Scott Webb (Host): A common question many parents have when their kids are sick is whether or not it's a cold or allergies. My guest today is going to help us to recognize the signs and symptoms of each and offer expert advice on the best treatment options. I'm joined today by Dr. Soniya Mehra. She's a pediatrician with Stanford Medicine Children's Health.

This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Dr. Mehra, it's so nice to have you here. We're going to try to answer the age-old question, and I've had this question myself as a parent, is it a cold? Is it allergies? So, it's great to have you here. Great to have your expertise. So, let's start there. What is the difference between a cold and allergies?

Dr. Soniya Mehra: So, the major difference between cold and allergies is that a cold is an infection. It's caused by a virus, whereas allergies are the body responding to allergens in the environment, which can be seasonal or year-round. The common allergens include pollen, dust mites, pet dander, mold spores. So, you can imagine that those sort of wax and wane, depending on what your allergy is.

Now, cold and allergies can be commonly confused, because they have similar symptoms in that they both have sneezing, runny nose, stuffy nose, coughing, affect our energy level. But the major difference is that a cold, because it is an infection, is related to having a fever and body aches. And the allergies include itchiness with eyes and ears, nose and throat.

Host: Yeah, right. They do have some common symptoms. But as you say, you know, allergies, you wouldn't have a fever. So if you've got those symptoms, the sneezing and whatever, but you also have the fever involved, then it's likely not allergies. It's a cold, it's flu, something else, right?

Dr. Soniya Mehra: I should also mention that a cold occurs one to three days after the exposure to the virus, whereas allergies occur immediately after exposure to the allergens and last as long as you're exposed to the allergens without the help of medication, of course. Allergies will continue to affect someone as long as they are exposed, whereas a cold will last on average three to seven days.

Host: There's a sort of the incubation period for a cold. But allergies, if you're allergic to pollen or trees or grass or whatever it is, if you're outside and you're allergic to those things and you haven't taken any medications to help, obviously, for as long as you're out there, you're going to be suffering, right?

Dr. Soniya Mehra: Exactly. Exactly.

Host: And I think we all sort of learned during COVID, if we wash our hands, if we maybe use sanitizer when we can't wash our hands, there's some things that we can do basically to avoid getting colds. But from an expert, is there like tried and true, just known gold standard ways of avoiding a cold?

Dr. Soniya Mehra: Exactly what you're saying is as much good hand hygiene that we can do as well as teaching our little ones, which I know can be a difficult task, how to sneeze and cough into their elbow and not on other people. That's one that takes some time.

Host: It sure does. Of course, during COVID people were wearing masks, but just simple hand hygiene, washing our hands well and properly. And, you know, I always keep sanitizer in the car, because I can't wash my hands in the car. So, trying to keep those hands as clean and free of, you know, bacteria and germs as possible. And I think I know the answer to this one, but how common are allergies? You mentioned that you went through the list of the different types of allergies, especially in certain seasons. So, how common are they?

Dr. Soniya Mehra: Over 50 million Americans have allergies. It's the sixth leading cause of chronic illness in the U.S. and allergies can start at almost any age, so it's very common.

Host: Yeah. And we're the kind of people who had two people in our home who were allergic to cats, pets in general, but especially cats. So, we went out and of course got two cats. So, my wife and my daughter are just always miserable, but they love the cats so much and they love to cuddle with them. So, it's sort of a good and bad. You get the cuddling, but then you also get the sneezing. So, are there certain allergies though that are more common in the spring versus summer versus fall? What can we expect with the different seasons?

Dr. Soniya Mehra: Sure. So, you can imagine that pollen is especially rampant in the spring here locally. But some things such as dust mites or pet dander last as long as those exist, which can be year-round in most houses.

Host: Yeah, definitely a year-round. And, you know, it makes me wonder, you go to the store and you see lots of these OTC allergy medications, we'll call them, right? So, when we think about preventing allergies, other than avoiding the triggers, which makes sense. Prudent for adults. You know, if you know what triggers your allergies, maybe stay away from those things, but sometimes we just can't, right? We have to go outside, we have to go to work, we have to cuddle with our pets, whatever it is. Is there any particular ways or ways that you recommend to prevent allergies?

