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Runny Nose: Is it a Cold or an Allergy?
All children get runny noses now and again. But all runny noses are not the same—most are caused by the “common cold” or respiratory viruses, but some are caused by allergies. Determining the cause of your child’s runny nose can help you know how to aid your child’s recovery and prevent future runny noses.

Telling the Difference Between Colds and Allergies
Although it can be difficult to tell the difference between runny noses from colds and allergies, the symptoms may suggest which cause is more likely:

1. What does the mucus look like?
  • Does the mucus begin clear and watery but then become thicker and cloudy, yellowish or greenish and then dry up within a week or two? A cold is more likely.
  • Does the mucus stay clear and watery? An allergy is more likely.
2. Besides the runny nose, what other symptoms does your child have?
  • Does your child also have a sore throat, cough, low-grade fever, and fussiness? A cold is more likely.
  • Does your child also have eyes that are swollen, red, watery and itchy, with dark rings underneath? Is her nose congested and itchy? Does she sneeze or snore a lot? Has she ever been diagnosed with food allergies, eczema skin rashes, hay fever, or asthma? An allergy is more likely.
3. How long does the runny nose last?
  • Does the runny nose only last 1-2 weeks and then clear up for weeks or months before the next episode? A cold is more likely.
  • Does the runny nose last for weeks or months? An allergy is more likely.
4. What helps relieve your child’s symptoms?
  • If you give your child antihistamine medication, does it not really help? A cold is more likely.
  • If you give your child antihistamine medication, does it help? An allergy is more likely.
5. Do friends or family members have similar symptoms?
  • Did you notice that your child’s playmates or siblings had runny noses before your child did? A cold is more likely.
  • Does it seem that your child is the only one of her friends that has a runny nose for long periods of time? Do other family members have allergies, eczema, hay fever, or asthma? An allergy is more likely.
6. When does your child develop the symptoms?
  • Does your child get his first runny nose a few weeks after school starts in September, then a few more over the course of the fall and winter? Did he have more runny noses as an infant and toddler, then fewer each year as he got older? A cold is more likely.
  • Does your child develop the same symptoms whenever she’s exposed to something (e.g., a friend’s cat or playing in the grass), at the same time each year (e.g., every spring, summer or fall), or all year round? An allergy is more likely.
If it’s cold, what can you do about it?
Colds are caused by a virus infection in the nose and throat. Fortunately, our immune systems are naturally able to fight off the cold viruses. There’s an old saying: A a cold gets better on its own within a week or two; with medication, it gets better in 7-14 days. During this time, there are ways you can help your child feel more comfortable:
  • Give your child tender loving care and plenty of rest.
  • Keep up with good nutrition and plenty of fluids.
  • Run a cool-mist humidifier or vaporizer in your child’s room.
  • If your child’s nasal secretions are too thick and make breathing difficult, consider using “normal saline solution” (salt water) nose drops. For infants, you can use a soft rubber infant suction bulb to suck out nasal mucus.
  • Be cautious about giving your child medications since they may not relieve her symptoms or help her recover quicker, and they can have harmful side-effects. Consult the doctor before giving your child any medications including fever and pain reducers, antihistamines, decongestants, cough suppressants, antibiotics, or alternative medicines.
  • Call your doctor if your child is not getting better or has new symptoms of concern such as difficulty breathing, severe ear pain or sore throat, excessive fussiness, or high fever.
Colds are spread when the germs in nasal mucus and saliva are coughed into the air or picked up on hands, toys and food. Here are some tips to help prevent the spread of colds:
  • Wash your hands and your children’s hands frequently.
  • Don’t share food or drinks.
  • Kiss your children on the forehead or cheek instead of the mouth.
  • Cough or sneeze into your elbow instead of your hands.
  • Clean toys regularly.
  • Make sure your children get fresh air every day.
  • Don’t smoke in the home or car.
If it’s an allergy, what can you do about it?
Children develop allergies when their immune system overreacts to things in their environment. The allergic runny nose, also known as “allergic rhinitis,” is usually caused by airborne allergens such as pollens, molds, house dust mites, animal saliva and dander, and cigarette smoke. A child is more likely to have an allergy if one or both parents had allergies, eczema or asthma since these diseases are interrelated and hereditary.

If you think your child might have allergies, talk with your doctor. Treatment for allergies can involve the following:
  • Medications: These can be very helpful in reducing the symptoms of allergies. But they may also have some side-effects. Some medications are available over-the-counter (e.g., antihistamines) and others can be prescribed by the doctor. Talk with your doctor about the best treatment and the proper dosage.
  • Allergy testing: Sometimes the cause of your child’s allergies is clear (e.g., she sneezes whenever she’s near the neighbor’s cat), but sometimes you can’t identify the cause. Your child’s doctor may refer her to an allergy specialist who may do skin and blood tests to determine the causes of your child’s allergies, suggest ways to avoid the allergens, and prescribe the appropriate treatment. Some children are also helped by allergy shots.
  • Avoiding the causes of the allergies: It is very important to try to avoid the causes of your child’s allergies—both at home and at child care or school. To help prevent allergies, don’t smoke in the home or car.
Other suggestions:
  • For pollen allergies: Keep windows closed during the pollen season, especially on windy days.
  • For dust mite allergies: Encase the child’s mattress and pillow in a hypoallergenic cover. Remove stuffed animals from the bed. Remove wall-to-wall carpets from the house, especially the child’s room. Keep the house clean by mopping floors and using a HEPA-filter vacuum.
  • For mold allergies: Keep the house clean, dry, and free of mold. Repair any water leaks.
  • For pet allergies: Keep furry pets out of the home, especially the child’s bedroom.
  • Watch for possible signs of asthma such as persistent cough, wheezing, shortness of breath, or chest pain: Discuss these with your child’s doctor.

  • For more information on colds, see the articles on this website: “Colds: How to Prevent Them,” and “Recovering from Colds.” For more information on allergies, visit the Allergy and Asthma Network/Mothers of Asthmatics at www.aanma.org or Asthma and Allergy Foundation of America at www.aafa.org.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician