Darlene Mansoor, MD, is a board-certified, fellowship-trained allergy and immunology physician. She serves as Medical Director of Inova Children’s Allergy and Immunology service.
Coughing, sniffling, sneezing, and wheezing: These symptoms are very common in children during late summer and early fall in the Northern Virginia and Washington, DC, metropolitan areas. Because they share some of the same symptoms, it’s easy for parents to confuse seasonal allergies with asthma flare-ups. But since allergies and asthma are treated with different medications and recommendations, it’s important to know which one is the true cause of your child’s sniffling or coughing.
Allergies and Asthma: Understanding Key Differences
Seasonal allergies typically affect the upper respiratory system — the nose, sinuses, and throat — as well as the ears and eyes. Allergy symptoms are generally the body’s histamine reaction to the allergen. Asthma, on the other hand, affects the lower respiratory system, particularly the lungs, with inflammation that causes symptoms including coughing, wheezing, shortness of breath and other breathing difficulties.
In children, coughing is a common symptom of both seasonal allergies and asthma, but the type of cough varies. In seasonal allergies, children will usually have a wet-sounding cough. It’s often the result of postnasal drip irritating the throat. In asthma, children will often have a dry-sounding cough that doesn’t go away. It tends to get worse with exercise or at night. For example, a child might have minimal symptoms while reading a book at home, but the child will begin to cough partway through a soccer game, when the child is running a lot.
What Causes Asthma Symptoms in Children, and How Are They Related to Allergies?
Asthma symptoms — coughing, wheezing, trouble breathing — vary by age. In younger children (under 6 years old), these symptoms can be triggered by a viral infection. In older children (6 years and up), asthma symptoms can be related to an allergy. Outdoor allergies vary throughout the year. In our region:
- Tree pollen is highest in early spring.
- Grass pollen is highest in early summer.
- Weed pollen (especially ragweed) is highest in late summer and early fall.
Health care providers tend to see a spike in asthma symptoms in the early fall because children return to school, increasing the circulation of respiratory viruses. It’s also prime time for ragweed, a very common allergy cause. Allergic asthma tends to begin with upper respiratory symptoms. Then, the pollen or other allergen triggers the lower airway symptoms associated with asthma.
In addition to allergy-related asthma, environmental factors like second-hand smoke can cause asthma symptoms. Researchers also believe that some cases of asthma are related to a person’s genetic makeup, although more research is needed into how and why this happens. Indoor allergens such as mold, dust and other substances can also trigger asthma symptoms.
Diagnosing Allergies and/or Asthma in Kids
Diagnosing allergies and asthma in children — especially those under 6 years old — requires a nuanced approach. Allergy testing, such as skin prick tests, is most effective in children ages 6 and older. For younger kids, healthcare providers often rely on symptom observation and environmental assessments to identify potential triggers. Even without formal testing, treatments can be tailored to relieve symptoms like itchy eyes and nasal congestion, improving a child’s comfort and quality of life.
Asthma diagnosis in younger children is similarly complex. Lung function tests like spirometry are not reliable before age 5. Providers base their assessments on clinical symptoms — such as wheezing, coughing and difficulty breathing — along with a thorough physical examination and medical history. For older children, spirometry and other lung function tests can help confirm asthma and guide treatment decisions more precisely.
Treatment and Management of Allergies and/or Asthma in Kids
Because seasonal allergies and asthma symptoms are focused in different parts of the respiratory system, their treatments are different. Allergies cause stuffiness, nasal congestion, and itchy, swollen eyes, so treatments include antihistamines, nasal spray, and eye drops. If those don’t control symptoms well enough, additional medicines or even allergy shots — weekly shots for several years that desensitize a person to the allergen over time — can be considered.
For the lower airway symptoms common in asthma, medicine is often delivered by an inhaler. Asthma medicines come in two broad categories:
- “Rescue” medicines: short-acting medicines that help open airways during an “asthma attack”
- Maintenance medicines (also called controller medicines): daily, inhaled medicines designed to control asthma symptoms long term
Making changes to your child’s environment can also make a big difference when it comes to improving allergy or asthma symptoms. On high pollen days, take steps to keep pollen out of the house – an allergy sufferer can shower and change clothes after coming inside, keep windows closed, and change pillowcases frequently.
For indoor allergies like dust mites, washing bedding weekly in hot water can help, as well as investing in protective bed and pillow coverings. To avoid attracting indoor allergens, limit the number of stuffed animals your child has, and be sure to wash them or putting them in the freezer for 24 hours every few weeks to kill dust mites. If animal dander is an allergen and keep pets out of your child’s bedroom.
Allergy- and Asthma-Fighting Tips for Parents
- Take note of when your child’s symptoms happen (during exercise, while outdoors, etc.) to help your child’s medical provider identify the cause and treat it effectively.
- Think about what your child’s cough sounds like (wet or dry), and be ready to describe it to your child’s provider — it’s an important clue.
- Prevention is key in both allergies and allergic asthma – using a steroid nose spray (like Flonase or Nasacort) before seasonal allergies take hold can stop both allergy symptoms and prevent allergic asthma symptoms.
- For seasonal allergies, start treating before symptoms show up — for tree pollen, starting medicines in mid-February can make March and April much more bearable.
- Ask questions — treating your child’s allergies and/or asthma can be complex, with different medicines to use at different times.
- Understand that a person’s allergies can change over the course of a lifetime — children can “grow out of” allergies, and people can develop a new allergy later in life.
Learn more about Inova Children’s allergy and immunology services.
Feature image, stock.adobe.com