Dr. Soniya Mehra: Sure. So, you're exactly right in that number one is trying to eliminate or reduce the exposure to the allergens themselves. I talk to parents about if the kids go play outside, I don't want to keep them from playing outside, but maybe as soon as they come in they take a bath and change their clothes as the allergens tend to settle in the hair and clothes.

But if we know we're going to be doing field day outside today and the kids have a history of allergies, you may start the morning off with a children's antihistamine, such as diphenhydramine, cetirizine, or loratadine, making sure that, you know, they start off the day with that to help them with their symptoms.

Host: I'm assuming that the children's version of those things to deal with the symptoms of allergies, I'm assuming that they're all non-drowsy, is that right?

Dr. Soniya Mehra: Diphenhydramine is a drowsy medication. So if a child tends to get more allergies in the evening and it's affecting their sleep, I might time giving them that before bed. But cetirizine and loratadine as well as fluticasone nasal spray, which help with allergies, can be used any time of day since they're non-drowsy.

Host: Yeah, that's good to know, because last thing we want is our kiddos being at school falling asleep.

Dr. Soniya Mehra: Exactly.

Host: "Mom and dad gave me a pill and now I can't stay awake." So, let's talk about then treatment options for parents. Obviously, we're talking about avoiding triggers and there's some OTC medications. But in general, what do we do? Whether we're talking about colds or allergies, what's our best plan at home?

Dr. Soniya Mehra: So, the things that we can use for both colds and allergies include saline nasal drops or spray and nasal bulb suctioning for our little ones that won't squirm away. Using a humidifier at night to help with any of that nasal congestion and stay well hydrated helps with both colds and allergies. Now, something that won't really help for allergies include fever reducers. So, our Tylenol, Motrin won't help too much for allergies, because there are no fevers with allergies, but it would come in handy for a cold.

Host: Yeah. Our son used to suffer these inexplicable fevers when he was a kid. Just like repetitive fever syndrome or whatever they called it, right? And so, we found a lot of value in just colder baths. You know, just to try to get that fever down plus some OTCs, you know, because it was one of those things where there was just nothing anyone could do to help him and his fevers would spike. And it was like, "All right, bud, time for a bath," right?" Let's get that fever down." So, maybe do you recommend that as well like if it's you know on the higher side, maybe over 102, time for a somewhat cold bath or something like that?

Dr. Soniya Mehra: Absolutely. I mean you can start off with just minimizing the amount of clothes on the child to just let them cool off to room temperature and, if needed, a cool lukewarm bath.

Host: Yeah. I used to go into his room and he had all these blankets and things piled on him. And I'd say, "All right. Let's get some of these layers off and try to cool down here, bud. And if we have to, we'll jump in the bath." So, just finishing up here, doctor, when do we reach out to the pediatrician, you know, provider? When do we seek treatment, I guess, outside of the home? When do the alarms go off?

Dr. Soniya Mehra: For both cold and allergies, if your child has trouble breathing, is looking sicker, or is not improving with the above treatment that we were talking about, you definitely want to give your doctor a call or come on in. A cold can at times evolve into a bacterial infection that needs antibiotics, and poorly controlled allergies can be further managed by an allergist if needed. So, you know, these are things your pediatrician can help you with.

Host: Right. Yeah. Long term, maybe getting to the root cause of the allergic reactions or the signs and symptoms that your kiddos are experiencing. So, doctor, thanks so much for your time today. I really appreciate this. I know a lot of parents had these questions. You know, is it a cold? Is it an allergy? And what do we do? So, thank you so much.

Dr. Soniya Mehra: Of course, we are always here for you. Your pediatrician is always there for you. So don't hesitate to ask questions or reach out.

Host: Yeah, that's perfect. When in doubt, reach out to the professionals. They're here to help and pediatricians are just the best, which is why I love hosting these podcasts. So, thank you so much.

Dr. Soniya Mehra: Thank you.

Host: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.