Dr. Greene

Allergies & Asthma in Children: How to spot them

Even without sharing any statistics, I’m sure you can tell that the rates of childhood allergies and asthma are climbing. How many kids did you know with these conditions when you were a child? How many children do you know with them now?

Now for those statistics: According to a new report from the U.S. Centers for Disease Control and Prevention, food allergy prevalence increased from 3.4% to 5.1% between 1997 and 2011, while skin allergy prevalence more than doubled in the same time period. That means 1 in every 20 children will develop a food allergy, and 1 in every 8 children will have a skin allergy. And, the picture for asthma is no better. Asthma has become the most common chronic disorder of childhood impacting seven million children under the age of 18. Sadly, African American children have been hardest hit and have seen a 50% increase in rates in the past decade. The reasons for the dramatic increase are not entirely understood, but are thought to be related both to a decrease in healthy protective foods in kids’ diet, and an increase in unhealthy exposures.
The idea that eating peanut butter during pregnancy leads to peanut allergies appears to be a myth – but choosing organic milk over regular milk during pregnancy and nursing does appear to reduce allergies.
Thankfully, advances in the diagnosis and treatment of these conditions have dramatically improved life for these children. But, the most effective interventions are the ones that happen sooner rather than later, which means you need to be empowered to identify if your child has asthma or allergies.

Here’s how to spot them:


Food allergies can be so severe that the most trivial contact with the food causes immediate itching, tingling, and/or swelling of the lips, tongue, and throat. In worst-case scenarios, severe food allergies can trigger full-blown anaphylactic shock and require immediate medical attention. (Note: Most life-threatening food allergies are to peanuts, nuts, shellfish, or fish.)
Usually the symptoms of a food allergy are much more mild and include the following:
  • Babies with food allergies may be fussier than their peers. Colic symptoms can be caused by food allergies (either to the formula or to a food in the mother’s diet).
  • Gastrointestinal symptoms are often the easiest to recognize. A food allergy might cause loose stools, excess gas, diarrhea, nausea, or vomiting. Infants will sometimes have streaks of blood or mucus in the stools, especially with allergies to cow’s milk. Sometimes the amount of blood is too small to see, but still enough to cause anemia. Sometimes food allergies cause constipation.
  • Symptoms or signs elsewhere in the body are also common. These include hives, ear infections, stuffy noses, runny noses, watery or red eyes, wheezing, asthma flare-ups, and eczema. Sometimes eczema (or fussiness) is the only sign of a food allergy, and the eczema (or fussiness) will disappear if the offending food is eliminated.
  • If you suspect any of these, discuss the possibility with your pediatrician.
  • Tip: keep some Benadryl in the house for possible allergic reactions.
  • Tip: there is no evidence that delaying any food beyond 6 months old reduces allergies – but I do recommend avoiding starting the most common allergic foods when a child is on antibiotics.

Nasal and respiratory allergies can be due to seasonal exposures (like pollen) or occur from triggers like pets, dust mites, or even household cleaning or care products.
Watch for the following symptoms:
  • Nasal allergies typically feature a clear nasal discharge with sneezing.
  • There may be itchy, watery eyes and/or a dry cough.
  • Parents often notice a “rabbit nose” — a child crinkling her nose to relieve the itchy sensation inside.
  • The “allergic salute” — rubbing the nose with the hand, sometimes leaving a horizontal crease on the nose — is another common sign.
  • “Allergic shiners” — dark circles under the eyes — have long been associated with allergies, but are less predictive than the other symptoms.
Children with these types of allergies tend to get more ear infections, more colds, and have more sleepless nights than their peers. Far too often, the underlying allergies are missed and children are treated for each symptom as it occurs.  Allergy testing can provide powerful information for taking control of allergies. I’m a fan of testing sooner rather than later, to better understand what is – and is not – triggering allergies in a child.
For most people, an insect bite or sting means redness, swelling, itching, and potentially some pain. But, for some, the venom causes an overreaction from their immune system. That’s an insect allergy.
Here’s how to distinguish the two:
  • Some immediate reactions are classified as local (a two – or three-inch area of swelling, redness and pain that lasts less than 24 hours). Others qualify as large local reactions (those that are larger — often an entire limb — or that last longer, but all symptoms are adjacent to stings).
  • Systemic reactions are allergic responses distant from the sting and include symptoms such as hives, generalized itching, generalized swelling, low blood pressure, difficulty breathing, or anaphylactic shock — a severe reaction involving most or all of these symptoms.
As mentioned above, asthma is one of the most common disorders affecting children. As many as 10 percent of children have some degree of asthma, and the number has been rising steadily since about 1980.
Here’s how to spot it:
  • Although wheezing (a tight noise when breathing out) is the classic symptom of asthma, many children’s major symptom is a cough. The cough is non-productive and often sounds tight. It tends to get worse at night, with exercise, or after being exposed to a trigger (e.g. cigarette smoke, animal dander, or house dust). Children with asthma often have a prominent cough when they catch a cold.
  • Some children with asthma have wheezing with no cough; some have cough with no audible wheezing; and some have both.
  • As the airways narrow, breathing becomes faster. The child might have to work hard to breathe, as evidenced by grunting, flaring of the nostrils, or pulling in of the muscles between the ribs. The shortness of breath may exhaust the child, who becomes slow moving and talks only with difficulty.
If a child with asthma has difficulty speaking or sleeping because of wheezing, cough, or shortness of breath, it is important to contact the doctor immediately.
With allergies and asthma on the rise, it’s more important than ever to watch for symptoms and discuss concerns with your pediatrician. Clearly, severe reactions need immediate medical attention. But, for any mild circumstances that can wait until the next check-up, be sure to keep a detailed diary about types of symptoms, frequency, and any triggers you notice (diet, environment, etc). The more information you have, the better equipped your doctor will be to help.
Tip: Air quality in the home is related to likelihood of asthma and asthma attacks. Use HEPA filters or open windows for fresh air. When choosing cleaning products, look for alternatives to those with warning labels about using in a well-ventilated space.
Tip: Several studies have linked a Mediterranean style diet to a lower chance of getting asthma – and to better asthma control if a child has asthma. Increasing fresh produce in the diet, and decreasing fast food, may help a child breathe easier.

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Dr. Greene

Dr. Greene is a practicing pediatrician, author, speaker, children’s health advocate, and father of four.

Dr. Levine

Dr. Alanna Levine is a New York based pediatrician and a mom of two children.