Reader Question: My 21-month-old daughter has had a stuffy nose and chest congestion since last fall. Since October she has been on four rounds of antibiotics. A month ago, she had a fever (which resolved with Tylenol) and a bad cough, which persists even after all this time. She was getting better more recently, but when we put her back into daycare she started to get worse again.
Is it possible that she has allergies? If so, what measures should we take to find out to what she may be allergic to?
Dr. Naba Sharif: Dear Rupsha –The question about whether someone has allergies vs. a cold or other respiratory illness (flu, sinus infection etc) is one of the most common questions we get. In fact, it is so common that I have a chart produced by the Department of Health and Human Services noting some general difference that is hanging in my office waiting room.
The only modification I would make to the chart is that decongestants are not a mainstay treatment for allergies. Oral decongestants (many have a "-D" in their name) can have side effects such as increased heart rate and blood pressure, so long-term use is not recommended. Nasal decongestants can cause rebound congestion (worse symptoms) if you use them for more than a few days in a row.
The reason this is such a common question is because both allergies and respiratory illness share many symptoms and so it can be hard to tell the difference. These symptoms include nasal congestion or blockage, runny nose or drainage in the back of the throat (post-nasal drip), cough, and /or headaches or "sinus pressure". However, there are key differences that can help distinguish between them.
Let's start with the sensitive topic of allergies (ba-dum ching!). Allergy symptoms are a result of the immune system's response to a trigger, for example pollen or dust mite, which is identified as harmful. The immune system defends the body against these triggers by activating special cells called mast cells in the lungs, skin, eyes, lining of the nose and intestinal tract. The mast cells release a chemical called histamine, which causes the familar symptoms of sneezing, runny or stuff nose, and coughing. If these symptoms develop suddenly and occur at the same time every year, it's possible they are due to seasonal allergies. They can also be accompanied by itchy, watery eyes or even itching of the skin. Treatment of seasonal allergies includes avoidance of exposure to the trigger (if possible), antihistamines (oral or nasal), nasal steroid sprays, and/or short-term use of decongestants. If symptoms improve with antihistamines alone, an allergic cause is likely.
Respiratory infections, on the other hand, can be triggered by a virus or bacteria, leading to irritation and inflammation of the respiratory tract (the nose, the sinuses etc). This can lead to similar symptoms, though the presence of a fever is highly suggestive of an infectious process. Viral illnesses or colds generally last less than two weeks and get better after about 3-5 days, but if a bacterial infection is left untreated, problems can last from weeks to months. Treatment of a common cold may include rest, fever-reducers, pain relievers and/or over-the-counter remedies such as decongestants or throat lozenges. Treatment for a bacterial infection includes antibiotics with close monitoring by a physician. Adding to the confusion is that those that have environmental allergies can be more prone to having sinus infections as well.
Your daughter -- who has been having problems for months now -- doesn't necessarily seem like she fits the category of allergies or a simple cold. Her fever suggests an infectious process, and the fact that it has been long-term suggests that she may either have a chronic bacterial infection that needs stronger antibiotics or a longer-course (without interruption), or that she has just been getting colds back to back. By the way, children often do get sick more often once they start daycare, because they are exposed to so many other possible infectious agents around other children. Up to about six infections per year are normal in children, unless they are due to unusual organisms or are serious infections requiring hospitalization.
I would recommend having her re-evaluated by her pediatrician for these possibilities. If either of you is still concerned about the possibility of allergies, please do make an appointment to see an allergist. She will likely have allergy skin testing done on her back. I hope this helps and that your daughter feels better soon! Here's a picture to get a smile :)
- Dr. Sharif
Dr. Naba Sharif is director of allergy and immunology at Allergy and Asthma Associates, A Division of Riverside Medical Group, located in Upper Marlboro. She'll be answering your allergy questions regularly on Patch. Email questions to Dr. Sharif at firstname.lastname@example.org.