Allergies in children

Allergies in children, an incidence which

has increased over the last fifty years, are
overreactions of the immune system often
caused by foreign substances or genetics
that may present themselves in different
ways.[1] There are multiple forms of
testing, prevention, management, and
treatment available if an allergy is present
in a child. In some cases, it is possible for
children to outgrow their allergies.
 Allergy

Other names Allergic diseases

Hives are a common allergic symptom

Specialty Allergy and

immunology

Symptoms Red eyes, itchy rash,

runny nose, shortness
of breath, swelling,
sneezing

Types Hay fever, food

allergies, atopic
 dermatitis, allergic
asthma, anaphylaxis

Causes Genetic and

environmental factors

Diagnostic method Based on symptoms,

skin prick test

Differential diagnosis Food intolerances,

food poisoning

Prevention Repeated exposure to

allergens,
prophylactic
respiratory
medications

Treatment Avoiding known

allergens,
 medications, allergen
immunotherapy

Medication Steroids,
antihistamines,
epinephrine

Morbidity
Children affected by allergies in the
developed world:[2]

1 in 13 have eczema
1 in 8 have allergic rhinitis
3-6% are affected by food allergy

Children in the United States under 18

years of age:[3]
 Percent with any allergy: 27.2%
Percent with seasonal allergy: 18.9%
Percent with eczema: 10.8%
Percent with food allergy: 5.8%

Children in the United Kingdom:[2]

1 in 6 with eczema
1 in 5 with allergic rhinitis
7.1% of breast-fed infants who develop
food allergies

Pathophysiology
A child's allergy is an immune system
reaction to a foreign substance, or
allergen, that is considered harmless to
most. According to Dr. James Fernandez
with the Cleveland Clinic Lerner College of
Medicine at Case Western Reserve
University, "Genetic and environmental
factors work together to contribute to the
development of allergies."[4] Upon contact
with an allergen, a child’s immune system
produces antibodies which patrol the body
for future encounters with the invader.[5]
During any future encounters, the
antibodies release immune system
chemicals, such as histamine, that cause
allergy symptoms in the nose, lungs,
throat, sinuses, ears, eyes, skin, or
stomach lining.[5][6] The development and
symptoms of asthma can also be
triggered by allergies; indoor allergens and
indoor volatile organic compounds, such
as formaldehyde, have been known to do
so.[6][7][8][9] Anthony Durmowicz, M.D., a
pediatric pulmonary doctor at the FDA also
says that, if a child has both allergies and
asthma, "not controlling the allergies can
make asthma worse."[6]

Risk Factors
Children are already at a higher risk of
developing an allergy due to their age.[5]
Other risk factors include:[5][10][11]

Having a family history of allergies or

asthma
 Having asthma or other
allergies/allergic conditions

Causes/Allergens

Ragweed is a plant and some are allergic to its pollen.

Airborne allergens, certain foods, insect

stings, medications, and latex or other
substances one touches are the most
common allergy triggers.
Examples of airborne allergens
include:[5][11]

Pollen
Animal dander
Dust mites
Mold
Cockroaches

The top 9 food allergens are:[12]

Milk
Eggs
Fish
Crustacean Shellfish
Tree Nuts
 Peanuts
Wheat
Soybean
Sesame

Vitamin D deficiency at the time of birth

and exposure to egg white, milk, peanut,
walnut, soy, shrimp, cod fish, and wheat
makes a child more susceptible to
allergies.[1] Soy-based infant formula is
associated with allergies in infants.[13]

Common drug allergens in children are:[14]

Amoxicillin (most common)

Penicillin
 Other penicillin-based antibiotics

The most common insect bite/sting

allergens are:[15][16]

Bees
Wasps
Ants
Mosquitoes
Fleas
Ticks

Common skin allergens and triggers

include:[5][17][11][16]

Latex
 Chemicals (cleaning products,
fragrances, laundry detergents)
Formaldehyde
Plants
Heat & cold
Excessive sweating
Stress & anxiety
Infections

Signs/Symptoms
According to the Mayo Clinic, “Allergy
symptoms, which depend on the
substance involved, can affect your
airways, sinuses and nasal passages, skin,
and digestive system.”[5] The severity of
the following symptoms varies from child
to child.[5]

