

• Is she constantly wiggling, wiping, or pushing her nose up in what doctors call the allergic salute?

• Is the mucus that drains from her nose clear and thin (as opposed to yellow or greenish and thick)?

• Does she seem to sneeze a lot?

• Are her eyes itchy, red, and watery?

• Does the skin under her eyes look dark or purple or blue (doctors call these allergic shiners)?

• Does she breathe through her mouth?

• Does she have a dry cough?

• Is her skin irritated or broken out in an itchy red rash?

If you answered "yes" to one or more of these questions, there's a good chance your toddler is allergic to something in her environment. Kids with nasal allergies are also more prone to ear infections, asthma, and sinus infections.

What causes allergies?

An allergy is a special immune reaction to a substance in the environment. When a child with allergies comes into contact with one of these substances, known as an allergen — either by touching it, breathing it, eating it, or having it injected — her body views it as a dangerous invader and releases histamines and other chemicals to fight it off. These chemicals irritate the body and cause symptoms such as a runny nose, sneezing, itching, and coughing.

Possible allergens include food, drugs, insects, animal dander, dust mites, mold, and pollen. Depending on the type of allergy, it can cause respiratory symptoms (allergic rhinitis), skin symptoms (like eczema), or intestinal problems (from food allergies, for example).

When it comes to nasal allergies in babies and toddlers, these are the most likely culprits:

• Dust mites — microscopic organisms that thrive on human skin flakes (nearly 85 percent of allergy sufferers are allergic to dust mites)

• Animal dander — those white flaky specks (shedding skin and hair) on cats, dogs, and other furry animals

• Molds — fungi found in wet, damp places such as bathrooms and basements

Some children are allergic to down and feather pillows, or chenille or wool blankets. And while most experts don't think children can be allergic to tobacco smoke, it can certainly make their allergic symptoms worse.

A child will inherit the tendency to be allergic, but not necessarily the specific allergies. For example, if one of your child's biological parents has hay fever or pet allergies, there's a 50 percent chance that your child will have some sort of allergies as well. That probability jumps to 75 percent when both biological parents have allergies. Family members may differ widely in the kinds of things they are allergic to.

If my toddler is allergic, when will I know?

It can take time for an allergy to develop. Each allergic person has a threshold that must be met before an allergy causes a reaction, and this can take several months.

So if your toddler inherited a tendency to be allergic to cat dander, she may have no trouble at all for the first few months she's around Fluffy, or she may have a reduced reaction. But then one day, when the exposure level reaches her threshold, her body will react and mount an offense against it.

Seasonal allergies to things such as pollen and grass usually don't rear their ugly (and stuffy) head until a child is about 3 to 4 years old.

How can I figure out what my child is allergic to?

It takes some careful detective work and sometimes the help of medical tests to pinpoint the exact cause of an allergy. One clue may be when the allergy attacks occur.

Mold allergies usually develop during damp or rainy weather and can be hard to distinguish from colds. Dust mites or pet allergies often cause morning congestion throughout the year. Pollen-related allergies are more common in spring, summer, and fall.

Unfortunately, sending Fluffy away for a few days won't tell you for sure whether your toddler has a pet allergy. Studies at Johns Hopkins University suggest it can take more than a year for cat dander to degrade in a room, for example.

On the other hand, if you take your toddler away from the pet (on vacation, for example) and she seems better, then you have a good — but by no means conclusive — lead. (You'd also want to consider that your toddler might be allergic to something else in your house.)

If your own sleuthing doesn't give you the answer, it's time to see the doctor. He'll examine your toddler and ask lots of questions. If he believes the problem is allergies, he may refer you directly to an allergic specialist or he may suggest a blood test to measure levels of IgE (allergy) antibodies in your toddler's blood.

Blood tests may be less accurate than skin tests. So if the blood test does suggest an allergy, the next step for your little sniffler is a skin test. You'll need to see an allergist for that.

