ALLERGIES

“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.

Allergic symptoms in Infants

In the very young infant, allergy may be manifested by diarrhea, bloody diarrhea, nasal congestion, rash, wheezing and colic. Among other causes, these symptoms are most commonly due to a food allergy. 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 an office visit with one of our doctors.

Food allergy symptoms

Older infants and children tend to have allergic manifestations that are very similar to those of adults. 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 cow’s milk protein. There are cow’s milk proteins in cow milk-based infant formula, in many processed foods, and even tiny amounts in breast milk that a child can react to.

Another common food allergy in the US is peanut allergy, affecting 1 to 3% of all US children. Please see the section on nutrition for a detailed discussion of peanut allergy.

What happens with a food allergy is that the body makes antibodies against a particular protein in the food. These antibodies, which have been made against 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 is made with a careful history, a thorough physical examination, sometimes laboratory testing, and sometimes referral to an allergist for skin testing and/or food challenge. Elimination of the offending food is the needed treatment. Sometimes, however, elimination of the offending food is quite difficult to do because of all the processing of foods today.

If a food allergy occurs in the young infant, formula changes are needed. This change may be switching from a cow milk-based formula to a hydrolysate formula. An example of a hydrolysate formula is Nutramigen LGG. 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 usually can’t make antibodies against them (an allergic reaction). Since the body is unable to make the antibodies, no allergic reaction happens and the symptoms of allergy gradually fade.

Even more elemental anti-allergy formulas exist that are amino acid-based. Neocate, EleCare, and Puramino are common brands of amino acid-based formula. 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 to be changed on our direct advice.

Inhalant allergies

Beyond food allergies, individuals can also experience allergies caused by environmental inhalant allergens. These allergens are harmless particles that can trigger an immune response. The body produces antibodies against these allergens, mistakenly perceiving them as threats and prompting the immune system to react, even though they pose no real harm.

Environmental allergens come in various forms. Common airborne allergens, such as grass and tree pollen, can lead to nasal congestion, a runny nose, sneezing, and itching of the nose, a condition called allergic rhinitis. Inhalant allergens can also cause an allergic reaction in the lungs with the development of coughing, wheezing, and shortness of breath. This condition is called asthma. Please refer to the asthma section later in this handbook.

Allergic reactions of the eye can cause watery, red, and itchy eyes, a condition called allergic conjunctivitis. Other allergens, like house dust or dust mites or certain foods, can trigger chronic skin irritation in sensitive individuals, resulting in red, itchy, dry rashes known as eczema or atopic dermatitis.

The symptoms of allergies can closely resemble infections, which can lead to confusion in diagnosis. Even physicians sometimes face challenges in distinguishing allergic disorders from other health issues.

If your child experiences allergic symptoms, along with recurrent ear infections, sinus infections, or persistent cold-like symptoms, they may be exhibiting signs of allergy. Trying to remove the suspected allergen is a reasonable first option, although identifying the allergen (something a person is allergic to) is quite challenging. This is why the specialty of allergy exists.

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.

The following approaches may be helpful for a child with a chronic runny nose, chronic infection, or a continual cold:

1. 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 smoke 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. Do not smoke in your car with your child. We recommend, however, that you stop smoking completely for your and your child’s health sake.
2. Try to avoid exposure to sick children: Coming down with many viral upper respiratory infections (colds) in a short time is a problem for children who attend day-care centers or have babysitters with large numbers of children. Cold viruses are extremely contagious, roaring through daycare centers. It seems that children in daycare keep a cold most all the time. One cold may not be over before the next cold comes. Many parents whose children suffer from a chronic runny nose become concerned that something is very wrong with their child. If this is the case with your child, try to place your child in a day-care situation that minimizes exposure to large numbers of children. This will help lessen their exposure to cold viruses and help relieve their runny nose. Although children in daycare experience more upper respiratory infections (colds) than those cared for at home, these infections can protect against developing asthma and other allergies. Children in daycare are exposed to many viruses, which keeps their immune systems engaged and may prevent them from reacting to harmless allergens. Furthermore, all children eventually catch numerous cold viruses, resulting in numerous runny noses. The key difference is timing, not severity. Whether in daycare, church nurseries, or kindergarten, children naturally encounter cold viruses until they build immunity, which generally takes about one to two years. A persistent runny nose in daycare children is typical and due to infectious exposures, which should decrease as viral immunity strengthens over time. This too shall pass...
3. Avoid house dust: Naturally, no one can avoid house dust complete- ly, 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 occasionally. Take stuffed animals out of the room. Vacu- um frequently.
4. Keep dogs and cats out of the house.
5. Try avoiding certain foods: The most common food allergies are to milk, certain fish, shellfish, eggs, strawberries, tree-nuts, soy, wheat and peanuts. Try eliminating these foods one at a time from the diet and observe the response. This is usually done under our direct supervision. We do have food allergy blood tests that can be done to evaluate this possibility. Please see our nutrition advice section on peanuts in this handbook.

Medication allergy:

If your child has an allergic reaction to a certain medication, you should 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 an allergy. Sometimes, viruses cause rashes that develop while a child is taking an antibiotic. Make an appointment for an evaluation. You should immediately stop the antibiotic and give no further doses. You may want to treat your child with Benadryl (see Dosing Guide on page 237) for allergic complaints before an office visit. Should the rash become severe or associated with swelling or breathing difficulty, go to the nearest emergency room. You should keep a list of all medications to which your child is allergic. For more information on antibiotic allergy, see the section on page 79.

Allergy Treatment:

There are several medications that can reduce the symptoms of allergy. These include antihistamines, cortisone-type medications (oral, inhaled, topical, injectable), leukotriene modifiers, mast cell stabilizers, immune therapy, biologic monoclonal antibodies, and others. Please consult us regarding the proper use of these medications. 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 an allergy, we strongly recommend bringing your child in for an appointment.