Part 28 - The Treatment of Sleep Apnea in Children (Allergy Treatment)
Treatment for sleep apnea in a child will be determined in large part based on the cause and may include allergy treatment, tonsillectomy
The Treatment of Sleep Apnea in Children
Treatment for sleep apnea in a child will be determined in large part based on the cause and may include allergy treatment, tonsillectomy, and an orthodontic protocol called rapid maxillary expansion. In some children, the use of continuous positive airway pressure (CPAP) machines may be helpful. As children grow closer to adult stature, other treatment options become available.
Allergy Treatments and Medicine for Kids
Allergies are common in children, and fortunately, there are many good treatments that can help you control your child's allergy symptoms.
Allergy symptoms can vary widely, but they all are the product of an abnormal immune system reaction to a normally harmless substance (an allergen). When a person who is allergic encounters the trigger, the body reacts by releasing chemicals that affect the skin, respiratory system, digestive tract, and more to produce allergy symptoms. These can range from a runny nose to an itchy rash or even to a life-threatening asthma attack or anaphylactic reaction.
Frequent Symptoms
In children, allergic disease first occurs as atopic dermatitis (eczema) or food allergies. Children with atopic dermatitis are then at an increased risk of developing allergic rhinitis and asthma; both are more likely to occur in school-age children.
Typically, atopic dermatitis goes away by adulthood, as do many types of food allergies. Allergic rhinitis and asthma, however, most often start during the adolescent, teenage, and young adult years, and are likely to persist throughout a person’s life. The severity of allergic symptoms, however, may wax and wane, and even temporarily disappear.
There can be some overlap of allergy symptoms between types of allergies, so it's best to consider what is most frequently associated with which conditions.
Atopic Dermatitis
Atopic dermatitis, or eczema, is typically the first sign of allergies and is seen in 10% to 20% of all children, frequently during infancy. It is characterized by itching, with rash formation at the sites of scratching. The rash is typically red and dry, may have small blisters, and can flake and ooze over time.
In infants and very young children, this rash involves the face (especially the cheeks), chest and trunk, back of the scalp, and may involve the arms and legs. This distribution reflects where the child is able to scratch, and therefore usually spares the diaper area.
The location of the rash changes in older children and adults to classically involve the skin in front of the elbows and behind the knees. Food and environmental allergies have been shown to worsen atopic dermatitis.
Food Allergy
Food allergies can occur at any age. Almost all people with food allergies will have a skin symptom as a result of eating the culprit food. These symptoms typically occur within a few minutes of eating the food in question, although they can be delayed up to several hours. Skin symptoms may include:
• Hives
• Swelling
• Itching
• Redness of the skin
Other symptoms of food allergies can include:• Nausea
• Vomiting
• Stomach aches
• Diarrhea
• Breathing difficulties (asthma symptoms)
• Runny nose
• Sneezing
• Lightheadedness
In some cases, children can experience a severe allergic reaction called anaphylaxis, which can be life-threatening.
Nasal Allergies
Allergic rhinitis, including hay fever and seasonal allergies, occurs in up to 30% of adults and up to 40% of children. Symptoms of allergic rhinitis include:
• Sneezing
• Runny nose
• Itchy nose and eyes
• Nasal congestion
Some people may also experience post-nasal drip, allergic shiners (dark circles under the eyes called “venous pooling”), and a line across the nasal bridge from an upward rubbing of the palm of the hand on the nose, a sign called the “allergic salute.”
The tissues of the sinuses can also be swollen in an allergic reaction, which can result in pressure inside the head and produce a sinus headache. Fatigue from disrupted sleep is another potential symptom of nasal allergies.
Contact Dermatitis
Some skin allergy symptoms are triggered when your skin comes in contact with an irritant or allergen. Common triggers include nickel, latex, fragrances, poison ivy, hair products, and skin medications. You may experience these skin symptoms:
• Rash
• Blisters
• Burning
• Itching
You won't usually have the reaction the first time you come into contact with the allergen. But on a future exposure, you will have symptoms.
Rare Symptoms
Anaphylaxis is a life-threatening allergic reaction that can be triggered by exposure to many different substances (allergens). The most common allergies that can produce anaphylaxis are to drugs, insect stings, foods, and latex.
The most common symptoms of anaphylaxis are:
• Swelling of the face, tongue, lips, throat, or limbs
• Hives
• Breathing problems including coughing, wheezing, and difficulty taking a breath
• Low blood pressure, which may lead to confusion or dizziness
Other symptoms include an irregular heartbeat, chest pain, nausea, vomiting, cramping, and headaches.
Asthma
Allergies are a major cause of asthma, a condition that occurs in about 8% of all people. Though it can occur at any age, it is most often seen in males in the pre-teen years and in females in the teenage years. In fact, asthma is the most common chronic disease in children and young adults. Sometimes asthma is difficult to diagnose in very young children and may require a physician who is an asthma specialist.
• Coughing: This can be the only symptom in some people who have what's called cough-variant asthma. The cough is often dry, hacking, and may be worse with allergic triggers and after exercise. The cough may only be present at night. Cold air may also trigger this symptom.
• Wheezing: This is a high-pitched, musical instrument-like sound that can occur with breathing in and out in people with asthma. Wheezing usually occurs along with other asthma symptoms and may get worse with exercise and allergic triggers.
