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.
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.
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
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]
Related Research Articles
Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermatitis, allergic asthma, and anaphylaxis. Symptoms may include red eyes, an itchy rash, sneezing, coughing, a runny nose, shortness of breath, or swelling. Note that food intolerances and food poisoning are separate conditions.
An allergen is a type of antigen that produces an abnormally vigorous immune response in which the immune system fights off a perceived threat that would otherwise be harmless to the body. Such reactions are called allergies.
Anaphylaxis is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of use of emergency medication on site. It typically causes more than one of the following: an itchy rash, throat closing due to swelling that can obstruct or stop breathing; severe tongue swelling that can also interfere with or stop breathing; shortness of breath, vomiting, lightheadedness, loss of consciousness, low blood pressure, and medical shock. These symptoms typically start in minutes to hours and then increase very rapidly to life-threatening levels. Urgent medical treatment is required to prevent serious harm and death, even if the patient has used an epipen or has taken other medications in response, and even if symptoms appear to be improving.
A radioallergosorbent test (RAST) is a blood test using radioimmunoassay test to detect specific IgE antibodies in order to determine the substances a subject is allergic to. This is different from a skin allergy test, which determines allergy by the reaction of a person's skin to different substances.
A food allergy is an abnormal immune response to food. The symptoms of the allergic reaction may range from mild to severe. They may include itchiness, swelling of the tongue, vomiting, diarrhea, hives, trouble breathing, or low blood pressure. This typically occurs within minutes to several hours of exposure. When the symptoms are severe, it is known as anaphylaxis. A food intolerance and food poisoning are separate conditions, not due to an immune response.
Atopy is the tendency to produce an exaggerated immunoglobulin E (IgE) immune response to otherwise harmless substances in the environment. Allergic diseases are clinical manifestations of such inappropriate, atopic responses.
Peanut allergy is a type of food allergy to peanuts. It is different from tree nut allergies, because peanuts are legumes and not true nuts. Physical symptoms of allergic reaction can include itchiness, hives, swelling, eczema, sneezing, asthma attack, abdominal pain, drop in blood pressure, diarrhea, and cardiac arrest. Anaphylaxis may occur. Those with a history of asthma are more likely to be severely affected.
Soy allergy is a type of food allergy. It is a hypersensitivity to ingesting compounds in soy, causing an overreaction of the immune system, typically with physical symptoms, such as gastrointestinal discomfort, respiratory distress, or a skin reaction. Soy is among the eight most common foods inducing allergic reactions in children and adults. It has a prevalence of about 0.3% in the general population.
Allergic contact dermatitis (ACD) is a form of contact dermatitis that is the manifestation of an allergic response caused by contact with a substance; the other type being irritant contact dermatitis (ICD).
Oral allergy syndrome (OAS) or pollen-food allergy is a type of food allergy classified by a cluster of allergic reactions in the mouth and throat in response to eating certain fruits, nuts, and vegetables. It typically develops in adults with hay fever.
Milk allergy is an adverse immune reaction to one or more proteins in cow's milk. Symptoms may take hours to days to manifest, with symptoms including atopic dermatitis, inflammation of the esophagus, enteropathy involving the small intestine and proctocolitis involving the rectum and colon. However, rapid anaphylaxis is possible, a potentially life-threatening condition that requires treatment with epinephrine, among other measures.
Egg allergy is an immune hypersensitivity to proteins found in chicken eggs, and possibly goose, duck, or turkey eggs. Symptoms can be either rapid or gradual in onset. The latter can take hours to days to appear. The former may include anaphylaxis, a potentially life-threatening condition which requires treatment with epinephrine. Other presentations may include atopic dermatitis or inflammation of the esophagus.
A tree nut allergy is a hypersensitivity to dietary substances from tree nuts and edible tree seeds causing an overreaction of the immune system which may lead to severe physical symptoms. Tree nuts include almonds, Brazil nuts, cashews, chestnuts, filberts/hazelnuts, macadamia nuts, pecans, pistachios, shea nuts and walnuts.
Wheat allergy is an allergy to wheat which typically presents itself as a food allergy, but can also be a contact allergy resulting from occupational exposure. Like all allergies, wheat allergy involves immunoglobulin E and mast cell response. Typically the allergy is limited to the seed storage proteins of wheat. Some reactions are restricted to wheat proteins, while others can react across many varieties of seeds and other plant tissues. Wheat allergy is rare. Prevalence in adults was found to be 0.21% in a 2012 study in Japan.
Skin allergy testing comprises a range of methods for medical diagnosis of allergies that attempts to provoke a small, controlled, allergic response.
Allergy testing can help confirm or rule out allergies and consequently reduce adverse reactions and limit unnecessary avoidance and medications.
Rice allergy is a type of food allergy. People allergic to rice react to various rice proteins after they eat rice or breathe the steam from cooking rice. Although some reactions might lead to severe health problems, doctors can diagnose rice allergy with many methods and help allergic people to avoid reactions.
Fish allergy is an immune hypersensitivity to proteins found in fish. Symptoms can be either rapid or gradual in onset. The latter can take hours to days to appear. The former may include anaphylaxis, a potentially life-threatening condition which requires treatment with epinephrine. Other presentations may include atopic dermatitis or inflammation of the esophagus. Fish is one of the eight common food allergens which are responsible for 90% of allergic reactions to foods: cow's milk, eggs, wheat, shellfish, peanuts, tree nuts, fish, and soy beans.
Shellfish allergy is among the most common food allergies. "Shellfish" is a colloquial and fisheries term for aquatic invertebrates used as food, including various species of molluscs such as clams, mussels, oysters and scallops, crustaceans such as shrimp, lobsters and crabs, and cephalopods such as squid and octopus. Shellfish allergy is an immune hypersensitivity to proteins found in shellfish. Symptoms can be either rapid or gradual in onset. The latter can take hours to days to appear. The former may include anaphylaxis, a potentially life-threatening condition which requires treatment with epinephrine. Other presentations may include atopic dermatitis or inflammation of the esophagus. Shellfish is one of the eight common food allergens, responsible for 90% of allergic reactions to foods: cow's milk, eggs, wheat, shellfish, peanuts, tree nuts, fish, and soy beans.
A food allergy to sesame seeds has prevalence estimates in the range of 0.1–0.2% of the general population, and are higher in the Middle East and other countries where sesame seeds are used in traditional foods. Reporting of sesame seed allergy has increased in the 21st century, either due to a true increase from exposure to more sesame foods or due to an increase in awareness. Increasing sesame allergy rates have induced more countries to regulate food labels to identify sesame ingredients in products and the potential for allergy. In the United States, sesame became the ninth food allergen with mandatory labeling, effective 1 January 2023.
↑ Ahluwalia, SK; Matsui, EC (April 2011). "The indoor environment and its effects on childhood asthma". Current Opinion in Allergy and Clinical Immunology. 11 (2): 137–43. doi:10.1097/ACI.0b013e3283445921. PMID21301330. S2CID35075329.
Walker, Marsha (2011). Breastfeeding management for the clinician: using the evidence. Sudbury, Mass: Jones and Bartlett Publishers. ISBN9780763766511.
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