If a child has cold symptoms that go on and on, is it really allergies? Or is it just one long cold? Or several colds, back-to-back? This is especially difficult in the spring when all the flowers and trees are in bloom. Are the treatments the same? Either way the symptoms are miserable!!!

How right you are! Cold and allergy symptoms are often very similar. When cold-like symptoms persist, allergies may be the reason. Many of the treatments for cold and allergy symptoms are the same.

Walking into a drugstore, you are confronted with an overwhelming display of brightly packaged allergy products, each promising greater allergy relief than its neighbors. Many of these products can actually harm your child and make the effects of allergies even worse. Included in this category are the myriad of cough suppressants that more and more doctors are recommending parents avoid. The right choices, however, used in the right ways, can dramatically improve your child's springtime.

For years, the centerpieces of over-the-counter allergy therapy have been decongestants and antihistamines. Decongestants are caffeine-like compounds that work by constricting blood vessels throughout the body, including in the nose. By limiting blood flow to the nose, nasal congestion and swelling are somewhat decreased, providing a measure of relief.

Decongestants temporarily raise the blood pressure and make extra work for the heart. Since most kids have strong, healthy hearts this is usually not a problem. Rather, the tendency for kids on decongestants to experience irritability or sleeplessness is a more practical concern. Allergy preparations advertised as "non-drowsy" are typically decongestant preparations. Multi-symptom allergy or cold medicines usually contain a decongestant called phenylephrine, which has replaced pseudoephedrine. Topical decongestants (nose drops or nasal sprays) provide far greater relief with fewer side effects, but these powerful medicines should not be used for more than three days at a time (or they begin to work backwards and can also be habit-forming). These may be a great option for a night or two while another strategy is beginning to work, but are a poor choice for beating the effects of the allergy season.

Antihistamines reduce allergy symptoms by blocking the action of the histamine released by mast cells in response to allergic triggers such as pollen. These can be very effective, but all of the over-the-counter antihistamines cause some change in kids' levels of alertness. Most of the time, they produce drowsiness in children (which can be quite welcome -- especially at night), but around 5% of kids act hyper instead.

Of far greater concern is the effect of antihistamines on thinking and learning. We know that kids who are experiencing allergy symptoms don't think or learn or remember as well as kids who are feeling well (Annals of Allergy, Aug 1993). Careful studies have now been performed to determine whether this reduction in learning ability could be reversed by using over-the-counter antihistamines to relieve the allergy symptoms. The surprising results were that even though kids felt better on the antihistamines, their learning abilities were even worse than with no treatment (Annals of Allergy, Asthma, and Immunology, Mar 1996). When it comes to learning, children are better off congested than drugged. (Better yet is having the symptoms relieved in less problematic ways!)

Over-the-counter antihistamines are a reasonable choice for nighttime use, or for an occasional day or two when a child is home from school.