During the winter months more people get sick, so more people are treated with antibiotics. While antibiotics can help treat bacterial infections, they do carry risks. One of those risks is an allergic reaction. This is one of the reasons pediatricians avoid using antibiotics liberally. Most of the time our bodies can fight off the germs that cause illness and antibiotics don’t help treat viruses at all. How do you know if it’s an antibiotic allergy or just a rash?
Rashes are common
When someone is on a medicine and they develop a rash it can sometimes be hard to sort out if symptoms are part of the illness, a non-allergic drug reaction, or an allergic reaction.
There are many people who had a rash while taking an antibiotic as a child and were told that they are allergic to that antibiotic, but really aren’t. Unfortunately this can lead to more expensive and broader-range antibiotics being used inappropriately and unnecessarily.
About 2% of prescription medications (not just antibiotics) cause a “drug rash”. The rash usually begins after being on the medicine for over a week (earlier if there was previous exposure to the medicine), and sometimes even after stopping the medicine.
It can look different in different people.
Some get pink splotchy areas that whiten (blanch) with touch.
Often the rash seems to worsen before it improves, whether or not the medicine is stopped.
Skin can peel in later stages.
It can itch but doesn’t have to.
Some people have mild fever with these symptoms.
Adults vs kids
In adults this type of rash is often a sign of allergic reaction, but in kids a rash is most often a viral rash – meaning they have a virus that causes a rash but they happen to be on an antibiotic (or other medicine).
This is why diagnosing allergy versus drug reaction is tricky.
These symptoms can mean allergy to the drug, but (especially in kids) is often just a symptom of a virus (or some bacteria, such as Strep or Mycoplasma).
Up to 10% of children taking a penicillin antibiotic (which includes the commonly used amoxicillin and augmentin) develop a rash starting on day 7 of the treatment. (It can be earlier in people who have had the antibiotic previously.) This rash tends to start on the trunk, looks like pink splotches that can grow and darken before fading. It does not involve difficulty breathing, swelling of the face or airway, or severe itching.
Because of this reaction many people live their life thinking they have an allergy to penicillin, even though many of them don’t.
Up to 80 -90 % of people who have mono develop a rash if they are treated with a penicillin antibiotic (like amoxicillin).
This is common since symptoms of Strep throat and mono are very similar, and penicillins are the drug of choice for Strep throat. Some people with mono have a false positive test for Strep throat, meaning they do not have Strep but the test is positive.
This is why it is very important for the medical clinician to take a careful history of symptoms and do an exam, even with “classic” Strep symptoms. (If I had a dollar for every parent who says the symptoms are just like all her kids when they get Strep, can’t I just call it in…) Always be sure to get a Strep test and full exam to evaluate if it is really Strep or possibly mono. Blood tests for mono can be ordered if clinically indicated.
Never treat a sore throat without a full evaluation.
Doctors will take a careful history of all symptoms of the illness, the timing of when the rash developed during the illness and when the medicine was given.
If it is a classic viral rash, nothing further needs to be done. If there are symptoms (see below) that help identify a true allergy and make a clear diagnosis, then avoidance of that medication should be done.
Be sure all your doctors and pharmacists know of this allergy.
Spring is a beautiful time of year. The flowers bloom, the birds chirp… it’s like we’re all awakening after a long, cold winter. But with the flowers (and birds) comes pollen. And with pollen comes allergies. I don’t want anyone to be afraid to enjoy the beautiful outdoors, so learn to control allergies.
Why treat allergies?
I often hear parents say that they don’t want to give their kids medicine to treat allergies because, well, it’s medicine. They prefer to be natural and the symptoms don’t seem “that bad”.
Before you decide if the symptoms require treatment or not, be sure to recognize all the potential consequences of allergies. It’s not just a runny nose and sneezing.
For people with asthma, allergies are a known trigger. It’s especially important that people with wheezing tendencies keep up on allergy prevention and treatments.
Some will chronically mouth breathe, which can affect the growth and development of their jaw, lead to bad breath, and increase the risk of cavities. Dr. Deborah Burton, an ear, nose, and throat specialist, discusses these and other consequences of mouth breathing in one of her DrMommaSays blogs.
How do you know it’s allergies?