• Shortness of breath: Most people with asthma feel as if they’re not getting enough air at times, particularly when they are physically exerting themselves or when an allergic trigger is present. People with more severe asthma have shortness of breath at rest or wake-up with this symptom during the night.
• Chest tightness: Some people describe this as a sensation that someone is squeezing or hugging them. Children may say that their chest hurts or feels “funny.”
Nasal Allergy Complications
Nasal allergies can put you at more risk of developing respiratory infections, including lung infections, sinus infections, sinusitis, and middle ear infections (otitis media and otitis media with effusion). Hearing impairment can result.
You may also develop nasal polyps, which are growths in the sinuses or nasal lining. Migraine headaches are also associated with allergies.
When nasal allergies impair sleep, you can have daytime fatigue and poor mental functioning. The medications prescribed can likewise have effects on performance.
Co-Existing Conditions
Over-the-counter medications used to treat allergy symptoms can be unsafe to take if you are being treated for a variety of health conditions including heart disease, diabetes, high blood pressure, thyroid disease, and more.
If you are under treatment for any condition, talk to your doctor before you begin taking an allergy remedy. It may interact with prescription medications or worsen your condition.
When to See a Doctor
If you are unable to control your allergies with occasional use of over-the-counter medications, see your physician. You should also see your doctor if your symptoms are impairing your quality of life, reducing productivity at work or school, or disturbing your sleep.
Allergy symptoms in children and older people should always be checked by a physician so appropriate medications can be used, including those available without a prescription, and dangerous interactions avoided.
Allergy symptoms can range from annoying to life-threatening, and ongoing symptoms don't have to simply be tolerated. See your doctor or an allergy specialist so you can learn how to avoid allergy triggers and which medications will most improve your quality of life.
Although parents usually try over-the-counter cold and allergy medicines, their frequent use should usually be avoided, because they are sedating and can make your child sleepy. Newer OTC allergy medicines are the exception, though, as most are non-sedating, including Allegra, Claritin, and Zyrtec.
Prescription allergy medications for older kids are the same as those that are used for adults, including Clarinex and Xyzal, both of which come in over-the-counter formulations as well. In addition, you can use steroid nasal sprays in most older kids with allergies, including Flonase, Rhinocort Aqua, Nasonex, Nasacort AQ, Omnaris, and Veramyst.
That's a lot of different allergy medications and different combinations that can be used, so don't let your kids suffer from allergy symptoms. See your pediatrician for help finding the right allergy medications.
Young Kids With Allergies
Choices are a little more limited for younger infants and children. These choices do include Clarinex and Xyzal, both are which available as a syrup and are approved for children over age 6 months.
Claritin and Zyrtec are also available as a syrup and chewable tablet, but they are officially only approved for kids over age 2 years. And keep in mind that both are now available over the counter, both as brand name Claritin (loratadine) and Zyrtec (Cetirizine) and as cheaper generic and store-brand versions.
Singulair is another good alternative for younger children. Although this medicine has already been used to prevent asthma in kids, it recently was also approved as a treatment for seasonal and year-round allergies.1 It can be given to children over age 6 months from a packet of oral granules, or as a chewable tablet for kids over age 4.
Allegra is the latest allergy medicine to be available in a liquid form. It is now available in an oral suspension that can be given to children between the ages of 2 to 11 years with seasonal allergies and over 6 months with chronic idiopathic urticaria (hives). It is also the latest allergy medicine to be available over-the-counter.
Steroid nasal sprays are also often used for younger kids. Nasonex and Veramyst are both approved for use in kids over age 2 years, and Flonase can be used in children over age 4.
Antihistamine nasal sprays are another option for kids and include Patanase for children who are at least 6 years old and Astelin and Astepro for older kids who are at least 12 years old.
Remember that many medications are used off-label in children younger than the FDA-approved age.
Older Kids With Allergies
Until your children are able to swallow a pill, they will likely need to take the same medications that younger children do, although perhaps in a higher dose.
In addition to the oral granules and 4mg chewable tablet for younger kids, a 5mg chewable tablet of Singulair is available for children 6 to 14 years of age. Children over 14 can take the regular 10mg tablet that adults take.
Older kids can also take Allegra, which is available as a 30mg tablet for children 6 to 11 years of age, and either 60 or 180mg for children over age 12.
Children over age 12 could also take Clarinex, Allegra-D, Zyrtec, Xyzal, Zyrtec-D, Claritin, or Claritin-D.
The steroid nasal sprays are also commonly used in older children, either alone or with another medication for control of allergy symptoms.
Alternative Treatments
Even before you start an allergy medication, steps should be taken to help control indoor allergies and avoid common things that cause allergies (allergens). This includes dust mites, mold and pet dander for year-round or perennial allergies. Seasonal allergies are more difficult to avoid.
When simple allergen avoidance and/or allergy medications don't work, your next step is usually allergy testing to help find what your children are allergic to. If allergy testing is positive, you might then proceed with allergy shots. The American Academy of Allergy, Asthma, and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) has recently introduced a new practice parameter that calls for increased use of allergy shots, especially to 'prevent allergic rhinitis from progressing to allergic asthma.