How Do I Know If My Child Has Allergies?

How can you know if your child has allergies? What are the symptoms usually seen first in very young children, and how does this change over time?

The Progression of Allergies in Children

Allergies present in different ways in different age groups. In infants and young children, allergic disease occurs as atopic dermatitis (eczema) or as food allergies. Children with atopic dermatitis are at increased risk of developing allergies and asthma, which are more likely to occur in the toddler years to school-age. This pattern of progression from one form of allergic disease to another is referred to as the “atopic march.” Atopic is a term that physicians use to mean that someone is allergic to various things (foods, environmental triggers such as pollens, molds and pet dander, for example).

Atopic Dermatitis

Atopic dermatitis, an itchy skin rash, is typically the earliest manifestation of allergies. Atopic dermatitis is seen in 10% to 20% of all children and is frequently seen during infancy. Atopic dermatitis, or eczema, is characterized by itching, with rash formation at the sites of scratching. The rash is typically red and dry, may have small blisters, and can flake and ooze over time.

In infants and very young children, this rash involves the face (especially the cheeks), chest and trunk, back of the scalp, and may involve the arms and legs. This distribution reflects where the child is able to scratch and areas that get dry, and therefore usually spares the diaper area. The location of the rash changes in older children to classically involve the skin in front of the elbows and behind the knees. Food allergies and environmental allergies have been shown to worsen atopic dermatitis. It is important to note that in many cases of atopic dermatitis, children will still have symptoms even if they avoid all their food and/or environmental allergens.

Food Allergies

Food allergies can also present in infants and young children and usually occur after the introduction of solid foods. Almost all children with food allergies will have some form of skin symptoms as a result of eating the culprit food, such as hives and swelling, itching or redness of the skin. These symptoms typically occur within a few minutes of eating the food in question, although can be delayed up to a couple of hours.

Sometimes it can be hard to tell if a reaction to food is a food allergy. It's important to learn about the differences between food allergies and food intolerance.

Other symptoms of food allergies in young children can include nausea, vomiting, stomach aches, diarrhea, breathing difficulties (asthma symptoms), runny nose, sneezing, and lightheadedness. In some cases, children can experience a severe allergic reaction, called anaphylaxis, which can be life-threatening.

Food Allergies Doctor Discussion Guide

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Nasal Allergies

Allergic rhinitis (also called hay fever) will occur in more than 50% of those children with atopic dermatitis. While most children won’t start to experience allergic rhinitis until grade school age, some children develop it sooner. Most children with allergic rhinitis experience symptoms from pets, dust, and mold at an earlier age and from pollens at a later age.

Symptoms of allergic rhinitis include sneezing, runny nose, itchy nose and eyes, and nasal congestion. Some children may also experience post-nasal drip, allergic shiners (dark circles under the eyes), and a line across the nasal bridge from an upward rubbing of the palm of the hand on the nose, a sign called the “allergic salute.”

Asthma

Asthma occurs in about 8% of all people and is the most common chronic disease in children. The majority of cases of asthma are due to allergies. In fact, between 15% and 38% of children with allergic rhinitis will develop asthma. Asthma can occur at any age, although is most often seen in males in the pre-teen years and in females in the teenage years. Sometimes asthma is difficult to diagnose in very young children and may require a physician who is an asthma specialist.

Symptoms of asthma may include:

• Coughing: This can be the only symptom in some children who have “cough-variant asthma." The cough is often dry, hacking, and worse at night and after exercise. Some children cough so hard that it causes them to vomit. Keep in mind that there are many causes of a cough, and not all coughing is due to asthma.
• Wheezing: Wheezing is a high-pitched, musical-like sound that can occur with breathing in and out in children with asthma. This usually gets worse with other asthma symptoms, and flares with exercise and other asthma triggers. Keep in mind that not all wheezing is due to asthma.
• Shortness of breath: Some children may get out of breath faster than their friends, and as a result, become less active. Children with more severe asthma have shortness of breath at rest or wake-up with this during the night. As with wheezing, not all shortness of breath is due to asthma, and causes in children can range from a foreign body in the airways to acid reflux.
• Chest tightness: A child may describe this as a feeling of someone squeezing or hugging them. Other children say that the chest hurts or feels “funny."

Other symptoms that are not specific to asthma include infants with feeding difficulties, children who are tired all of the time or who avoid sports and other activities, and children who have difficulty sleeping.

If You Suspect That Your Child Has Allergies

If your child is experiencing any of the above signs or symptoms, they may have allergies. It is recommended to see your child’s doctor so that a diagnosis can be made, or a referral sent to an allergist/immunologist for specialized allergy testing.