Category: Uncategorized

Provided by Evan Tobin, MD
and Roger Friedman, MD

Young children are more susceptible to upper respiratory infections (aka “URI” or “common cold”) because they are still growing, their immune systems are still maturing, and they are exposed to more viral infections through daycare and early school years.

The symptoms of a cold are well known to all of us. The symptoms include cough, runny nose, nasal congestion and sometimes a low-grade fever.

Some children, however, seem to have a “never ending cold”. They may mouth breathe, snore loudly and have a constant runny nose.

• What is the cause for these symptoms?
• As a parent, should you be concerned?
• What can be done?

Two common problems of childhood can explain these nasal symptoms that simply won’t go away.

1. Allergies
2. An enlargement or infection of the adenoids

There are similarities between these two conditions. Both can cause chronic congestion and runny nose. These two problems can also overlap, both being present in the same patient.  If left untreated, the child may develop sleep and behavior problems and alteration in facial or dental development from long-term mouth-breathing.

Allergies can be seasonal or can be year-round. Seasonal allergies can include reactions to grasses, trees and ragweed, to name a few. Year-round allergies include allergies to pets, dust and mold. In addition to nasal congestion and runny nose, which is usually clear drainage, there can be sneezing, itchy eyes and sensitive skin. Children with allergies are also at higher risk to develop asthma. Initial treatment involves use of antihistamines and sometimes nasal steroid sprays, under the guidance of the patient’s pediatrician.

If the patient is not responding to medical treatment, consideration should be given to other potential causes, the most common of which is enlargement or chronic infection of the adenoids. The adenoids are a collection of immune system tissue – called “lymphoid tissue”. The adenoids are present in the location where the nose joins the throat, called the “nasopharynx”. This tissue helps to fight infection, but can itself become infected and enlarged. When that occurs, symptoms such as nasal congestion, mouth breathing, snoring, restless sleep and runny nose can occur. These symptoms can become severe enough that they can mimic or even cause a sinus infection.  Ear problems can also occur.

When adenoid enlargement is suspected by the pediatrician, nasal steroids can be tried. This medication will sometimes decrease the size of the adenoids and improve symptoms. The use of nasal saline may also help. Antihistamines typically will not work if there are no allergies present.

If your child has tried antihistamines and/or nasal steroids but their symptoms did not improve, the pediatrician may send a referral to a specialist.

(July’s BLOG will have the continuation of this article,  focusing on when it might be time to see a specialist for these continued symptoms.)

Provided by David Hauswirth, MD

What is the difference between immunotherapy (IT) and Cluster immunotherapy?

Immunotherapy (“allergy shots”) is a treatment for allergies.  The patient is given gradually increasing doses of allergen (substance that causes your allergies), trying to make them tolerant or not allergic.  There are typically two phases to immunotherapy, build-up and maintenance.  For any build-up type (traditional, Cluster, etc.), the length of treatment is the same, typically 3-5 years.  The difference between Cluster and traditional immunotherapy is the buildup phase.  

With Cluster immunotherapy, the build-up phase is accomplished slightly more quickly, hopefully reaching a higher dose and relief a little quicker. This is accomplished by receiving a few shots each session and making larger changes in the dose.  With all types of immunotherapy, there is a risk of an allergic reaction when receiving a shot.  The risk with Cluster immunotherapy is slightly higher than traditional buildup schedules.

Cluster allergy shots are different from “Rush” immunotherapy.  “Rush” immunotherapy is an attempt to do the whole buildup in a day or two.  There is a much higher risk of a systemic reaction with this type of treatment.  “Rush” therapy is done when someone really needs to get rapid protection, such as a life threatening venom allergy.

Does Cluster immunotherapy work better than traditional immunotherapy?

Cluster IT is not better, but it may work more quickly.  All build-up programs have the same final result.  The only difference is how quickly you reach the maintenance dose.  A patient on Cluster, a patient on “Rush”, and a patient on traditional immunotherapy will all be on the treatment for 3-5 years and will have the same outcome, regardless of the build-up schedule.  Benefit for any immunotherapy program is based on the time it takes for your immune system to shift away from allergy responses after you reach maintenance.

Is Cluster immunotherapy safe?

Yes.  With all types of immunotherapy there is a risk of anaphylaxis or a systemic allergic reaction.  The faster you increase the dose, the more risk of a reaction.  Therefore, a slower traditional buildup has the lowest rate of reaction.  Cluster buildup has a rate of reaction slight above traditional.  “Rush” immunotherapy has a higher rate of anaphylaxis than either of these other two types.

Does the The American Academy of Allergy, Asthma & Immunology (AAAAI) have statements, either way, about the use of accelerated schedules for immunotherapy?

No system of build-up is endorsed by the AAAAI.  Cluster and rush immunotherapy are used in specific situations when the doctor and patient feel it is appropriate to do so and is safe.  They are not appropriate for everyone.  Very accelerated build-up (“Rush”) is only FDA approved for venom immunotherapy.  This is a specific situation where a rapid push to maintenance is necessary for a life-threatening venom allergy (bee sting). Cluster and rush immunotherapy are not FDA approved and are considered off-label use.  Speak with your doctor if you are interested in more information on immunotherapy.