A Cold That Won’t Go Away – Is it Just “A Cold”? (continuation)

Provided by Evan Tobin, MD
and Roger Friedman, MD

If your child has tried antihistamines and/or nasal steroids but their symptoms did not improve, the pediatrician may send a referral to a specialist.

Which specialist? An Allergist or an ENT (Ear, Nose and Throat)?

At Ohio ENT & Allergy Physicians, both specialties work together to sort these problems out.  At one of our 10 convenient locations, a pediatric patient with chronic nasal and sinus symptoms can be evaluated for both adenoid problems and allergies. Testing will include routine allergy testing, a thorough physical exam and sometimes the use of a small flexible endoscope to evaluate the nasal passages and check the size of the adenoids. This scope also allows diagnosis of other problems such as a nasal foreign body, a polyp, or a deviated nasal septum (which is rare in children).

Medical treatment may be tried again by our specialists. This may include stronger nasal sprays, antihistamines, antibiotics or allergy shots (immunotherapy).

If this treatment is still not effective, surgical treatment may be offered. This may include removal of the adenoids and treatment of the nasal swellings called “turbinates”.  Sometimes tonsillectomy or ear tube insertion may be necessary, as well. (These will be discussed in a future blog.)



Provided by Evan Tobin, MD
and Roger Friedman, MD

Young children are more susceptible to upper respiratory infections (aka “URI” or “common cold”) because they are still growing, their immune systems are still maturing, and they are exposed to more viral infections through daycare and early school years.

The symptoms of a cold are well known to all of us. The symptoms include cough, runny nose, nasal congestion and sometimes a low-grade fever.

Some children, however, seem to have a “never ending cold”. They may mouth breathe, snore loudly and have a constant runny nose.

  • What is the cause for these symptoms?
  • As a parent, should you be concerned?
  • What can be done?

Two common problems of childhood can explain these nasal symptoms that simply won’t go away.

  1. Allergies
  2. An enlargement or infection of the adenoids

There are similarities between these two conditions. Both can cause chronic congestion and runny nose. These two problems can also overlap, both being present in the same patient.  If left untreated, the child may develop sleep and behavior problems and alteration in facial or dental development from long-term mouth-breathing.


Immunotherapy: Standard Build-Up vs. “Rush” Build-Up

Provided by David Hauswirth, MD

What is the difference between immunotherapy (IT) and rush immunotherapy?

Immunotherapy is a treatment for allergies.  The patient is given gradually increasing doses of a substance they are allergic to, trying to make them tolerant or not allergic.  For all types, the length of treatment is the same, typically 3-5 years.  The difference between “rush” and traditional immunotherapy is the buildup phase.  There are typically two phases to immunotherapy, build-up and maintenance. 

With “rush” immunotherapy, the build-up is accomplished in a rapid fashion.  Usually the patient will come into the office for a half or a whole day and receive many shots trying to build up more quickly.  There is a much higher risk of a systemic reaction with this type of treatment.  Rush is different from traditional build-up with weekly injections.  A third type is cluster immunotherapy with the patient receiving a few shots each visit trying to build a little faster.

Does rush immunotherapy work better than immunotherapy?

All of the immunotherapy styles have the same efficacy.  The only difference is how quickly you reach the maintenance dose.  A patient on rush, a patient on cluster and a patient on traditional immunotherapy will still be on the treatment for 3-5 years and will have the same outcome, regardless of the build-up schedule.