girl with allergiesAllergists are trained to look for certain symptoms that are not always obvious to parents or even to pediatricians or general practitioners.

Paul Ehrlich, MD and Larry Chiaramonte, MD are the authors of the book Asthma, Allergies, Children: A Parent’s Guide. Here are their answers to the most common situations and questions they hear from parents asking about the problems that plague their children:

If your child rubs the tip of her nose with her index finger and then with the palm of the hand upward towards her forehead, it means:

A. She is coming down with a cold.
B. She has disobeyed mommy and put beans in her nose.
C. She is performing what allergists call an “allergic salute.”

This is a classic “allergic salute.” It is a specific behavior that all trained allergists recognize, but that might look like nothing out of the ordinary to a parent or pediatrician.

If your 5-year-old has no history of respiratory problems but starts scratching his nose persistently in the evening before bed, it means:

A. The child is thinking deeply.
B. He is working up to picking it after he goes to bed when no one is watching.
C. The child should be tested for sensitivity to milk, cats, dust mites, molds, trees, ragweed, and grass.

While your child is undoubtedly a deep thinker, these symptoms are typical of any number of common sensitivities and your child should be tested.

If your 4-year-old has recurring bronchiolitis and develops dark circles around her eyes, it means:

A. Congestion has made her irritable and the child got into a fight.
B. School difficulties are causing her a loss of sleep.
C. She has allergies.

Congestion may be a symptom of many childhood conditions, but the dark circles are a tip-off: they are caused by chronic nasal congestion.

Your 2-month-old, born in July, starts getting red, rosy cheeks and the skin starts to itch at the height of ragweed season in September. Your child is probably:

A. Allergic to pollen.
B. Allergic to house dust mites.
C. Reacting to changes in the weather.

Allergic to house dust mites. How can we be so sure? Because your child is encountering ragweed pollen for the first time at the age of 2 months, and thus has not been sensitized to it. The current problems are due to the household dust that he has been breathing for the past two months, unless there’s a dog or cat in the house, in which case it might be the pet.

Your 3-year-old starts getting congested at the end of ragweed season in the fall. She is probably:

A. Allergic to pollen.
B. Allergic to house dust mites.
C. Reacting to changes in the weather.

A: She is allergic to pollen. Unlike the 2-year-old in the previous problem, your 3-year-old is now experiencing her second ragweed season. She was exposed last year, developed antibodies, and is now allergic.

Your child has “hay fever” in the spring when there is no hay but not in the fall when there is. Why is that?

Hay fever is a term that describes symptoms, not specific causes, and is misunderstood. There is a well-defined seasonal pollen cycle. In the Northern U.S., tree pollen appears early in the spring, before the leaves unfold. Grass pollen appears later in the spring and early summer. Finally, there is a late summer peak of weeds and ragweed. Hay fever is named for the period when grasses mature and are mown for hay, although the pollens may have nothing to do with agriculture. In warmer areas of the U.S., such as the Southeast or Southern California, the grass season may last six months or more. Also, areas such as Southern California, much of which is essentially desert, are devoid of ragweed, and do not have a hay-fever season.

Children sneeze a lot at night. What can a parent do about it?

Keep your house as free as possible from any dust. This is the single most important step in treatment of asthma and allergies. Remove any furry or feathered animals from the bedroom, permanently. Discard any feather (or down) pillows or quilts. Use hypoallergenic (polyester) pillows and washable blankets. Forced-air ventilation is very bad for patients. Buy filter material and install in the bedroom air vents. Wash or change filters monthly. Do not use humidifiers of any kind. Increased humidity increases the growth of dust mites and molds. The most effective way to keep your air passages comfortable during the night is to keep the bedroom very cool (55°F –60°F). Use plastic covers that completely encase any pillows, the mattress, and box spring even if the mattress and pillows are new. Remove rugs and carpets except for washable throw rugs. If it is impossible to remove carpeting, vigorous vacuuming must be performed daily. Vacuum cleaners blow a lot of fine dust out the back. Purchase special allergen-proof vacuum cleaner bags. HEPA air purifiers are very useful for pet dander, mold spores, or cigarette smoke, or if you have forced-air ventilation. Avoid ion air purifiers. Clean regularly.