The symptoms of indoor and outdoor

allergies in children may include:[18][19]

Runny nose
Itchy, watery eyes
Sneezing
Itchy nose or throat
Nasal congestion

Symptoms of indoor allergies can occur

year-round but tend to be more
troublesome during the winter months
when children are inside more often.[18]
However, outdoor allergies, or seasonal
allergies, normally change with the
season.[19]

The potential symptoms of a food allergy

include:[10][5]

Tingling/itching in the mouth

Swelling of the lips, tongue, face, throat,
or other body parts
Hives, itching, or eczema
Abdominal pain, diarrhea, nausea, or
vomiting
Anaphylaxis (life-threatening)
Possible symptoms of a drug allergy
include:[5]

Hives
Itchy skin
Rash
Facial swelling
Wheezing
Anaphylaxis

Symptoms of a potential insect bite/sting

allergy include:[5]

A large area of swelling (edema) at the

bite/sting site
Itching or hives all over the body
 Cough, chest tightness, wheezing or
shortness of breath
Anaphylaxis

Symptoms of allergic skin conditions such

as atopic dermatitis, or eczema, include:[5]

Itching
Redness
Flaking

Diagnosis
There are some different ways that can
lead allergists to an official diagnosis of an
allergy. These methods include:[5][10][4]

Family history of allergies

 A diary with potential triggers or foods
the child eats and reactions to them
Elimination diet
Skin tests (skin prick test and
intradermal test)
Blood test (allergen-specific serum IgE
test)
Provocative testing (oral food challenge,
etc.)

Family medical history can be used to help

determine if a child may have an allergy
because of genetics. "Genes are thought
to be involved because specific mutations
are common among people with allergies
and because allergies tend to run in
families."[4] However, it is not the specific
allergies that are passed down, just the
likelihood of developing allergies.[11]

Keeping a diary of the child’s symptoms

and possible triggers can help an allergist
determine if the child has an allergy or
guide decisions for further testing. The
possible allergens tracked in this manner
include food, skin, indoor and outdoor
allergens. Keeping track of when the
symptoms appear/the reaction occurs can
also help determine the possible triggers,
as "[f]ood allergy symptoms usually
develop within minutes to 2 hours after
eating the offending food."[10]
An elimination diet involves complete
avoidance of suspected food allergens for
1–2 weeks and readding them to the
child’s diet one at a time to watch for
symptoms.[10] This method, however, may
not always be accurate in identifying food
allergies because it also works for
determining food
sensitivities/intolerances, which are
different.[10]

Skin Prick Test

There are two types of skin tests that are
commonly used for diagnosing allergies.
The first one done is the skin prick test,
which can identify most allergens.[4] This
test involves pricking a needle through a
drop of each control and allergen test
solutions into the child’s skin.[4] The
intradermal test may be done second if no
allergen is identified with the skin prick
test.[4] This test is more sensitive and
involves injecting tiny amounts of the
control and allergen test solutions into the
child’s skin with a needle.[4] For either test,
any allergies will result with a wheal and
flare reaction (swelled center and
surrounding circular red area) at the
pinprick site.[4] For accurate results, any
child undergoing either test will need to
stop taking any drugs/medications that
may suppress a reaction.[4]

For children who cannot receive either skin

test, the blood test is used to determine
"whether IgE in the person's blood binds to
the specific allergen used for the test."[4]
IgE is immunoglobulin E – the antibody
produced by the immune system to
protect the body from the "invader."[11] A
specific allergy can be confirmed if binding
occurs with that allergen.[4] Provocative
testing for any type of allergen involves
directly exposing the child to small but
increasing amounts of a suspected
allergen.[4][10] It is done at a doctor’s office
by a doctor who can confirm the allergy if
a reaction occurs during the test.[10]

Provocative testing for any type of allergen

involves directly exposing the child to
small but increasing amounts of a
suspected allergen.[4][10] It is done at a
doctor’s office by a doctor who can
confirm the allergy if a reaction occurs
during the test.[10]
Prevention, Management, &
Treatments

Some older children can be taught to use their prescribed Metered-Dose Inhaler.

Metered-Dose Inhaler Mask (Child)

There is no cure for allergies, making the
avoidance of allergens one of the most
important ways to prevent a reaction.[5]
Keeping a diary of symptoms, potential
triggers, activities, and what helps reduce
symptoms is also a helpful form of
prevention and management.[10][5]

For pet allergies, it may help to keep pet-

free zones in the house (bedrooms), give
furry friends frequent baths, have kids
wash hands after petting and avoid
touching their eyes, and use over-the-
counter (OTC) allergy medicine to reduce
symptoms.[18] These OTC allergy
medications include antihistamines, such
as Benadryl, Claritin, and Allegra, and nasal
corticosteroids, such as Flonase and
Afrin.[20] However, it is important to
consult a doctor before taking any new
medications. OTC medications may not
work for every child, but a doctor may be
able to prescribe a different, stronger
medication or alternative treatment.[6]
Immunotherapy in the form of allergy
shots is one alternative treatment.[6] If the
child’s reactions cannot be maintained
using these methods, it may be better to
find a new home for the pet and get a
different one.
For other indoor allergies, thoroughly clean
the house, bedding, and stuffed animals
frequently.[18] Using special hypoallergenic
furniture and covers for bedding, trading
carpet for hardwood flooring,
dehumidifying, and letting in sunlight may
also help with some allergens.[18] If
present, cockroaches, mice, and rats
should be controlled to reduce symptoms
as well.

Outdoor allergy symptoms can be

managed by strategically planning outdoor
play time, removing shoes and clothes and
bathing after playing outside, keeping car
and house windows closed and using the
air conditioning, planting an allergy-friendly
yard for kids, and keeping allergy medicine
handy.[6][19] It may also help to keep leaves
and grass clippings away from the house,
keep trees and bushes trimmed, and avoid
drying clothes on outdoor
clotheslines.[6][19] Allergy shots are another
possible means of
management/treatment for these allergies
as well, if necessary.[6]

Reactions to food allergens can also be

prevented in multiple ways. One of these
ways is avoiding cross contamination of
allergens into safe foods.[10] Keeping
hands/gloves, utensils, surfaces, etc.
clean is important. Another effective way
to avoid these allergens is to read food
labels on everything that has one that may
be ingested.[10] If a product contains or
may contain one of the major nine
allergens, the food labels are required to
have a special note to inform potential
consumers.[10] Other preventative
measures include informing the child,
relatives, babysitters, teachers, and any
other care givers of the child’s allergy and
ways to avoid/treat it and avoiding any
foods that you are unsure of that were
made by others.[11][10] This could be food
at school, a restaurant, or any social
gathering.[10]
For bug bite/sting and skin allergens,
using fragrance-free skincare products,
keeping the skin moisturized, using insect
repellent, and wearing protective clothing
are some of the easiest ways to prevent a
reaction.[16] OTC medications, prescription
(steroid) medications and creams, allergy
shots, and biologics are also effective
ways to manage/treat some skin
allergies.[5][4][21] It is also best to avoid
scratching any affected area(s) as much
as possible.[16]

As they get older, some children may

outgrow their allergies.[10] Others can also
be desensitized to an allergen through
exposure to the allergen, but this is a
process that takes time and is not always
necessary or possible.[4]

Severe Allergies & Reactions

If a child has any severe allergies that may
be life-threatening, the Mayo Clinic
recommends having the child wear a
medical alert bracelet or necklace that
would inform others of the allergy if the
child was ever unable to communicate.[5] It
is also crucial to always have an
epinephrine auto-injector (EpiPen, etc.) on
hand that is not expired.[5] Antihistamine
medications are also helpful.[4]
If the child encounters the allergen and
shows signs of anaphylaxis, use the
epinephrine auto-injector first, if available,
and seek medical help immediately.
Antihistamine medication can also help
slow the reaction in addition to
epinephrine if it has been approved for
combination by your doctor.[4] Otherwise,
call 911 or your other local emergency
number immediately for emergency
medical help.[5]

Epidemiology
Up to 5% of infants that are fed cow's
milk-based formula will develop an
allergy to cow's milk.[22]
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