"Is my child allergic?" is a question that we are asked many times in our practice. Allergy is a disease that tends to run in families. Allergic disorders have a wide variety of manifestations. They may cause symptoms as benign as a runny nose or they may result in a severe life-threatening event known as anaphylaxis, with breathing difficulty and cardiovascular collapse (shock). Thankfully, anaphylaxis is quite rare.
In the very young infant, allergy may be manifested by diarrhea, bloody diarrhea, nasal congestion, rash, wheezing and colic. Among other causes, these symptoms may be due to a formula allergy, which, if untreated, can be serious. Additionally, the same symptoms may not be due to allergy at all, but to an infection or other cause. Because of this, we recommend bringing any infant with the above symptoms to the office for a checkup.
Older infants and children tend to have allergic manifestations that are very similar to what adults have. Food allergies can cause vomiting, diarrhea, blood in the stools, abdominal cramps, bloating or a rash (eczema). More rarely, some food allergies can cause nasal congestion, wheezing and/or anaphylaxis. The most common food allergy is to cow's milk protein. This is probably because infants are exposed to so much cow's milk in their diets at an early age. There are cow's milk proteins in cow milk based infant formula, in many processed foods and even tiny amounts in breast milk.
What happens with a food allergy is the body makes antibodies against a particular protein in the food. These antibodies which have been made against those certain food proteins stimulate the body to fight against those proteins even though the proteins themselves are harmless to the body. In essence, the immune system of a person with food allergies harms its own body as it tries to defend against this otherwise harmless "enemy".
The diagnosis of food allergy depends on a careful history, a thorough examination and sometimes laboratory testing. Elimination of the offending food is curative. Sometimes however elimination of the offending food is quite difficult to do because of all the processing of foods today. If the food allergy occurs in the young infant, formula changes are needed. This change could entail switching from a cow milk based formula to either a soy formula or to a hydrolysate formula. Two examples of hydrolysate formulas are Nutramagen and Alimentum. Hydrolysate formulas contain a cow milk protein called casein which has been predigested, or broken up into smaller pieces. These smaller protein pieces are more easily digested and are small enough that the body can't make antibodies against them (an allergic reaction). Since the body is unable to make the antibodies, no allergic reaction can occur and the symptoms of allergy gradually fade. If you think that your child has a milk or soy allergy, please consult us prior to changing your baby's formula. We consider infant formula to be a medication, only changed on our direct advice. Cow milk allergy in breast fed infants is treated by having the mother avoid cow's milk in her diet.
There are other types of allergies besides food allergies. Particles in the environment which people are allergic to are called "allergens". Like what happens in food allergy, the body makes antibodies against allergens in the environment. These antibodies which have been made against the particles stimulate the body to fight against them even though the particles themselves are harmless to the body. Just like food allergy, the immune system of a person with environmental allergies harms its own body as it tries to defend against this otherwise harmless "enemy".
These allergens can be anywhere in the environment and can be one of many different types of particles. Allergens such as grass and tree pollens, which float in the air and are inhaled may cause nasal congestion, runny nose or asthma (please see the section on asthma). Airborne allergens can also cause watery, red, itchy eyes. Allergens such as house dust or house dust mites that come into contact with the skin in allergic people can cause a chronic itchy, red, dry rash called eczema (see the section on rashes). The symptoms of allergy may mimic other diseases, especially infection. It is no wonder that there is a great deal of confusion about allergic disorders. Even we as physicians sometimes have difficulty sorting out allergic diseases from other problems.
If your child has any of the above symptoms or suffers from recurrent ear infections, sinus infections or if he seems to keep a cold all of the time, he may be showing signs of allergies, irritation from smoke or an immune disorder. The simplest approach to stop these symptoms is to eliminate the suspected allergen, infectious agent or irritant from the environment or the diet. The following approaches may be helpful in the child with a chronic runny nose, chronic infection or a continual cold:
- AVOID CIGARETTE SMOKE. Although not strictly an allergic problem, we are learning more and more about the harmful effects on children of parents who smoke (passive smoking). Because cigarette smoke is so irritating, children exposed to passive smoking are much more likely to suffer from ear infections, upper respiratory infections, sinus infections, bronchitis, pneumonia and other problems than are children who are not exposed to passive smoke. If you must smoke, do this outside or in a well-ventilated room, completely away from your child. We recommend, however, that you stop smoking completely for you and your child's health sake.
- AVOID EXPOSURE TO OTHER SICK CHILDREN. This is especially a problem in day-care centers and with baby-sitters with large numbers of children. Try to place your child in a day-care situation that minimizes exposure to large numbers of children.
- AVOID HOUSE DUST. Naturally, no one can avoid house dust completely, but strive to keep the child's bedroom as free of dust as possible. Enclose pillows and mattresses in plastic cases and wash these with a damp cloth two or three times per week. Take stuffed animals out of the room. Vacuum frequently.
- KEEP DOGS AND CATS OUT OF THE HOUSE.
- AVOID CERTAIN FOODS. The most common food allergies are to milk, certain fish, eggs, strawberries, chocolate and peanuts. Try eliminating these foods from the diet and observe the response. This is usually done under our direct supervision.
Medication allergy is an important thing to note in your child should this occur. If your child has an allergic reaction to a certain medication, you should always call the office with this information. If your child has an allergic rash to an antibiotic for instance, we like to examine the child to determine if the rash is consistent with allergy. In addition to this, you should keep a list of all medications to which your child is allergic and be sure to read labels. Many medications are marketed under several different trademarks. For more information on antibiotic allergy see the section on antibiotics.
There are a number of medications which can reduce the symptoms of allergy. These include antihistamines, cortisone type medications (anti-inflammatory steroids, oral, inhaled, topical, IV), leukotriene modifiers, mast cell stabilizers, immune therapy and others. Please consult us regarding the proper use of these medications. You may want to treat your child with Benadryl for allergic complaints prior to an office visit.
Because the topic of allergy is such a complicated one, it is impossible to evaluate this problem by telephone. If you feel your child may be suffering from allergy, we strongly recommend bringing your child in for an appointment.