What can I do to relieve my child’s painful eczema so he (we!) can (both) get a good night’s sleep?

The itching of eczema is partly a function of severe dehydration of the skin as the immune system works overtime to combat allergy and infection. The fluids in the skin stop doing their normal work of keeping the tissue moist. The object is to get the skin rehydrated long enough to stop the itching and provide relief.

Start with a warm bath to hydrate the skin. Then coat the afflicted areas with a layer of Vaseline to trap the moisture already in the skin. Wrap the area with cotton gauze.

Now, wet a pair of cotton PJs, wring them out with your hands—you want them wet enough to compensate for the dehydrating effects of any perspiration overnight but not so wet as to be uncomfortable or chilling—and dress the child in them. Finally, put on another pair of dry cotton PJs.

You might also add half a cup to a cup of Clorox to a bathtub of water for toddlers and up—for infants in a bassinette, use just an ounce—bathe with the face out of the water for 10 minutes and then rinse with clean water. The reason for doing this is that when we scratch, the staph germs that sit on all our skins get into the skin when we scratch, which causes infections.

Why do allergies seem to be more common than they used to?

The most convincing explanation is called the “hygiene hypothesis.” Allergies are a response by the immune system, which evolved to attack parasites and other things that our ancestors faced in daily life. Now that we live in more hygienic environments, some of our immune systems have gone rogue—attacking proteins in harmless substances that remind them of the parasites they were meant to fight.

How can I tell if my child has a food allergy?

No area of allergy science is more misunderstood than food allergies. People attribute all kinds of symptoms to food allergies—headaches, bad moods, depression, and many others. True food allergy involves a very limited number of symptoms: mild symptoms include: itchy mouth, few hives around mouth/face, mild itch, or mild nausea/discomfort.

Severe food allergy symptoms include: shortness of breath, wheeze, repetitive cough, pale or bluish skin, fainting, weak pulse, dizziness or confusion, tight throat, hoarseness, trouble breathing/swallowing obstructive swelling (tongue and/or lips), and lots of hives over much of the body, vomiting and abdominal cramps, rashes, and swelling.

Will asthma keep my child from playing sports?

First of all, a very high percentage of elite athletes also have asthma. David Beckham and Kristy Yamaguchi are probably the most well-known. Asthmatics play all kinds of sports. That said, it is very important that you work to keep your child’s asthma under control using medications as prescribed by a qualified specialist and taking precautions in warming up.

How do I know if my child’s asthma is under control?

Many asthmatics think that if they are not currently wheezing or coughing, their asthma is under control. They are wrong. They can still have underlying inflammation that can be triggered by any number of things, including polluted air, pollen, cold air, and so on.  If they have to rely on a relief inhaler, their asthma is not controlled.

Are inhaled corticosteroids, which the doctor prescribes for my asthma the same as the steroids athletes use?

No. They are derived from different parts of the body. They will not make your muscles grow, cause ‘roid rage, or any of the other symptoms. They are very safe and work only in the lung tissues where they are supposed to. The health benefits, such as better performance and attendance at school and work, and preventing chronic, destructive inflammation, far outweigh any of the very small side effects listed on the package.

The bottom line? The most important thing that parents can do is to see an allergy specialist. Get a referral or get an appointment, do whatever it takes. Seeing a specialist is to best way to make sure your child gets the best and most effective treatment.

Asthma, Allergies, Children: A Parent’s Guide by Paul Ehrlich, MD and Larry Chiaramonte, MD with Henry Ehrlich (Third Avenue Books Published June 30, 2010). Available in bookstores nationwide and online. For more information visit