Allergies can cause runny nose, headache, congestion, sneezing, watery eyes, itching eyes, sore throat, itchy throat, and itchy skin. Not all symptoms need to be present.
An upper respiratory tract infection (AKA common cold) can also cause a runny nose, headache, congestion, sneezing, watery eyes, and sore throat. The difference is the cold symptoms tend to not last as long as allergies. There also could be a fever, body aches, and a general feeling of “not well” with viral infections.
Seasonal allergies tend to follow a seasonal pattern, so they can be easier to recognize than allergies to indoor allergens.
These days it’s easy to track pollen counts online. If you realize that every day the counts for one type of tree or grass is elevated you have symptoms, that’s strong support that you’re allergic to that plant.
Of course, it’s possible to get a cold on top of your allergies, which adds to the confusion sometimes.
Treatments to control allergies
It is best to treat before the symptoms get bad. Treatments include not only medicines, but also limiting exposure.
Use what you can to prevent and treat allergies, which most often means using more than one of the following treatments.
Limiting exposure can help decrease symptoms.
Avoid Bringing allergens into the Home
Remove clothing and shoes that have pollen on them when entering the house to keep pollen off the couch, beds, and carpet.
Keep the windows closed. Sorry to those who love the “fresh air” in the house. For those who suffer from allergies, this is just too much exposure!
Beloved pets cause unique issues
If someone’s allergic to animals or suffers from year long symptoms, learn if your family pet is a problem.
When you have pets that go outdoors and then into the home, bathe them regularly.
Don’t let pets on the couch or beds and keep them out of the bedrooms of allergic sufferers.
If you know a family member is allergic to an animal, don’t get a new pet of this type!
If you already have a loved pet someone in the home, consider allergy shots against this type of animal. Talk to your pediatrician and consider a trip to an allergist.
Wash and clean
Wash towels and sheets weekly in hot water.
Vacuum and dust weekly. Consider cleaning home vents. Consider hard flooring in bedrooms instead of carpeting.
Wash stuffed animals and other toys regularly and discourage allergic children from sleeping with them.
Keep smoke away. Smoke is an airway irritant and can exacerbate allergy symptoms.
Remember that the smoke dust remaining on hair, clothing, upholstery, and other surfaces can cause problems too, so kids can be affected even if you don’t smoke near them.
And for those of you who vape, it’s not better. We’re still learning the risks of e-cigarettes because vaping is relatively new, but early data supports staying away from e-cigs!
Wash it off of you!
Wash hair, eyelashes, and nose after exposures — especially before sleep. They all trap allergens and increase the time your body reacts to them.
Learning to rinse your nose
I have found the information and videos in Nasopure.com‘s library to be very helpful. You can teach kids as young as 2 years to wash their noses. Note: I have no financial ties to Nasopure… I just love the product and website!
I am an Amazon Affiliate member, so if you buy from this Amazon link, I do get a small percentage.
If you wear contacts
If itchy eyes are a problem for contact lens wearers, a break from the contacts may help. Talk with your eye doctor if eye symptoms cause problems with your contacts.
I don’t want kids with outdoor allergies to be afraid to go outside, so taking medicines to keep the symptoms at bay while out can help.
Antihistamines work to block histamine in the body. Histamine causes the symptoms of allergies, so an antihistamine can help stop the symptoms.
Some people respond well to one antihistamine but not others, so sometimes you must use trial and error to find the right one.
In general I prefer the 12-24 hour antihistamines simply because it’s very difficult to cover well with a medicine that only lasts 4-6 hours, such as diphenhydramine (Benadryl) and they’re less sedating. Long acting antihistamines include loratadine -Claritin (24 hour), fexofenadine- Allegra (12 hour for kids, 24 hour for teens and adults), and cetirizine- Zyrtec (24 hour).
Different antihistamines work better for some than others. Personally loratadine does nothing for me, fexofenadine is okay, but cetirizine is best. I have seen many patients with opposite benefits. You will have to do a trial period of a medicine to see which works best.
If they make your child sleepy, giving antihistamines at bedtime instead of the morning might help.
Prescription antihistamines are available, but usually an over the counter type works just as well and is less expensive. Insurance companies rarely cover the cost of antihistamines these days.
