ABSTRACT: Allergen avoidance measures are the first course of action in the treatment of allergic rhinitis in children. Of the many pharmacological options for allergic rhinitis, second-generation oral or intranasal antihistamines remain the mainstay of treatment for mild intermittent symptoms. Intranasal corticosteroids are the most effective medications for moderate to severe symptoms. In patients who do not respond to pharmacotherapy, allergen immunotherapy may be effective. Immunotherapy can change the clinical course of allergic disease by reducing the risk of new allergic sensitizations and by preventing the progression of allergic upper airway disease to lower airway disease, such as asthma. To be successful, this lengthy treatment requires family commitment to patient adherence.
A 3-year-old girl is brought by her mother for evaluation of a rash that began as a single painful, itchy blister on the lip 4 days earlier. After the blister resolved, similar lesions appeared on the face, trunk, and upper extremities. The mother reports that the child had cold symptoms a week before presentation, but no fever, chills, body aches, nausea, or vomiting. The patient has a history of atopic dermatitis and both parents have asthma. She has had no hospitalizations or surgeries and no recent medication use. She is up-to-date with her immunizations.
Deepak M. Kamat, MD, PhD, professor of pediatrics and longtime Consultant For Pediatricians Editorial Board member, was recognized by Wayne State University with the 2012 President’s Award for Excellence in Teaching. The faculty members who receive this award have made outstanding contributions in their field of education and demonstrate exceptional knowledge, unwavering enthusiasm, and an uncanny ability to motivate students.
A 4 1/2-year-old girl is brought for evaluation of a generalized, pruritic, erythematous rash. The rash first appeared on the face and upper trunk and then spread to the upper and lower extremities over the next 12 hours.
A 16-year-old boy has had recurrent right knee pain for the past few months. A few months earlier, he had a minor injury to the knee, which caused minimal pain. However, the knee continued to hurt on and off, and he now feels “something inside the knee.” The patient is an athlete, and the parents are concerned that the pain will hinder his participation in sports. He has had no knee swelling or redness. He denies pain in any other joint.
A 10-month-old boy was brought to the emergency department because of labored breathing and fever. His symptoms developed the previous evening and also included drooling, cough, gagging, nasal congestion, and mildly loose stools. The mother attributed the symptoms either to food allergy, because they occurred a few hours after the infant had accidentally ingested kiwi (a known allergen), or to teething. The morning of presentation, an uncle noticed a chemical odor on the boy’s breath but had not witnessed a chemical ingestion. The infant was drinking less than usual but had normal wet diapers.
A 2-year-old girl with tearing and redness of her right eye for the past 2 to 3 days. Her parents stated that she occasionally rubbed her right eye and squinted in the sunlight. The child had been healthy and had no other acute concerns. Prior medical history was unremarkable, and review of systems was negative.
A 17-month-old girl recently adopted from China was brought for evaluation. She was noted to have a 2.5-cm appendage protruding from the sacrum (A). The mass was soft, with no bones or pain on palpation and no swelling or erythema. Examination was remarkable for a left arm that ended mid-forearm, consistent with amniotic banding. Physical findings were otherwise normal, with no noted neurological deficits.
One hour after sustaining a puncture wound to the left ankle, a 2-year-old boy was brought the emergency department. The father, a commercial fisherman, was attempting to free a catfish from a crab trap when it fell and its dorsal spine punctured the child’s ankle. The boy had immediate pain, erythema, and edema. After several unsuccessful attempts at removal, the father cut the spine 1 cm above the skin with a pair of pliers.
A 3-year-old girl is brought by her mother for evaluation of a rash that began as a single painful, itchy blister on the lip 4 days earlier. After the blister resolved, similar lesions appeared on the face, trunk, and upper extremities. The mother reports that the child had cold symptoms a week before presentation, but no fever, chills, body aches, nausea, or vomiting. The patient has a history of atopic dermatitis and both parents have asthma. She has had no hospitalizations or surgeries and no recent medication use. She is up-to-date with her immunizations.
Deepak M. Kamat, MD, PhD, professor of pediatrics and longtime Consultant For Pediatricians Editorial Board member, was recognized by Wayne State University with the 2012 President’s Award for Excellence in Teaching. The faculty members who receive this award have made outstanding contributions in their field of education and demonstrate exceptional knowledge, unwavering enthusiasm, and an uncanny ability to motivate students. 
A 4 1/2-year-old girl is brought for evaluation of a generalized, pruritic, erythematous rash. The rash first appeared on the face and upper trunk and then spread to the upper and lower extremities over the next 12 hours.
A 16-year-old boy has had recurrent right knee pain for the past few months. A few months earlier, he had a minor injury to the knee, which caused minimal pain. However, the knee continued to hurt on and off, and he now feels “something inside the knee.” The patient is an athlete, and the parents are concerned that the pain will hinder his participation in sports. He has had no knee swelling or redness. He denies pain in any other joint.
A 10-month-old boy was brought to the emergency department because of labored breathing and fever. His symptoms developed the previous evening and also included drooling, cough, gagging, nasal congestion, and mildly loose stools. The mother attributed the symptoms either to food allergy, because they occurred a few hours after the infant had accidentally ingested kiwi (a known allergen), or to teething. The morning of presentation, an uncle noticed a chemical odor on the boy’s breath but had not witnessed a chemical ingestion. The infant was drinking less than usual but had normal wet diapers.
A 2-year-old girl with tearing and redness of her right eye for the past 2 to 3 days. Her parents stated that she occasionally rubbed her right eye and squinted in the sunlight. The child had been healthy and had no other acute concerns. Prior medical history was unremarkable, and review of systems was negative.
A 17-month-old girl recently adopted from China was brought for evaluation. She was noted to have a 2.5-cm appendage protruding from the sacrum (
One hour after sustaining a puncture wound to the left ankle, a 2-year-old boy was brought the emergency department. The father, a commercial fisherman, was attempting to free a catfish from a crab trap when it fell and its dorsal spine punctured the child’s ankle. The boy had immediate pain, erythema, and edema. After several unsuccessful attempts at removal, the father cut the spine 1 cm above the skin with a pair of pliers.
