Allergies in Children

Does your child keep getting itchy rashes on the skin? Do their lips swell after they eat a certain food? Is their nose always running, do they sneeze, or do they go through periods of coughing and wheezing?

Some of these symptoms may be related to allergic conditions. However, not every rash, runny nose, cough or tummy ache seen in children means allergy.

What matters most in evaluating allergies in children is when the symptom began, how long it lasted, in which situations it comes back and whether it is linked to a particular food, substance or environmental factor.

For this reason an allergy diagnosis in children is not made by looking at a blood test or a skin test result alone, but by evaluating the child's history, the physical examination and any tests considered necessary together.

What Is Allergy in Children?

Allergy is the immune system producing an inappropriate or exaggerated immune response to certain substances that do not cause problems in most people.

These substances are called allergens.

Allergens commonly encountered in children may include;

• Certain foods
• House dust mites
• Pollens
• Animal-derived allergens
• Molds
• Certain medicines
• Insect venoms

Allergic disease does not have to appear in a single organ. The skin, the respiratory system, the nose and eye area and the digestive system may be affected in different ways.

What Are the Symptoms of Allergy in Children?

The symptoms of allergy vary according to which system is affected.

On the skin;

• Itching
• Eczema
• Dryness and redness
• Urticaria, that is hives
• Swelling of the lips, eyelids or face

may be seen.

In the nose and eyes;

• Repeated sneezing
• Runny nose
• Nasal congestion
• Itching in the nose and eyes
• Watering and redness of the eyes

may appear.

In the airways, symptoms such as;

• Cough
• Wheezing
• Shortness of breath
• Tightness in the chest

may be seen.

In the digestive system, symptoms such as;

• Vomiting
• Abdominal pain
• Diarrhea
• Bloody or mucous stools in some infants
• Feeding problems
• Growth being affected in certain specific conditions

may develop.

Symptoms appearing in more than one system at the same time may be important in terms of a more serious allergic reaction.

Why Does Allergy Occur in Children?

There is no single cause behind the development of allergic conditions in children.

Genetic predisposition and environmental factors play a role together.

The presence of allergic conditions such as;

• Asthma
• Allergic rhinitis
• Atopic dermatitis
• Food allergy

in the mother, father or siblings may increase the likelihood that the child will develop an allergic condition.

However, allergy can also develop in a child with no allergic disease at all in the family.

What Is Atopy?

One of the concepts often used in allergy evaluations is atopy.

Atopy refers to a person's genetic tendency to develop an IgE-type immune response to certain environmental or food allergens.

In atopic children, conditions such as eczema, allergic rhinitis and asthma may be seen together or at different periods of life.

However, having an atopic constitution does not mean that the child will certainly develop all allergic conditions.

Allergic Skin Conditions in Children

Some of the most common allergy-related problems of childhood appear on the skin.

Foremost among these are atopic dermatitis (eczema), urticaria and angioedema.

Atopic Dermatitis – Eczema

Atopic dermatitis is an inflammatory skin condition with a chronic or recurring course, in which skin dryness and especially itching are prominent.

In infants it may be noticeable particularly;

• On the cheeks
• On the face
• On the scalp
• On the outer surfaces of the arms and legs

In older children the inner elbows, the backs of the knees, the neck, the wrists and the ankles may be affected more often.

Dry skin and itching are among the core features of atopic dermatitis.

However, there is an important distinction:

Not every child with eczema has a food allergy.

Especially in young children with moderate-to-severe, treatment-resistant eczema, evaluation for food allergy may come onto the agenda if the clinical history also supports it. Since unnecessary food restrictions can negatively affect a child's nutrition, removing a large number of foods from the diet on the sole grounds that "the child has eczema" is not correct.

Urticaria – Hives

Urticaria consists of rashes appearing suddenly on the skin that are;

• Raised
• Red or pink
• Usually intensely itchy
• Able to move from place to place

Individual urticaria plaques often disappear within hours and can reappear on another part of the body.

Urticaria does not always mean allergy.

Especially in children, viral infections are one of the frequent causes of acute urticaria.

Recurrent urticaria appearing shortly after a particular food or medicine is taken should be evaluated separately in terms of an allergic reaction.

What Is Angioedema?

Angioedema is swelling that develops in the deeper layers of the skin.

Most often;

• The lips
• The area around the eyes
• The face
• The hands
• The feet

may be affected.

Swelling of the tongue or throat area together with difficulty breathing may be a sign of a serious allergic reaction and requires emergency evaluation.

Food Allergy in Children

Food allergy is the immune system producing an immune response to a particular food or to a protein in that food.

Not every discomfort that follows a food is a food allergy.

Unwanted reactions to foods may arise through different mechanisms, such as;

• Immune-mediated allergic reactions
• Intolerances not related to the immune system, such as lactose intolerance

Which Foods More Often Cause Allergy in Children?

Theoretically any food can cause an allergic reaction.