Antihistamine and decongestant combinations
Antihistamine and decongestant combinations are available but are not usually recommended. Decongestants can cause dizziness, heart flutters, dry mouth, and sleep problems, so use them sparingly and only in children over 4 years of age.
Once control of the mucus is achieved, a decongestant isn’t needed. Giving a medicine that isn’t needed just increases the risk without increasing the benefit.
If you need a decongestant initially, you can use one with your usual antihistamine.
Most decongestants on the shelves are ineffective. If you ask the pharmacist for pseudoephedrine, it is available behind the counter. It was replaced by phenylephrine years ago due to concerns of methamphetamine production, but works a little better than phenylephrine.
Decongestants do NOT fix a cold, they only dry up some of the mucus.
They are available both as over the counter allergy drops and as prescription allergy eye drops. If over the counter drops fail, make an appointment to discuss if a prescription might help better. Most insurance companies don’t cover prescription allergy eye drops well, so you might want to check your formulary before asking for a prescription. This is usually available on your insurance website after you log in.
If your child resists eye drops
Tips to administer eye drops include washing hands before using eye drops, put the drop on the corner of the closed eye (nose side) and then have the child open his eyes to allow the drop to enter the eye.
It helps control both allergies and asthma and is best taken in the evening.
Once a person has been on montelukast for a couple of weeks, they usually don’t need an antihistamine any longer.
Montelukast is available only by prescription, so make an appointment to discuss this if your child might benefit.
Steroids decrease allergic inflammation well. These include both oral steroids for severe reactions (such as poison ivy on the face or an asthma attack) and inhaled corticosteroids for the nose (or lungs in asthma).
The nasal steroids are discussed above and are highly recommended for kids and adults who tolerate putting a spray in their nose.
Other steroids require a prescription, so a visit to your provider is recommended to discuss proper use.
What if all of the above isn’t helping to control allergies?
Maybe it’s really not allergies.
There are many things that can seem to be allergies but aren’t. If proper treatment is not working, reconsider the diagnosis.
It’s possible that the allergy treatment is working, but you caught a cold on top of the allergies. Both are common, so they can occur together.
Allergies to things other than foods are rare before 2 years of age. If you’re treating allergies in an infant or toddler, be sure to keep your pediatrician in the loop.
I’ve known people who are treated for years by an allergist for allergies, but when they’re tested due to a poor response, they have no allergies. They might have frequent infections or other irritants like smoke exposure. Learn to control these issues too, starting with good hand washing, avoid touching your face, and avoiding smoke.
Allergy testing is possible by blood or skin prick testing, but can be costly. Not to mention the fact that kids tend to not like needles, which are used with most testing.
Allergy testing isn’t recommended for most allergy sufferers. It can be used to guide allergy immunotherapy, which involves routine allergy shots. Most suffers don’t need allergy shots, but if you think your child would benefit (and allow them), talk to your doctor.
In most cases I don’t find test results very helpful for environmental allergens because you can’t avoid them entirely. You can limit exposures as discussed above, regardless of test results.
Tracking patterns and symptoms to identify allergies
By tracking seasonal patterns over a few years can identify many of the allergens. You can still treat as needed during this time. Reports of pollen and mold counts are found on Pollen.com.
Rather than testing, note animal exposures and household conditions and any symptoms seen with exposures.
Write symptoms and exposures weekly (or daily). It often doesn’t take long to see patterns. Testing is important if allergy shots are being considered.
Need help tracking allergy symptoms? There’s an app for that! Here’s one review I found of allergy apps. I don’t have any personal experience of any, so please put your favorite in the comments below to help others!
Wrong medicine or wrong dose.
Some people have more severe allergies and need more than one treatment. I personally use eye drops, nasal spray, and an oral antihistamine in addition to nasal washes and daily (sometimes twice daily) showers when my allergies flare.
Switching types of medication or adding another type of medicine might help. If you need help deciding which medicines are best for your child, schedule an office visit with your PCP for an exam and discussion of symptoms.
Some kids outgrow a dose and simply need a higher dose of medicine as they grow. Talk to your pharmacist or physician to decide if a higher dose is indicated.
Is Nothing working?
