Allergy conditions are common in children, whose sinuses continue to develop well into the teen years. Allergy and sinus symptoms are similar, making a proper diagnosis a bit challenging. An ENT specialist can recommend diagnostic testing to help pinpoint the cause of what is ailing your child.
How Allergies Affect Your Child’s Ear, Nose and Throat
One of the most common medical problems children experience is otitis media, or middle ear infection. In most cases, allergies are not the main cause of ear infections in children under two years old. But in older children, allergies may play a significant role in ear infections, fluid behind the eardrum or problems regulating ear pressure. Diagnosing and treating allergies is an important part of healthy ears.
Allergies often generate mucus, which can make the nose run or drip down the back of the throat, leading to “post-nasal drip.” It can lead to cough, sore throats, and a husky voice.
Chronic nasal obstruction is a frequent symptom of both seasonal and year round allergic rhinitis. Congestion caused by this can contribute to sleep disorders such as snoring and obstructive sleep apnea. This can lead to fatigue, which is one of the most common, and most debilitating, allergic symptoms. Fatigue not only affects a child’s quality of life, but has been shown to affect school performance.
Allergies should be considered in children who have persistent or recurrent sinus disease. Depending on the age of your child, their individual history, and an exam, your doctor should be able to help you decide if allergies are to blame.
Food Allergies in Children
Food allergies may cause a wide range of reactions to the skin, respiratory system, stomach, and other physiological functions of the body. Determining what foods are the cause of an allergic reaction is vital to treatment. But before you identify the source, you must consider what type of food allergy your child has. There are two types, classified as:
- Fixed (immediate) food allergies: When an immediate food reaction occurs, symptoms occur within hours of ingestion. Symptom onset is rapid and may include tingling of extremities, wheezing, coughing, tightening of the throat, nausea, abdominal cramps, and diarrhea. Sometimes in cases where nuts, shellfish and fish have been eaten anaphylaxis may occur. Blood testing (i.e., RAST test) is typically used to verify fixed food allergies. Approximately 5 to 15 percent of food allergies are of the fixed variety.
- Cyclic (delayed) food allergies: Symptoms of a delayed food allergy can take up to 72 hours to appear. Unlike fixed food allergies, this allergic response is cyclical in nature. Cyclic food allergies are more common than fixed food allergies, accounting for approximately 85 percent of cases, although usually a little more difficult to identify.
Diagnosis and Treatment of Cyclical Food Allergies
If your child is experiencing allergic reactions to food of unknown origin, you should ask, “Are there any foods that my child craves or any food that I avoid offering?” These foods may be the ones that are causing difficulties for the young patient.
Your physician may suggest the Elimination and Challenge Diet. This dietary test consists of the following steps:
- Keep a detailed food diary, tracking what was eaten (including ingredients), when it was eaten, medications taken, and any symptoms that developed. Be honest! Some well-meaning parents or caregivers often create a food diary that looks healthier than it really is. Your child can receive the best diagnosis if the diet records are accurate, timed precisely, and truthful. The diet diary can be evaluated by the doctor to identify food items that may be the culprits.
- Conduct an elimination and challenge diet at home based upon your physician’s assessment of your child’s diet diary. It is best if you carefully maintain a new diet diary for your child during this period. During this diet, your child must abstain from one, and only one, of the possible food culprits at a time for a period of four days. This can be difficult to carry out if the food is very common, such eggs or cereal, so you need to pay strict attention to your child’s diet during the elimination phase. Any cheating will invalidate the results. On the fifth day, you will be asked to feed your child the suspected culprit food item. This is the challenge! Provide your child an average-sized portion of the food in question to be eaten in five minutes. In one hour the child should eat another half portion if no symptoms have developed. Any symptoms that develop are then timed and recorded. With a true cyclic food allergy, you would expect a significant worsening of the symptoms described in the original diet diary, although the challenge symptoms may vary as well.
- If the Elimination and Challenge Diet confirms a cyclic food allergy, then you will be asked to abstain from feeding your child this food for a period of three to six months. After this time you can slowly reintroduce the food on a rotary basis; it is not to be eaten more frequently than every four days (once or twice a week).
For minor, moderate discomfort from the testing, the caregiver may choose to offer one the following: 1) a child’s laxative to decrease the transit time through the digestive system; 2) Alka Seltzer Gold; 3) Buffered Vitamin C (one gram).
Fixed food allergies should never be deliberately challenged unless under the direct supervision of a physician.
Call Charleston ENT & Allergy at (843) 766-7103 for more information or to schedule an appointment.