Food allergens commonly encountered in childhood may include;

• Cow's milk
• Egg
• Peanut
• Tree nuts
• Wheat
• Soy
• Fish
• Shellfish
• Sesame

Which foods more often cause problems may change according to the child's age and the eating habits of the community.

How Is Food Allergy Recognized?

Symptoms such as;

• Urticaria
• Swelling of the lips or around the eyes
• Vomiting
• Cough
• Wheezing
• Shortness of breath
• Weakness or fainting

appearing again and again, especially after a particular food is eaten, may suggest IgE-mediated food allergy.

Some food allergies, on the other hand, may produce later symptoms.

Especially in infants;

• Repeated vomiting
• Diarrhea
• Bloody stools
• Certain gastrointestinal symptoms

may be seen in non-IgE-mediated food allergies.

The symptoms of food allergy may affect the skin, the respiratory system and the digestive system.

How Is Allergy Diagnosed in Children?

The most important step in an allergy diagnosis is a detailed history.

The pediatrician or the relevant specialist evaluates;

• When the symptom began
• What it appeared after
• How long the symptoms lasted
• Whether it recurs with the same exposure
• If a food was taken, in what amount and in what form it was consumed
• The child's other allergic conditions
• The family history of allergy

Testing may then be planned according to the clinical suspicion.

How Is Allergy Testing Done in Children?

The tests used vary according to the type of allergy suspected.

These may include;

• Skin prick test
• Measurement of allergen-specific IgE in the blood
• Component-based allergy tests in certain selected cases

However, allergy tests are not screening tests.

Testing at random against dozens of foods or allergens to which the child has never reacted may lead to false positive results and unnecessary restrictions.

Does a Positive Allergy Test Mean the Child Is Allergic?

Not always.

This is one of the most important points in childhood allergies.

A positive skin test or specific IgE test may show that the child has become sensitized to that substance.

However, sensitization and clinical allergy are not the same thing.

If the child can eat that food without any problem, saying "he or she is allergic to this food" based on the test result alone may not be correct.

Test results need to be interpreted together with the child's clinical history.

What Is an Oral Food Challenge in Food Allergy?

In some children the diagnosis of food allergy may not be settled by history and tests alone.

In that case an oral food challenge may come onto the agenda.

In the test the suspected food is given to the child in a controlled way, in gradually increasing amounts, and it is observed whether a reaction develops.

Because this test can provoke an allergic reaction, it should not be done at home; it should be carried out by an experienced team in a medical setting where the necessary treatment can be given.

In current international guidelines the oral food challenge is accepted as one of the main diagnostic methods in uncertain food allergy.

How Is Allergy Treated in Children?

Treatment varies according to the type of allergic condition.

The main aims are;

• To identify the real trigger correctly
• To avoid unnecessary restrictions
• To bring symptoms under control

And, if there is a risk of a serious reaction, to prepare the family for it.

While protecting the skin barrier and using appropriate topical treatments are important in atopic dermatitis, treatment in urticaria is different.

In food allergy it may be necessary to remove from the diet the food that has been shown to be truly responsible.

However, especially if milk, egg or more than one staple food is to be removed from the diet, the diet must be planned carefully so that the child's growth and nutrition are not affected.

If My Child Has an Allergy, Should I Cut the Food Out Completely?

A broad elimination diet should not be applied before the diagnosis is certain.

Removing staple foods such as;

• Milk
• Egg
• Wheat
• Nuts
• Gluten

unnecessarily, especially on the basis of "allergy tests" bought over the internet or of a laboratory result alone, may negatively affect the child's nutrition.

Whether the food really causes a reaction should first be evaluated properly.

Do Childhood Allergies Go Away?

It varies according to the type of allergy.

In some childhood food allergies tolerance may develop as the child gets older, while some allergies may continue for a longer time.

The course of atopic dermatitis also varies from child to child.

For this reason a general approach such as "the allergy will last a lifetime" or "he or she will grow out of it anyway" is not correct.

The child needs to be re-evaluated regularly.

What Is Anaphylaxis?

Anaphylaxis is a serious systemic allergic reaction that can develop rapidly and can be life-threatening.

After contact with a food, a medicine or another allergen, symptoms such as;

• Difficulty breathing
• Wheezing
• Swelling in the throat or tongue
• Change in voice
• Widespread urticaria together with respiratory symptoms
• Severe vomiting
• Dizziness
• Fainting
• Change in consciousness

may appear.

In that situation emergency medical care is required.

In children found to be at risk of anaphylaxis, the family should be told what to do in an emergency, and in suitable children an adrenaline auto-injector should be prescribed and its use taught.

When Should You See a Doctor for Allergy in Children?

The child needs to be evaluated especially in the case of;

• Repeated reactions after the same food
• Recurrent or severe eczema
• Frequent urticaria or angioedema
• Unexplained wheezing and shortness of breath
• Repeated vomiting or bloody stools related to feeding
• Growth and development being affected
• A previous serious allergic reaction

If there is swelling of the lips, tongue or throat, shortness of breath, fainting or rapidly developing multi-system symptoms, emergency medical care should be sought.