Consider allergy shots (immunotherapy) to desensitize against allergens if symptoms persist despite your best efforts as above.
Schedule an appointment with your pediatrician to discuss if this is an option for your allergy sufferer.
I see a lot of kids with circles under their eyes. There’s a lot of confusion as to what causes them. Dark circles under the eyes may simply be hereditary – a trait that runs in families, but they also can signify chronic disease.
I’ll cover some causes that are feared but not likely and common causes that can be treated to help decrease the dark appearance of the circles.
Not likely causes
Many parents worry that anemia, or a low red blood cell count, is causing their child’s under eye circles. I’m not sure why this thought is so prevalent, but it’s not the first thing I think about when I see dark circles under the eyes of a child.
Iron deficiency is linked to anemia because iron is a building block of a red blood cell. Iron deficiency is relatively common in kids due to poor diet, so if your kids don’t eat foods rich in iron, you should talk to their doctor.
Anemia can happen in kids, but if under eye circles is the only symptom, it’s not likely. If there are other symptoms then blood work might be indicated.
Symptoms of anemia may include:
Pale skin, including the inner eyelids
Feeling tired or having low energy
Poor focus and attention
Craving of ice or eating non-food items (pica)
Rarely (with more severe anemia)
Yellow jaundice (yellow eyes and skin)
Rapid heart rate
Swelling of hands, feet, or puffy eyelids
Yes, we often think of circles under the eyes from poor sleep. Poor sleep is not usually the cause of under eye circles in a child, especially when they otherwise appear well rested.
Kids who have chronically poor sleep can appear tired and sluggish, but they also have other symptoms, such as irritability, hyperactivity, poor school performance, and increased injuries.
If you’re worried about your child’s sleep, talk to your pediatrician.
There are many products containing various vitamins that are sold to help decrease under eye circles, but evidence is lacking that vitamin deficiencies are common causes of under eye circles in children.
Unless there are other significant problems, it is not recommended to check vitamin levels to evaluate under eye circles.
If your child is a picky eater and has a limited intake of nutrients, talk to your pediatrician.
What does cause dark under eye circles?
The skin under the eyes is very thin, so when blood passes through the thin skin it can produce a dark color, much like the blue color of your veins. If the blood circulation slows, the blue color can be more noticeable.
Congestion in your sinuses can lead to congestion in the small veins under your eyes. The blood collects in the skin under your eyes and these swollen veins dilate and darken. This creates the effect of dark circles and puffiness.
Dark circles are of course more noticeable in fair skinned people.
The most common cause of under eye circles is chronic congestion, but chronic congestion can be from various causes.
Allergies are probably the most common cause of dark circles under the eyes, so the circles are also called “allergic shiners.” They get this name due to the purplish hue of the skin, resembling a black eye, AKA “shiner.”
If allergies are the cause, you will usually see other symptoms of allergy, such as
Viruses that cause nasal congestion can also lead to dark circles under the eyes. These can be brief if the cold clears quickly, or seem to come and go with recurrent infections, as often happens during the cold and flu season.
Sinus infections can cause chronic congestion, leading to dark under eye circles.
Smokers and their children often have chronic congestion.
Studies show that second hand smoke leads to more frequent upper respiratory tract infections and ear infections in kids. It’s not surprising that these kids also develop chronic circles under their eyes.
Mouth breathing can itself be from many causes.
Commonly nasal congestion from allergies and upper respiratory tract infections leads to mouth breathing.
If chronically congested or mouth breathing, talk to your child’s doctor to find and address a cause
Avoid smoke and secondhand smoke, which lead to chronic congestion
Use moisturizers if skin is dry
Avoid pollution as much as possible, since it can contribute to chronic congestion
I often refer to Nasopure’s website because it has great instructions on how to rinse the nose for kids as young as 2 years of age. It also has videos to help kids get comfortable with the idea. I refer to the site simply because I like it, and I receive no compensation for the recommendation.
I do participate in the Amazon Affiliate program, and if you use one of these links to purchase a nasal wash kit, I do make a small profit. As always, I only link to products that I endorse regardless of where you purchase it.
Most of us have heard of the claims of cures for all sorts of ills, including behavioral problems (especially ADHD and autism) with simple dietary changes (with and without supplements). This post covers some diets for ADHD that have been recommended as treatments. Supplements will be covered tomorrow.
