Pediatric Allergist Explains How to Tell If It’s Allergies or a Cold

Daniel DiGiacomo, M.D., M.P.H.

Credit: Hackensack Meridian Health

As the seasons change, many parents notice their children experiencing runny noses, coughs or watery eyes and wonder whether it’s just a lingering cold — or something more. Seasonal allergies are increasingly common in children, often beginning after age 2 and becoming more frequent through adolescence. According to Daniel DiGiacomo, M.D., M.P.H., a pediatric allergy and immunology specialist at K. Hovnanian Children’s Hospital, recognizing the signs of allergies and understanding how to manage them at home can make a big difference in a child’s comfort, sleep and overall quality of life.

From distinguishing symptoms from a cold to minimizing exposure to triggers and knowing when to seek professional care, parents have practical tools to help their kids breathe easier and feel better.

To begin, what are the most common signs that a child's runny nose or cough might be due to seasonal allergies instead of a cold?

Daniel DiGiacomo, M.D., M.P.H.: The first thing to consider is a child’s age. Seasonal or year-round allergies typically begin after age 2 and become more common as children grow into adolescence. When assessing whether symptoms are due to allergies, parents should look for signs such as itchy eyes or an itchy nose, red eyes with watery, clear discharge and clear nasal drainage. While both colds and allergies can cause a runny nose, allergy-related mucus is usually clear, not thick or [gooey], and allergies rarely cause fever. A child may have a mild sore throat due to post-nasal drip, but you won’t typically see the inflamed tonsils that often appear with a cold or bacterial infection. These distinctions can help parents decide whether what their child is experiencing is more likely seasonal allergies or a common cold.

What steps can parents take at home to reduce their child's exposure to pollen or other outdoor triggers?

DD: Both outdoor and indoor allergens can contribute to symptoms, and children are often sensitive to both. Outdoor allergens vary by season. In the spring, tree pollen is most common; in the summer, grasses tend to be the main trigger; and in the fall, ragweed is the primary culprit. Pollen counts tend to be highest early in the morning and later in the evening, though predicting the worst days can be difficult. Limiting outdoor exposure during peak pollen times, changing clothes and showering after returning inside can all help.

Mold is another common outdoor allergen, which tends to peak during hot, humid summer months or after thunderstorms and high winds. Mold spores can worsen allergy symptoms year-round in susceptible children.

Indoor allergens can also significantly contribute to symptoms. Common indoor triggers include dust mites, pet dander and pests such as cockroaches or mice. Parents can reduce exposure by keeping windows closed, running air conditioning with regularly maintained filters, and keeping indoor humidity around 50%, particularly in bedrooms. Using dust-mite-proof mattress and pillow covers, limiting upholstered furniture and keeping pets out of bedrooms can also help. HEPA air filters are useful for reducing airborne allergens. For pest-related triggers, maintaining cleanliness, storing food properly and using traps can reduce exposure.

When should families see an allergist versus managing symptoms with over-the-counter medications?

DD: Allergic rhinitis is very common, and many families can manage mild symptoms with over-the-counter medications. First-line treatments include nondrowsy antihistamines such as loratadine, cetirizine or fexofenadine. Nasal steroid sprays or antihistamine nasal sprays may also be used for more persistent or severe symptoms. However, if a child’s allergies disrupt sleep, interfere with school performance or do not respond adequately to these medications, it’s time to see an allergist. Allergists have additional diagnostic and treatment tools, including allergy testing and immunotherapy, that can provide long-term relief and better symptom control.

What advice do you have for parents of children with asthma or eczema, since these conditions often overlap with allergies?

DD: Many children experience what we call the “atopic march,” a progression where early eczema can lead to asthma and allergic rhinitis. Managing allergies effectively can improve asthma control and reduce related complications. Allergy shots, or immunotherapy, can help children who have multiple allergic conditions, sometimes improving both eczema and respiratory symptoms. Addressing these overlapping conditions as a whole can make a significant difference in a child’s quality of life.

Is there anything else you’d like families to know?

DD: Timing and consistency of treatment are key. If you know your child’s seasonal triggers, starting medications before the season begins can help prevent symptoms from becoming severe. Consistent use of medications, especially nasal sprays, is essential for controlling symptoms effectively. Allergists are an invaluable resource — they can manage multiple allergic conditions simultaneously, including asthma, eczema and allergic rhinitis, and offer treatment options beyond over-the-counter medications. The goal is not just to treat symptoms but to improve a child’s overall well-being and quality of life.

This transcript has been edited for clarity.