Allergy in Children: Food Allergy or Allergic Rhinitis?

“Is my child allergic?” is a question I am asked often, usually after a bout of coughing, a blocked nose, or a refusal to eat a particular food. In childhood, however, the word allergy points to two different conditions, and they are frequently confused with one another: food allergy and allergic rhinitis. This post looks at how the two differ, what can be done at home, and which symptoms need urgent attention.

First, one point deserves saying: the same symptom can have quite different causes. Nothing here is a diagnosis; the aim is to help you recognise what you are looking at and to describe it properly when you see a doctor.

The first distinction: food allergy or allergic rhinitis?

Allergic rhinitis is the nose reacting to an allergen. Itching of the nose, repeated sneezing, clear watery discharge, itchy or watering eyes and itching around the ears are typical features. The pattern may change with the seasons, and in some children it persists all year. A cough or wheeze during a chest infection belongs to a different picture.

Food allergy follows a different timetable. Symptoms usually begin within minutes of eating the food, or within a few hours of it. The skin may show redness, raised weals, itching, or swelling of the lips or face; the abdomen may bring pain, vomiting or diarrhoea; the chest may bring cough, wheeze or difficulty breathing. In more severe reactions the child’s colour may become pale, they may feel floppy and their level of consciousness may change.

What gives a food allergy away

In a child with a food allergy, the reaction tends to recur with the same food and is not clearly related to the amount eaten; even a small amount may bring one on. Allergy to a particular food may also settle as a child grows, so a list drawn up years ago is not a reliable guide.

These features help separate food allergy from infection. If your child vomits in the same way every time after a particular food, if the lips swell, or if raised weals keep appearing on the skin, this must be reported to a doctor. Which foods need attention and which tests are appropriate are decided by a doctor.

Allergic rhinitis: the most frequently confused condition

Upper respiratory infections are very common in children, and they usually produce a blocked nose, a runny nose and a cough. That picture is often labelled “allergy”. In the other direction, true allergic rhinitis is frequently mistaken for another infection. The history helps: in allergic rhinitis sneezing is prominent, itching comes first, a cough may come from post-nasal drip, there is no fever, and the picture does not improve with antibiotics.

Allergic rhinitis carries a risk of asthma developing alongside it. If there is a recurrent cough, breathlessness that appears at night, or wheeze during exercise, the child should be assessed. Reducing exposure at home can matter as much as any medication. A repeatedly blocked nose interferes with sleep, concentration at school and ear health, so the picture should not be treated lightly.

The distinction has a practical side: if your child seems to catch a cold again and again through the year, with a blocked nose, sneezing and itchy eyes each time, allergic rhinitis may be the picture to consider. Even so, a doctor settles this during the consultation.

Is a raised, itchy rash always an allergy?

Most parents who see an itchy, wealed rash think of allergy first. In children, however, the commonest cause of a wealed rash is an infection, often seen after the viral illnesses of early childhood. Physical triggers, medicines, insect bites, sunlight and irritant substances can all produce the same picture. Eczema is sometimes linked to allergy, sometimes follows an atopic skin pattern, and sometimes is simply a matter of skin care.

So rather than deciding that a rash “is” or “is not” an allergy, it is more useful to describe when it started, how long it lasted, what sets it off, and how the child has been in general. Allergy testing may be arranged when the history and examination point that way; but a positive test on its own does not mean that your child is truly allergic to that food.

Taking a photograph of the rash when it appears, and noting which foods were eaten that day, is useful later on. A single episode does not mean allergy by itself; a recurring picture is another matter, and that record matters in the assessment.

Steps you can take at home

There are measures that help with allergic rhinitis at home. Dust, pillows and bedding are the most common sources of exposure; frequent washing of pillow covers and sheets, and regular airing of the bed, reduce the load. If you keep animals at home, they should not be allowed into the room where an allergic child sleeps. Mould, damp and tobacco smoke can all aggravate symptoms, and smoky environments are best avoided.

These measures do not help in food allergy. Reducing exposure where a food allergy is present is part of a plan you should prepare with your doctor; diets you put in place on your own may harm your child’s growth. Early childhood allergy and the precautions families can take at home are among the subjects covered in the Çocuk Alerjisi programme broadcast on TRT.

Allergens that travel with us should not be overlooked either. Clothes, shoes and toys brought in from outside carry dust and pollen into the home. Changing shoes at the door and washing fabric toys regularly are small steps, but they are the steps that last.

Symptoms that need urgent care

Some features of an allergic reaction can progress quickly. Difficulty breathing, a wheezy chest, a hoarse cough, swelling of the lips or tongue, swelling spreading across the face, loss of consciousness, the child feeling floppy, and pallor are all emergencies: call 112 or go to the nearest emergency department immediately.

Fever together with tiredness and a rash is also seen in infections. If you cannot be sure which picture you are looking at, it is better to be seen the same day than to wait for an appointment. Where there is breathlessness, a change in the voice or swelling of the face, do not wait at all: call 112 or go to the nearest emergency department.

In brief

• Allergic rhinitis brings itching of the nose and eyes, sneezing and clear discharge; fever is not expected.
• Food allergy shows symptoms shortly after the food is eaten, and recurs with the same food.
• An itchy, wealed rash is most often caused by an infection; allergy is only one possibility.
• With allergic rhinitis, bedding, animals, damp and smoke should be kept away from the child.
• If there is a food allergy, dietary changes should be planned with a doctor.
• Breathlessness, swelling of the tongue or loss of consciousness: call 112 or go to the nearest emergency department immediately.

Allergy is common in childhood and, once understood, a great deal of it can be managed. Noting when the complaint started, what sets it off and whether others in the family have similar symptoms will make the consultation more productive.