A child with a respiratory allergy may have a stuffy and/or runny nose, sneezing, itchy skin and eyes, and/or red, watery eyes. Needless to say, it can be very uncomfortable. Whether the condition is seasonal or chronic depends on the particular allergen involved. Seasonal allergies tend to be caused by pollen, so symptoms recur at about the same time every year, usually when the offending plant is in bloom. Hay fever is an example of a seasonal allergy. Spring hay fever is most often due to pollens from grass and trees, while hay fever in later summer and early fall is usually caused by sensitivity to ragweed pollen and molds.

Ongoing or chronic allergies are usually caused by factors that are present in the environment year-round, such as animal fur, dust, or feathers. Allergic rhinitis is a chronic inflammation of the mucous membrane lining the nasal passages that is caused by an allergic reaction. It is characterized by a stuffy, runny nose, frequent sneezing, and a tendency to breathe through the mouth A child's eyes may be red and watery. Headache, itchiness, nosebleeds, and fatigue may be secondary complications. Dark circles under the eyes (called "allergic shiners"), along with a puffy look to the face, are frequently seen. Infants with chronic rhinitis are frequently allergic to food, most often cow's milk Older children with constantly runny noses are often reacting to wool, molds, feathers, dust, animal dander, and/or pollen. In some cases, a chronic runny nose may not be the result of an allergic reaction, however, and should be distinguished from a more serious underlying illness, such as chronic sinusitis. This is a task best performed by a health care professional.

Whether symptoms occur seasonally or chronically, there is often a family history of allergies; many times a parent or grandparent of an allergy sufferer also had allergies. In the presence of an allergen, a child's immune system releases histamines and similar chemicals to fight what it perceives as an invader. These chemicals cause a string of reactions, including the swelling and congestion of nasal passages and increased mucus production. This is essentially a hypersensitive or overactive response by a child's body to an external stimulus. A growing child becomes more capable of fighting off infections as his immune system matures, and he may also outgrow allergies.

Allergies can also contribute to other chronic health problems, such as acne, asthma, bedwetting, chronic ear infections, eczema, irritability, and even difficulty maintaining concentration. Allergic reactions can occur immediately after exposure to the offending substance, or take days to surface. A delayed allergic reaction can make it more difficult to pinpoint the allergen.

Conventional Treatment
Treatment for an allergy often begins with identifying the allergens that are causing the problem. There are several tests your physician may recommend to identify the particular allergens that are making your child's life miserable:

• Scratch testing consists of placing a small amount of diluted allergen on a lightly scratched area of skin. If a bump develops there within fifteen minutes, your child is probably allergic to that substance.

• Intradermal testing is done by injecting the skin with suspected allergens at timed intervals. A control injection (one containing no allergen) is also given. If an allergen produces a wheel (a red, itchy bump), your child is allergic to that substance. An intradermal test is more accurate than a scratch test, but there is a greater risk that a child might suffer a severe reaction.

• Blood testing (a radioallergosorbent test, or RAST) measures total and specific levels of IgE and IgG, which are antibodies produced by the body's immune system. An elevated level of either of these may indicate an allergic reaction to the substance being tested.

Once testing has been completed, treatment may be recommended. Antihistamines are the medications most commonly used for respiratory allergies. Antihistamines work by blocking the action of chemicals called histamines, which are produced by the body in reaction to the presence of an allergen. Histamines cause swelling and congestion of nasal passages and increased mucus production. By blocking their action, antihistamines diminish allergic symptoms. Brompheniramine (in Allerhist and Dimetane, among others), diphenhydramine (Benadryl), and chlorpheniramine (Chlor-Trimeton) are common over-the-counter antihistamines suggested for respiratory allergies. Prescription antihistamines include azatadine (Optimine, Trinalin), clemastine (Tavist), astemizole (Hismanal), promethazine (Phenergan), and terfenadine (Seldane). Terfenadine and astemizole are relatively new medications that have the benefit of not causing the drowsiness that other antihistamines do. Check with your doctor before giving your child an antihistamine. Some of these medicines are not recommended for children under two years of age.

Cromolyn sodium (Intel or Nasalcrom) is a prescription medication that can be taken as a nasal spray to prevent the symptoms of respiratory allergies. It works by coating the membranes of the nose and stabilizing the white blood cells so that they do not react to foreign substances. In some cases this drug can cause gastrointestinal upset or throat and nose irritation, but it usually produces few side effects and is generally considered safe because it is minimally absorbed into the bloodstream. Its major drawback is that it must be used consistently, six times a day, for at least two weeks before it begins to take effect.

