Allergies in children are on the rise. The most common are food allergies, particles in the air from grasses and pollutants and medicines. Unfortunately, scientists seem unable to provide a strong case of evidence as to why allergies are increasing. It is shown that the increase is higher in western developed countries than third world countries. Some consideration is given to the way in which our immune systems are developing in modern society.

As we are now more aware of bacteria and parasites in our everyday environment, our responses to matters of hygiene are now a lot more attentive. This may mean that the kids of today are not exposed to many of the bugs as in past generations so their immune systems are not as developed as the adult population. A true allergy can cause very serious effects occasionally even risking life if anaphylaxis is suffered. Allergies also differ as the reaction caused can get worse the more the person is exposed to the allergic substance. It must be noted, however, that there are differences between food allergies and food intolerance. Food intolerance is less serious generally and the body is not normally in danger due to intolerance.

What is an allergy?

When a child has an allergy to something, that substance, known as an allergen, triggers the immune system into releasing antibodies called immunoglobulin E. These cause the body to release histamines, and it's these that are responsible for all the unpleasant symptoms.

Allergies can show up in different ways in children including:

Skin rashes (atopic dermatitis or eczema)

Asthma

Allergic rhinitis (also known as "hay fever")

Food allergies

Allergic rhinitis is the most common of all allergy problems. It causes runny, itchy nose; sneezing; postnasal drip and nasal congestion (blockage). The child with allergies may also have itchy, watery and red eyes and chronic ear problems. Despite its common name "hay fever," these allergy problems can occur at any time of the year – seasonally or year-round – and do not cause fever. We will concentrate on rhinitis and food allergies.

Nasal congestion

Allergies are the most common cause of chronic nasal congestion in children. Sometimes a child's nose is congested (blocked) to the point that he or she breathes through the mouth, especially while sleeping. This may also cause the child to not get a restful night's sleep and then be tired the next day. Early treatment of the allergies causing the nasal congestion may prevent problems later on.

Allergy and ear infections

Allergies lead to inflammation in the ear and may cause fluid accumulation that can promote ear infections and decreased hearing. If this happens when the child is learning to talk, poor speech development may result. Allergies can cause earaches as well as ear itching, popping and fullness ("stopped up ears"). Anyone with these symptoms should be considered for testing and treatment.

Diagnosis on allergies

The diagnosis is mostly determined by a thorough anamnesis by your doctor. Important to describe are the exact symptoms, the timeframe when they occur (an allergic reaction is within seconds to up to 6-8 hours noticeable, not from what you eat the day before), and if the symptoms can be repeated for instance by drinking the same milk again. Blood tests and skin tests can help confirm the diagnosis or pin the trigger for the allergy down.

Children may respond with a skin rash while taking a course of antibiotics. This is often due to a response to a virus infection, not an allergy to the antibiotic (i.e. penicillin). Best response is to stop the antibiotic since it is not helpful against viruses anyway– consult the doctor first.

Anaphylaxis

Anaphylaxis is a severe allergic response, bee stings are a well known trigger. The body responds with a massive release of histamine resulting in hives, itchiness, swelling, difficulty breathing, a sharp drop in blood pressure, hoarse voice or swelling of the tongue, dizziness, unconsciousness and even cardiac arrest. Reactions such as these require immediate medical attention.

Food allergy

Food allergy, defined as an adverse reaction to a food, is commonly based on patient self report. Doctor diagnosed is a more reliable estimate, and is generally established in only a third of self reports.

The foods most associated with food allergy in children are eggs, cow milk and peanuts. Foods most associated with food allergy in adults are fruits, tree nuts and fish and shrimp.

As infants and children grow older, many of them become more tolerant to dairy and eggs, less so for peanuts. In infants, cow milk and soy symptoms may not be hives and/or asthma, but may be colic or blood in the stools. Dietary manoeuvres that may assist in the management of food allergy in infancy include:

Exclusive breast feeding for 4-6 months

Delaying the introduction of solid foods

Using hydrolyzed milk if breast feeding is not an option

Therapy and treatment

Since there are a lot of misconceptions around allergies, education and advice on what to expect and treatment possibilities are important. If it is known what the allergen is, then preventing contact with the trigger is the goal. This can be special bed linen and pillowcases against mites as well as eliminating the cat or dog from the household. When you can avoid the food that causes the allergy, then medication is obviously not needed. It is more difficult to stay away from airborne allergens so in case of an allergic rhinitis, preventive medication may be needed on a daily basis.

Medications

For children two years and older, the second generation antihistamines are effective and have very limited side effects especially compared with the older ones like Benadryl. Benadryl works only 4-6 hours, gives drowsiness and dry mouth. Overdosing may cause problems.

The best known non sedating 24-hour antihistamines are Claritine, Zyrtec and Aerius. They can be used once daily. The antihistamines are also available for local effect in eye drops and nose sprays. They work fast but short, perfect for incidental use J. The effect in creams is limited.

The foundation for treatment of chronic rhinitis is the use of inhalation corticosteroids. They are more effective then the antihistamines but may take a day to become noticeable. Children often do not like the smell of the steroid inhalers or the slight irritation, a powder inhaler could be an alternative. Children should be encouraged to use the sprays on a regular daily basis.

Cromoglicate is a mestcell stabiliser, it reduces the release of histamine from the mestcells. It only works preventive and has to be used 4 times daily. It has limited use. It has no use in food allergies anymore either.