Allergies without allergy

The Pediatric Insider

© 2011 Roy Benaroch, MD

“My ten year old daughter seems to have allergies—she sneezes a lot, and is always congested. She’s been tested for everything and isn’t allergic. What is going on, and how can I help her?”

No one can be allergy tested for “everything.” With skin testing, there’s only so much skin to use to test; and for blood testing, well, even a vampire can only get so much blood out of a child. Allergy testing uses a panel of common allergens for the area, but can’t possibly cover all possibilities.  It may be that she really is allergic to something, but she wasn’t tested for it.

It’s also possible that the test itself didn’t give an accurate answer. Allergy testing isn’t close to 100% correct, and both false positives (the test is positive, but the child really isn’t allergic) and false negatives (the test is negative in a truly allergic child) do occur. Even though she’s been extensively tested, it could also be that the test is wrong, and she is allergic to something that she tested negative.

There are other things that might be going on, besides allergies. Cold viruses can trigger an itchy or runny nose, so if she’s been getting one cold virus after another it can seem like one long illness. There’s also a non-allergic condition called “vasomotor rhinitis” which causes nasal congestion and sneezing, especially in bright sunlight. Noses can also be bothered by cigarette smoke or other irritants, triggering allergic-like symptoms, without actually causing true allergy. Rarely, an anatomic obstruction like a nasal polyp may cause symptoms similar to chronic allergies.

It can sometimes be tough to tease these situations out. Often, a best next step is to try regular use of an effective allergy medication, even though she tested negative. The most effective allergy medicines are topical prescription nose sprays (do NOT regularly use an over-the-counter medicated nose spray—they’re addictive.) If allergy medications work,  at least she’ll get some relief. You can also try to rinse her nose out with gentle saline solution, which may relieve symptoms caused by irritation (warning: some kids do not like to have their noses rinsed out. Imagine that.) Further discussions and evaluation by an allergist, pediatrician, or ENT (ear-nose-throat) specialist may also be helpful if her symptoms continue to bother her.

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3 Comments on “Allergies without allergy”

  1. Kay Says:

    As someone with a Periodic Fever Syndrome, I didn’t realise that there could be other reasons for hives that are not allergies. I’d been popping anti-histamines for years on the advice of various doctors and slowly going deaf before someone in the family got diagnosed and the penny finally dropped. It’s a rare and extreme case but yeah, I learnt the hard way that not all allergies are allergies.

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  2. Hi.

    Just stumbled upon your site looking for info on sleeping and allergies for an article I’m writing on the subject. I’m really only commenting on one aspect of what you’ve written – the nasal rinsing. I have two very allergic children and we use a lot of saline on our house. Initially Ella, my three year old, was furious about having water sprayed up her nose against her will (can’t imagine why…:)) and we needed to hold her down to do it. I’m not a fan of holding crying children down..who is?…so I tried explaining to her what I was doing and warning her and asking her to let me know when she was ready. It worked! Both my children, from the age of 6 or 7 months, lifted their noses when they were ready to be “spritzed” and we neither ever cried or squirmed again. I’m just sharing this because the saline can really make a difference to a blocked nose and the trauma of administering it can be discouraging.

    Great blog, thanks!

    Catherine McCormack

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  3. Stan Says:

    A brief addendum – there is now one OTC nasal spray that is NOT addictive and can really help with allergic or non-allergic rhinitis – Nasacort. It’s a nasal steroid, rather than a topical decongestant like (addictive) Afrin and Neo-Synephrine.

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