Recognizing Allergies in Children

Allergies are very common. Over fifty million people in the US have some type of allergy and thirteen million adults and four million children have asthma.  If you have asthma you have an 80% risk of also having allergies. Most asthma symptoms begin after exposure to specific allergens and in children viral infections are the most common cause of an asthma episode.  Itchy and watery eyes or nose, sneezing, coughing and wheezing are the most common symptoms. Skin rashes including hives are common as are gastrointestinal symptoms. If one parent has a history of allergies a child has a 25% risk of also having allergies. If both parents have allergies this risk increases to over 60%.

In addition to general discomfort other consequences to allergies include an increased risk for infection, school absence and work loss. Life threatening consequences due to anaphylaxis although uncommon are also possible.

An allergy is caused by an overreaction of the body’s immune system. The immune system functions to fight off infection. In the case of allergies it becomes activated to a harmless substance called an allergen.  Antibodies (IgE) are produced that cause a cascade of events leading to the release of many chemicals such as histamine from allergy cells in the body. An allergy is not a disease. It is a reaction to something eaten, breathed, touched or injected.

The most common reactions include wheezing, skin reactions like hives, contact or atopic dermatitis, eczema, food allergy and hay fever. Common airborne allergens are pollens such as trees, grasses and weeds or molds, dust mites and animal dander. Food allergens include cow’s milk, eggs, soy milk, wheat, peanuts and tree nuts, seafood and shellfish. Medication, chemicals and the saliva from stinging insects are also common allergens.

The most serious reaction is anaphylaxis. After allergen exposure there is a rapid onset of skin, gastrointestinal, respiratory and cardiac symptoms that can lead to death if there is not rapid intervention with epinephrine. This is done through the use of an EpiPen or a Twinject.  An antihistamine like Benadryl is also given. In children the most common causes are peanuts, tree nuts, cow’s milk, soy, eggs, fish and shellfish. Insect stings from bees, wasps, hornets and fire ants can also cause anaphylaxis.

For mild to moderate symptoms avoidance and environmental accommodations are best. The best treatment is to determine the cause of the allergy symptoms and then to focus on avoidance measures. Options include vacuuming and dusting, carpet avoidance, the use of air conditioning, damp mopping, a HEPA filter and humidity control. Dust mites and molds thrive in a moist environment.  Indoor plants, smoke and pets can also cause allergy symptoms.  Working with your doctor and close observation are essential to develop the best action plan to treat your child.  Mild symptoms can often be managed with avoidance and over the counter antihistamines. For chronic or moderate to severe symptoms further allergy intervention including skin testing, prescription medications and immunotherapy (allergy shots) are often needed. Treatment is available. The proper intervention can alleviate or eliminate life threatening reactions and symptoms that make your child’s life very difficult.