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Allergies...or a Cold?
How to tell, how to treat
By Christine W. Wagner, RN, MSN, CPNP, AE-C
Spring brings new challenges to parents of children with asthma and allergies. The end of winter means more time outdoors, an increase in activities and greater exposure to allergens and infections.
With the end of the school year, the days becoming longer and the summer season approaching, many parents and children think that viral infections are no longer a concern. There might be less vigilance when it comes to watching for ill contacts and washing hands thoroughly. Unfortunately, viruses persist into the spring. Spring is also the time of blossoming trees, grasses and increased mold levels — making allergies an even bigger issue.
Allergies
Many of the allergens at home are also in the school. Look for triggers such as carpeting, plants, animals and air fresheners, and dust catchers like area rugs, upholstered furniture and stuffed animals. Eliminating triggers in the school, though more difficult, can be done. Now is the time to work with the school district on planning to reduce classroom allergens when school resumes in the fall. Most schools are eager to provide a healthy environment for their students and are willing to make the necessary changes. If you work closely with the Parent Teacher Organization (PTO), you can help facilitate healthy changes throughout the school.
Schedule an appointment with your child’s health care provider. Spring brings new allergens, and beginning treatment before allergy symptoms occur is much more effective. If your child has spring allergies, inhaled nasal steroids (INS) should be started early. Make  sure you have refills for all of your child’s medications, and when school is over be sure to get any medications left in the nurse’s office. Schools typically have to discard medications before closing up for the summer.
Viruses
For the child with allergies and asthma, colds can lead to more severe symptoms and exacerbations of their allergies and, especially, their asthma. Prevention is the best method of treating viruses. Frequent hand washing is critical year round. Teach your children to wash their hands frequently. Alcohol-based soaps are very effective in killing germs. Some studies show that these hand cleansers are more effective than soap and water, mainly because children rarely wash their hands as well or as long as is needed to kill bacteria and viruses. Keep a bottle near the door you use most often, and encourage everyone to use it whenever coming into the house. In addition, keep immunizations for common childhood diseases up to date.
Cold Versus Allergies
Parents ask frequently how they can decide if their child has a cold or allergies. The following chart helps to distinguish cold from allergy symptoms.
| SYMPTOM |
COLD |
ALLERGY |
| RUNNY NOSE |
Clear, changing to thick yellow and sometimes green |
Clear, thin and watery |
| FEVER |
Low-grade, usually less than 100° F |
None |
| MUSCLE ACHES |
Usually |
None |
| ITCHING |
Rare |
Eyes, ears, nose, mouth |
| SNEEZING |
Intermittent or one at a time |
Groups of rapid sneezes in multiple sequence |
| DURATION |
5 to10 days (colds that seem to linger may indicate other respiratory illnesses) |
Seasonal and/or for many weeks and/or ongoing |
 Treatment for Allergies
For children with known allergies, there are several good over-the-counter (OTC) antihistamines. Talk to your healthcare provider about which antihistamine is right for your child. These non-sedating antihistamines are approved for children two years and older. Sedation is a concern even in children. One study showed that children taking a sedating antihistamine had a lessened ability to comprehend and retain information. Sedation can also lead to accidents while children are riding bikes, skateboarding and participating in other sports activities if their responses are delayed, a common effect of sedation.
Treatment for Viruses
New recommendations have been made regarding OTC cough and cold preparations. Now these preparations are not recommended for children under age 6. Studies show that these preparations are not effective in children under 6, and one study found that over 7,000 Emergency Department visits were made in one year for adverse drug effects from these medications in children younger than 12. The American Academy of Pediatrics (AAP) recommends the following steps to treat the symptoms associated with viruses.
 • Nasal saline spray is one line of treatment for colds or allergies. For copious secretions, nasal washes with any of the commercially available devices found at the pharmacy are another option. You can also buy saline solution packets. Saline or salt water washes the mucus from the nose, reduces congestion and facilitates the fl ow of mucus. You will want to check with your health care provider before deciding on the best treatment for your child. Remember to follow the instructions on the package for any device you are using to administer the treatment.
• For chest congestion, gently tapping on your child’s back with cupped hands can help loosen mucus.
• Use a cool mist vaporizer.
• For a cough, give one-half teaspoon of honey to children aged 2 to 5 years, one teaspoon to 6- to 11-year-olds and two teaspoons to children 12 years of age or older. Brush teeth afterwards. NEVER give honey to children under one year.
• Give acetaminophen or ibuprofen if your child has a fever, as instructed by your health care provider.
Whether allergies or a cold are the cause of any discomfort, prevention or using appropriate therapies early will help make the trip into summer a smooth ride. When symptoms do occur, always try non-medication measures first, and consult your health care provider if they do not help or if your child’s symptoms seem to be getting worse.
Christine W. Wagner, RN, MSN, CPNP, AE-C, is a certified PNP and asthma/allergy educator. She is the program manager of the Comprehensive Asthma Center at Children’s Medical Center, Dallas, TX.
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