With the warmth of spring inching across the Wasatch Front and the return of allergy season the time seemed right to write about a common question I get when a child has a constant runny nose, “Doctor, is it Allergies?” With Allergic Rhinitis (Nasal Allergies) affecting somewhere between 10-30% of people in the U.S. there is a pretty good chance you know someone that has to deal with seasonal and sometimes year-round allergy symptoms.
Allergic Rhinitis is the activation (and some say over activation) of your immune system to naturally occurring elements in the environment such as Pollens, Dust, and Animal Dander leading to a cascading biological response and the eventual release of Histamine along the lining of your eyes, ears and nose. This release of histamine leads to the itchy eyes, ears and nose with chronic nasal congestion and discharge we associate with allergies.
So, is every prolonged runny nose allergies? Not always, interestingly in some studies as many as 42% of children aged 0 to 6 at some point will meet the definition of Chronic Rhinitis which is runny nose and congestion lasting more than four weeks. While a large portion of these cases end up being Allergic Rhinitis a significant number end up being non-allergic in origin. Examples of Non-Allergic chronic runny nose include recurrent colds, sinus infections, and irritant induced symptoms with the typical irritants being smoke, perfume and pollution.
This then brings the next question, “How do I tell the difference?” To give an honest answer, even after a decade of practice and seeing countless kids with this complaint, it isn’t always straightforward – so I understand when a parent expresses frustration. In general, infectious causes of runny nose are often accompanied by fever, fatigue and body aches. When these symptoms are present it decreases the probability that the source is allergies. On the other hand, if children have congestion with a clear runny nose accompanied by itchy eyes, ears and nose, and if these symptoms are repeatedly triggered by exposure to an allergen then you have the perfect story for Allergies. One thing to consider is that since Utah has four-seasons a more predictable allergy season can exist with Tree Pollen being in the spring, Grass Pollen in the Summer, Weed Pollen in the fall and a break in the Winter. Individuals with allergies to Animal Dander, Molds and Dust Mites tend to have symptoms year-round. With this said there can be overlapping causes and atypical presentations which may mean taking some time to work it through with your doctor to figure it out.
In children over the age of two, when the story fits allergies, trying a long acting Antihistamine such as Loratadine (Claritin) or Cetirizine (Zyrtec) before seeing a doctor is reasonable. In general, you should see a fairly convincing and reproducible response within a week or two.
If you have no response or partial response to treatment, then consider having a discussion with your doctor about other possible causes and additional treatment options. One of the tools available to help clarify the situation is allergy testing which can be done either by skin prick testing or blood testing. I always caution that just because you have some allergy symptoms doesn’t mean you need testing, especially if they aren’t particularly troublesome or if they are easily controlled. People most helped by allergy testing are those who have near year-round symptoms making it difficult to tell if they are truly allergies and those who have allergy symptoms that need multiple medications to control. In these situations, testing is helpful to determine if they are good candidates for Allergy Shots (Immunotherapy).
If you have additional questions about allergies all the Pediatricians here at Canyon View are available to discuss them further. Also, if you think allergy testing might be needed I’m available to discuss the matter further. Using the training I received while running the Allergy Clinic at Naval Hospital Rota in Spain, I am available to provide Allergy Skin Testing and Allergy Shots.
Patrick McVey, MD
Canyon View Pediatics