“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. 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 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 this topic.
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 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 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. Prosobee is an example of a soy based 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 Nutramigen 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 changed on our direct advice.
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 can make 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 (allergic rhinitis), runny nose or asthma (please see the section on asthma later in this handbook). 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 in this handbook). 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 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 you and your child’s health sake.
- TRY TO AVOID EXPOSURE TO OTHER SICK CHILDREN. Coming down with many viral upper respiratory infections (colds) is a problem for children who attend day-care centers or have baby-sitters with large numbers of children. Cold viruses are extremely contagious, roaring through daycare centers. It seems that children in daycare keep a cold 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 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. Please know however, that while children in daycare do have many more upper respiratory infections (colds) than children whose mothers are able to stay home with them, those colds actually are protective against the development of asthma and other allergic conditions. Simply, children in daycare are less like to have asthma because of all the viruses that they catch. Their immune systems are so busy fighting colds, that they typically don’t fight allergens that not harmful to them. In addition, all children will eventually catch a large number of cold viruses and have a continual runny nose. The question is not, will my child catch cold viruses and have a runny nose? The question is a matter of when. Whenever a child is placed in a situation in which they are exposed to large numbers of other children (daycare for babies, church nurseries, or kindergarten for kids whose mother stay home), that child will naturally come down with a series of cold viruses until such time as they build immunity against the viruses. It generally takes one to two years of multiple cold viruses for the child to develop sufficient immunity for the infections to diminish. Thus, a chronic runny nose, particularly for a child in daycare, is typically an infection exposure problem and will diminish with time.
- 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 occasionally. 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, shellfish, eggs, strawberries, tree-nuts, soy, wheat and peanuts. Try eliminating these foods 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.
- If your child is over the age of one year. You can try Benadryl for nasal allergies. Check our dosing guide page for the dose of Benadryl. If your child is two years and older, Claritin and Zyrtec are available without a prescription. They are more convenient to use for allergies because they are dosed once per day. Check their websites for the proper dosing information.
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 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) for allergic complaints prior to 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 antibiotics below.
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.
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.