How to recognize and treat a pediatric allergy: What parents should know

Learning that your child has an allergy can raise a lot of questions and concerns for parents, and it’s perfectly normal to feel uncertain about what to do next. Allergies in children are common, affecting more than one in four kids in the United States. They can range from mild seasonal sniffles to serious food reactions. With the right diagnosis and treatment plan, a pediatric allergy can be effectively managed.

Let’s dive into why children develop allergies, the signs and symptoms of allergies, how they’re diagnosed, treatment options and additional steps to take after an allergy diagnosis.

Why do children develop allergies?

Children develop allergies when their immune system mistakenly identifies a normally harmless substance as a threat, such as pollen, pet dander or certain foods. In response, the body produces allergic antibodies and releases chemicals like histamine, which cause the symptoms of an allergic reaction.

While the exact cause of allergies isn’t fully understood, genetics may play a role. If one or both parents have allergies, your child is more likely to develop them, too. Environmental factors may also contribute to the development of allergies, especially early in life. Exposure to certain allergens, air pollution or changes in gut health can influence how a child’s immune system develops.

Some children outgrow certain allergies over time, and others may carry them into adulthood.

How do you diagnose a child with an allergy?

Diagnosing a child with allergies typically starts with a visit to your child’s pediatrician, who will look at your child's symptoms and medical/family history. You might be asked about when the symptoms started, how often they occur, if anyone else in your family has allergies, and whether they seem linked to certain foods, environments or seasons.

Depending on the type of allergy suspected, your pediatrician may refer you to an allergist for further testing. The most common tests typically done in an allergy clinic include:

• Skin prick testing, where small amounts of potential allergens are introduced into the skin to check for reactions.
• Blood tests, which measure the immune system’s response to specific allergens by detecting IgE (allergic) antibodies that play a role in allergic reactions.

These tests help identify the exact cause of your child’s allergic reaction and guide treatment plans moving forward.

Common signs and symptoms of allergies in a child

Symptoms of a pediatric allergy can vary widely based on the type of allergen and the severity of the reaction. In some cases, symptoms are mild and go unnoticed. In others, they can be more immediate and intense.

Some common symptoms of a pediatric allergy to look out for include:

• Sneezing, nasal congestion, runny nose or itchy/watery eyes
• Skin rashes such as hives or eczema 
• Coughing, wheezing or shortness of breath
• Lip/facial swelling, abdominal pain, vomiting or diarrhea (particularly with food allergies)

In more serious cases, an allergic reaction can lead to anaphylaxis, a life-threatening emergency that can cause trouble breathing, swelling of the throat and a sudden drop in blood pressure. If your child has a known severe allergy, you may be advised to carry an epinephrine device.

Determining if your child has food or seasonal allergies

Understanding what kind of allergy your child has helps guide both treatment and lifestyle changes. The most common types of allergies in children are food and environmental allergies.

Food allergies often cause symptoms shortly after a child eats or comes into contact with a particular food. The most common triggers in children include milk, egg, peanut, tree nuts, soy, wheat, fish, shellfish and sesame.

On the other hand, seasonal allergies usually pop up during specific times of the year when pollen levels are high. If your child frequently has sneezing, itchy eyes or nasal congestion during the spring or fall, seasonal allergies could be the cause.

Some children may also have allergies to indoor allergens like dust mites, pet dander or mold, which can cause year-round symptoms.

What are the treatment options for children with allergies?

Treating allergies in children often involves a combination of avoiding the allergen, managing symptoms and planning for potential emergencies. Once your child’s allergies are diagnosed, your healthcare provider will work with you on a plan that’s tailored to your child’s specific needs.

Avoidance

This is typically the first line of defense when dealing with allergies. For example, if your child has a food allergy, you'll need to read ingredient labels carefully to ensure your child avoids ingestion of the food allergen. For environmental allergens like dust mites or pet dander, minimizing exposure at home can make a difference.

Medications

For children with allergies that are not helped by avoidance only, medication may be used to manage symptoms:

• Oral antihistamines can help control itching, sneezing and hives.
• Nasal steroid or nasal antihistamine sprays can reduce sinus and nasal inflammation caused by environmental allergies.
• Topical steroid creams may be prescribed for skin-related reactions like a rash or eczema.

For children at risk of severe food reactions, a device such as an epinephrine auto-injector or a nasal epinephrine device may be prescribed. It is important that caregivers, teachers and other adults in your child’s life know how to use the epinephrine device in case of an emergency.

Immunotherapy for environmental allergies

For some children, allergen immunotherapy, such as allergy shots or dissolvable allergy tablets taken under the tongue, may be recommended. This treatment involves exposing your child to small amounts of the allergen over time to build tolerance. Allergen immunotherapy is a disease-modifying treatment and is considered a long-term treatment option for seasonal or year-round environmental allergies.

Injection immunotherapy (allergy shots) involves two phases:

1. A buildup phase, where gradually increasing doses of an allergen are given weekly over several months
2. A maintenance phase, where once the optimal dose is reached, injections are spaced out, usually every two to four weeks, to help the body build lasting tolerance to the allergen over three to five years.

According to the American Academy of Allergy, Asthma, and Immunology (AAAAI), allergy shots are typically not recommended for children under the age of five due to the demands of the treatment schedule and the child’s ability to communicate symptoms. Allergy shots are also not used to treat food allergies, so they may not be suitable for some children.

Some new, FDA-approved treatments are now available for children with food allergies. There is an injectable medication called omalizumab that can be given to a child with a food allergy every few weeks to prevent a severe allergic reaction from occurring due to accidental ingestion of a food allergen. For peanut allergic children, peanut oral immunotherapy is also an option.

5 tips for managing a pediatric allergy

Once your child receives a definitive diagnosis of an allergy, the process of managing it begins. Here are five tips to get you started:

1. Work with your pediatrician or allergist to develop an allergy management plan.
2. Make sure your child understands what they’re allergic to and how to avoid it, as age-appropriate.
3. Share your child’s allergy plan with family and friends, caregivers, teachers and school staff.
4. Stay up to date on follow-up appointments with your child’s pediatrician or allergist, and adjust your management plan as your child grows or as their symptoms change.
5. Keep a diary of symptoms and reactions, which can help guide future treatment decisions.

Your child can thrive despite allergies. Talk with your pediatrician or an allergist about testing options, the best ways to treat and manage allergies in children and how to create a safe and healthy environment for your child.

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