Allergic diseases are one of the key challenges in health management worldwide. “Allergies can make one feel like a zombie.” Although it is difficult to point out one reason for the increasing trend, changing environmental factors and genetics play an important role. Allergies can involve all systems but may manifest in one or more. Early identification of childhood allergies will improve the quality of life both for the child and the family and reduce school absenteeism and parental stress.
Innumerable allergens may cause allergies and finding the exact allergen is impossible. The allergens can be airborne, food or by direct contact, airborne being the commonest. Automobile fumes are very high risk especially for children as these fumes are heavy and concentrate at around 3-4 feet which is the height of children. Seasonal, due to very high pollen count as we see in April-May and September-October and in winters, viruses can be bad allergens. The other common type is food allergy. Reactions vary from urticaria to anaphylaxis and death. Most children tend to outgrow milk and egg allergies.
Common Symptoms: Skin rashes or hives, difficulty breathing (asthma), sneezing, coughing, runny nose, itchy eyes and frequent stomach upset
Common Allergy Triggers
Outdoors: smog, dust, air pollutants, pollens, insect bites or stings
Indoors: pet’s furs, cockroach dander, dust mites, (carpets, cushions, mattresses, curtains), mould
Irritants: cigarette smoke-direct or passive, coal and wood fire smoke, perfume, aggarbattis, chalk dust, car exhaust, and recent addition- vehicle tyres rubbing on roads produce dangerous particles
Foods: tree nuts, peanuts, eggs, cow’s milk, wheat
Allergic rhinitis: It is most common, the symptoms include runny, itchy nose, sneezing and blocked nose (turbinate hypertrophy) along with itchy, watery red eyes, as well as itchy painful ears and chronic ear problems- like fluid collection in the ears causing a decreased hearing and poor speech development in long run. Also severely blocked nose and mouth breathing causes dry throat, infections of throat, lack of sleep and sleep apnoea and poor school performance. Also, severe congestion of surrounding areas leads to symptoms like headache, a swollen tongue, and loss of taste and smell. Allergens can trigger rashes like eczema and about 50% may have other allergic manifestations also
Food allergies are again very common in children. The common food allergens include eggs, tree nuts (pistachio, cashews, walnuts), wheat, soy and milk especially cow’s milk “A favourite in Indian homes”, fish and seafood (crab, lobster, crayfish and shrimp). Allergies tend to last lifelong although children often outgrow allergies to milk, eggs, soy and wheat.
All parents should be aware of the possibility of anaphylaxis—a potentially life-threatening reaction which impairs breathing, low blood and shock.
Parents must inform school authorities of any allergies.
Physical education and sports are an important part of the school curriculum. Children with asthma and allergic problems should participate in all sports activities. For asthma, prescribed controller medication should be administered by an inhaler before exercise to prevent any symptoms in asthmatic children.
Diagnostic tests have limited value in identifying the offending allergen. Skin prick tests and blood tests are available in the field of diagnostics but have a limited role. Some supportive tests can be done to establish allergy but then all cases may not show positive results. Avoiding the suspected allergens is the first and most important step in management. Symptoms can be relieved by drugs like antihistamines, anticholinergics, leukotriene-modifying agents, and topical and systemic steroids. Immunotherapy against the confirmed antigens can be tried but again not very successful because pointing out a single allergen is impossible.
The writer is MD paediatrics, Academic and DNB coordinator, Madhukar Rainbow Children’s hospital New Delhi