Why talk about diets for ADHD?
Fears of side effects from long-term medication or a history of medication failures cause families to look for alternative treatment options for child behavior issues. Diet modification and restriction is intriguing for parents since it fits into the ideal of a healthy lifestyle without added medicines and their potential side effects. However, there is a lot of controversy as to whether these restrictions help except in a small subset of children who have true allergy to the substance.
In general if a simple solution through diet was found, everyone would be doing it.
That just isn’t happening.
I do think that we all benefit from eating real foods — the ones that look like they did when they were grown, not processed and packaged. Fruits, vegetables, protein sources, whole grains, and complex carbohydrates should be the basis for everyone’s diet. It’s just good nutrition. But the direct effect of special diets on learning, behavior, and conditions such as ADHD is limited.
Natural does not equal safe.
When my kids were young and picky eaters I never would have considered stimulating their appetite with organically grown marijuana. While it is all natural (even organic!) and it might increase their appetites, it would have risks, right? In this case I don’t think the risks would outweigh the benefits. But so often parents think that if it’s natural, it’s healthier than something made by man.
Drugs have been tested. They have risks too, but those risks are a known. Some natural therapies have not been as thoroughly tested and they are not regulated, so the label might not correctly identify the contents. For this reason, I think that healthy foods are a great option for everyone, but I hesitate to recommend a lot of supplements, especially by brand.
Over the years there have been many foods or additives that have been blamed for causing learning and behavioral problems. Some of the proposed problematic foods:
salicylate and additives
I’m sure the list goes on, but I’ve got to move on. I’ll discuss some of the specific elimination diets and what evidence about each says.
Food additives have been blamed for learning and behavior problems for many years. In 1975, Dr. Ben Feingold hypothesized that food additives (artificial flavors and colors, and naturally occurring salicylates) were associated with learning disabilities and hyperactive behavior in some children.
Since then many case reports of similar claims have continued to surface, but those do not have the same weight as a double-blinded control study. Most studies done in a scientific manner have failed to show a benefit.
It never hurts to eliminate artificial dyes and additives in your child’s diet. If it helps, continue to avoid them. But if no change is noted, don’t continue to rely on dye avoidance as a treatment plan.
Another elimination diet is the GAPS (Gut and Psychology Syndrome) diet, designed by Dr. Natasha Campbell-McBride.
She asserts that a wide variety of health problems (autism, ADHD, schizophrenia, depression, and more) are from an imbalance of gut microbes. Not only has it not been proven to work, I worry that it restricts healthy foods, such as fruits, and kids will develop other problems on this diet.
Gluten is in the news to be the base of many problems. It seems to be recommended to go gluten free for just about any ailment you can think of.
There are a subset of people who are really sensitive to gluten, and they benefit greatly from a gluten free diet.
But the large majority of people gain no direct benefit from this expensive and restrictive diet. One indirect benefit of the diet previously was that it was nearly impossible to eat pre-packaged and processed foods, which leaves real fruits, vegetables, and other high quality foods. As more people are going gluten free there are more pre-package products made gluten free. I wonder if the benefits people have noticed previously will wane when they eat these foods.
Talk with your doctor before deciding if going gluten free will work for your child.
Sugar is often blamed on hyperactivity. By all means, no child needs extra sugar, so cut out what you can.
Well controlled studies did not find a behavioral difference in kids after refined sugars.
Food allergies are now commonly thought to be related to behavior and learning problems.
In some children with true allergies, foods can affect behavior. However, most children do not have food allergies and avoiding foods does not alter behavior. It can be challenging to determine if there is a food allergy since some of the tests offered are not reliable.
Elimination Diets Final Thoughts
In a small subset of kids food avoidance helps, but in the large majority studies do not support avoidance of foods.
If you think your child benefits from avoiding one or two foods, it probably isn’t a big deal to restrict those foods.
But if you suspect your child is allergic to everything under the sun, you will need to work with your doctor and possibly an allergist and a nutritionist to determine exactly what your child must avoid and how they can get all the nutrients they need to grow and develop normally.
Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!
CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!
Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.
Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.
Midwest ADHD Conference – April 2018
Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.