During a skin test, an allergist applies small amounts of common allergens to your child's skin. If your toddler is allergic to a substance, she'll have a reaction (similar to a mosquito bite) on that spot.

"Keep in mind that testing tells you what your child is allergic to at that point, but it may change as your child gets older," says Seattle pediatric allergist Frank S. Virant. If your toddler has a negative skin test but continues to have allergy symptoms, have her reevaluated in six to 12 months.

How are allergies treated in toddlers?

The most important thing you can do is reduce your child's exposure to the allergen. Here are the best ways to do that for the most common allergens:

Dust mites
Dust mites live in fabrics and carpets and are common in every room of the house. But most children are exposed to the most dust mites in the bedroom, where mattresses and pillows are veritable dust-mite condominiums.

The following steps may seem like a lot of work, but they really help. "Parents who take these steps might expect a 60 to 70 percent rate of improvement in their child's allergies," says Virant, "and this should markedly cut down the level of medication needed for the problem."

• Encase your toddler's mattress and pillow in an impenetrable cover made of very tightly woven fabric, found at allergy supply stores. Unlike vinyl covers, these provide a useful barrier that's breathable and not crinkly. Avoid big, fluffy comforters and use blankets instead.

• Wash bedding once a week in hot water to kill dust mites. Set your water heater to about 130 degrees Fahrenheit before laundering bedding. Don't forget to turn the water heater back down (to about 120 to 125 degrees) afterward so family members won't scald themselves when they go to wash their hands.

• Avoid piling up stuffed animals in your child's room — they're dust-mite magnets. Wash the few favorites your toddler can't live without in hot water weekly or stick them in the freezer for an overnight killing frost.

• Dust and vacuum weekly or every other week, but make sure your child isn't in the room when you do it. The action of dusting and vacuuming can stir up residual dust-mite particles in the room. Wet mopping can help prevent this.

• Consider investing in a vacuum cleaner with a HEPA (high efficiency particulate arresting) filter, which traps even microscopic particles that pass right through ordinary vacuum cleaners.

• If your toddler has a severe dust mite allergy, consider tearing up carpeting and replacing it with a smooth floor.

• Clean or replace filters on furnace and air-conditioners monthly during seasons they're in use. Have heating ducts cleaned each fall.

Pet dander
If your child is allergic to a pet, the only foolproof solution is to give the animal away. That's not an easy decision to make, of course, and, understandably, you'll want to consider it only as a last resort.

To keep the dander down, wash your pet frequently. (You can find shampoos that reduce dander in the pet store.) Also keep your pet off the furniture and out of your toddler's room.

Molds
Use a dehumidifier and air conditioner when the weather is warm and moist, especially in a wet basement or other areas of your home where mold growth is a problem. If your bathroom is a mold factory, clean it regularly with mold-inhibiting disinfectants, such as a little bleach and water or a natural solution like tea tree and water. And consider investing in a better ventilation system.

Mold can often be found growing in closets, attics, cellars, planters, refrigerators, shower stalls, and garbage cans, and under carpets. Even a fake Christmas tree can harbor mold.

Are there any medications that can help my child?

Yes, but don't give her over-the-counter allergy medicine without talking to your doctor first. He may suggest antihistamines and possibly offer you a prescription. Many of the newer allergy medicines have fewer side effects than other products on the market.

What can I do to prevent my child from getting allergies in the first place?

At this point, there's lots of conflicting information about preventing or delaying allergies by postponing — or accelerating — a child's exposure to potential allergens.

"Some day we will be able to look at genetics and really be able to know what a child is destined to be allergic to," says Virant, "But the reality is that, right now, there's nothing that predictably helps."

Of course, if you or your mate is allergic to cats, you won't want a feline in the house anyway. (Ditto for any other allergy-causing animal or substance.) And keeping your home — and in particular your toddler's room — clean and as free of mold and dust mites as possible is a good idea, regardless of whether your child has allergies.