Decongestants decrease nasal congestion and swelling by constricting the blood vessels in the nasal membranes, thus allowing the mucus to drain more effectively. Decongestants are available as pills, nasal drops, and nasal sprays. These include oxymetazoline (in Afrin, Dristan, Neo-Synephrine 12 Hour, Sinex, and others), phenylephrine (in Alconefrin, Allerest, Coricidin Decongestant Nasal Mist, Neo-Synephrine, and Vacon), phenylpropanolamine (found in many common over-the-counter formulas, including Bayer Children's Cold Tablets, Contac, Coricidin D, Ornex, Sine-Off, Sinutab, St. Joseph Cold Tablets for Children, and Triaminic), and pseudoephedrine (Cenafed, Neo-Fed, Novafed, Sudafed, or Sudrin). These medications have a number of common side effects, including restlessness and insomnia. Also, if a spray or drop form is used for more than three or four days in a row, it creates a dependency that results in a rebound—or worsening of symptoms--when the medicine is stopped. Check with your doctor before giving your child a decongestant. Some of these medicines are not recommended for children under two years of age.

An increasing trend has been to use steroid inhalant sprays such as triamcinolone (Nasacort) and beclomethasone (Beclovent, VanceriL Vancenase, or Be conase). They are especially useful for older children who suffer from chronic allergic rhinitis. These are powerful anti-innammatories, and decrease swelling and mucus production as well as the oral antihistamines do, without causing sedation. When used as nasal sprays, steroids tend to be well tolerated and safe, and they can be very effective. By contrast, nasal decongestant sprays (such as Afrin, Neo-Synephrine, and others), while highly effective for a few days, will rapidly produce dependency and should be avoided.

When antihistamines offer no relief, desensitization is sometimes recommended for the relief of allergies. This involves the injection of gradually increasing amounts of allergen into the body over a period of time. However, the procedure is complicated and costly, requires careful supervision by a physician, and is not always effective. It should be tried only in cases where no other form of treatment affords any relief.

Dietary Guidelines
Eliminate dairy foods from your child's diet. Dairy foods can thicken mucus and stimulate an increase in mucus production. If your child's allergies are seasonal, it may also be helpful to avoid whole wheat during the allergy season, as many children are sensitive to this food.

A child who has respiratory allergies may also be allergic to certain foods. In addition to dairy products and wheat, common culprits include eggs, chocolate, nuts, seafood, and citrus fruits and juices. Try eliminating one of these foods for a few weeks and watch for an improvement. Use an elimination or rotation diet to discover and work with food allergies (see Elimination Diet or Rotation Diet). Or keep a diary recording your child's symptoms and the foods eaten.

Encourage your child to drink lots of water to thin secretions and ease expectoration.

Cut out cooked fats and oils. When your child's body is under any type of stress, including the stress of an allergic reaction, the digestive system is not as strong as usual, and fats—which are difficult to digest at the best of times—can put a strain on the digestive system. Also, undigested fats contribute to mucus production and foster a toxic internal environment.

Nutritional Supplements
For age-appropriate dosages of nutritional supplements, see Dosage Guidelines for Herbs and Nutritional Supplements.

Beta-carotene is used by the body to make vitamin A. It also heals and soothes irritated mucous membranes. If your child's allergies are chronic, try giving him one dose of beta-carotene, twice a day, for two to three months. If his allergies are seasonal, give your child one dose of beta-carotene a day during the allergy season.

Bioflavonoids are potent anti-inflammatories with specific antiallergenic effects. They are chemically related to cromolyn sodium (discussed on page 90, under Conventional Treatment). They are best taken with vitamin C. Give your child one dose, three times a day, for two weeks.

Calcium and magnesium are important nutrients for the allergy sufferer. They help to relax an overreactive nervous system. Give your child one dose of a supplement containing 250 milligrams of calcium to 125 milligrams of magnesium, twice a day, while symptoms are acute. Then give the same dosage, once a day, for two months.

Essential fatty acids, such as those found in evening primrose, borage, black currant, and flaxseed oils, help to regulate the inflammatory response. You can give your child one or more of these oils either in capsule form or mixed into food such as salad dressing or butter. Follow dosage directions on the product label and give your child one dose of evening primrose oil, borage oil, black currant oil, or flaxseed oil, three times a day, for two weeks. Then give your child the same dose, once a day, for one month.
Note: Evening primrose oil should not be given to a child who has a fever.