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Part 4: Keeping Your Child Healthy  >  The A-Z of Childhood Illnesses  >  Allergies

ALLERGIES

An allergy is an abnormal/hypersensitive reaction to certain substances termed allergens. These substances are well tolerated by most people, but others may react adversely to these agents. These individuals would be termed allergic to those substances.

CAUSES: Common allergens include foods like eggs, fish, wheat, corn, artificial milk in liquid and powder form, milk products, soya preparations, nuts, peanut butter, chocolates, tomatoes, pork, citrus fruits, and coconut; house dust; certain drugs like penicillin and sulpha; pollen of some flowers; animal hair and feathers. Cockroaches, cats and dogs are dominant sources of indoor allergens. 

Children born into families with a history of allergy and those who consume animal milk in the first year of life are more prone to get allergic disorders. Babies exclusively breastfed for the first 6 months of life are less prone to it. Italian naval cadets who had been repeatedly exposed to bacteria that are normally thought of as pretty harmful were found to be less likely to develop allergies. The links between allergies and bacteria are new evidence for the theory that our immune systems have evolved to need the stimulus of fighting bacteria right from the moment of birth. 


Common Allergies

Allergies can manifest as

  • Asthma
  • Eczema
  • Hay fever (allergic cold)
  • Urticaria (hives)
  • Anaphylaxis (severe allergic shock); and
  • Diarrhoea


Asthma
SYMPTOMS: In a typical case, a 4-year-old child goes to sleep normally and gets up wheezing in the middle of the night. He has difficulty in taking in air as well as in pushing it out. His breathing is faster than usual. When he breathes in, he has to sometimes take the help of his neck muscles to take the air in. The normal gap between the two clavicles (collarbones) tends to dip during inspiration (breathing in). While breathing out, the child makes a musical hissing sound termed ‘wheezing’. The expiration (breathing out) is more prolonged than usual. The child finds it easier to breathe sitting up or wants a pillow or two on his lap to put his head on for comfort. If the child has had eczema before or has had similar attacks before this episode or has a strong family history of allergy or was artificially fed (not breastfed), the diagnosis is more or less confirmed. It does not mean that a breastfed child cannot get asthma. The point worth noting is that artificially fed children are at a much higher risk. 

Thunderstorms can precipitate an attack in those who suffer from seasonal asthma due to an increase in the amount of airborne pollen.


TREATMENT: Show your child to your doctor as soon as possible after the first attack to let him decide if it is indeed asthma. Do not overreact if your child gets an attack of asthma. You may pass your anxiety on to the child and so worsen the attack. Follow your doctor’s advice on handling the situation. Give the prescribed medication by mouth or by inhalation, keep the child comfortably warm without covering him excessively, let there be free flow of air into the room (switch on the air-conditioner, if you have one) and give him enough liquids including water. If he has fever, avoid aspirin and ibuprofen, as they can worsen the attack of asthma. Paracetamol would be better. Avoid giving cough syrups (specially those containing codeine). As long as your child is not in acute distress and is accepting some food and enough liquids, you can manage him at home. Wheezing by itself should not worry you. Consult your doctor, however, if his breathing becomes faster, if he has difficulty taking in air and if he is becoming exhausted. Your doctor may advise hospitalisation. This should be done before the child starts fighting for breath or becomes blue.

Even if you normally do not like the use of drugs like corticosteroids and antibiotics, do not hesitate to use thes  if your doctor prescribes them in this situation. If your child refuses to take oral steroids, a single injection of dexamethasone (1.7 mg/kg) is quite effective.

If your child is prone to frequent attacks, consider buying a nebuliser. This is very handy for use during an acute attack. However, a metered-dose inhaler (used by adults) with an easily-available spacer device and facial mask is considered better than a nebuliser for the treatment of acute wheezing in children less than 2 years old. You may also like to consult a child psychologist or a family counsellor to see if a slightly older child needs extra emotional support. An older child may be introduced to yoga, but do not force him to practise it if he is not interested or is not yet ready for it.

Skin tests for allergy and desensitisation are also now available. In these, repeated injections with increasing concentration of extracts of the substance to which the child shows an allergic reaction are given. They may be considered if you have tried other measures under expert supervision, and you find that your child cannot carry out his normal activities including schooling and your doctor assures you that there is a competent person who will do these tests and who will undertake the follow-up treatment.

PREVENTION: Besides a familial tendency, passive smoking, allergy to certain foods or the allergens listed above, sudden exertion in the form of unaccustomed exercise or sports, anxiety or unresolved conflict at home or school, abrupt variation in environmental temperature and respiratory infections may precipitate an attack. However, sports should be encouraged. Children who get exerciseinduced asthma are given medication for their asthma immediately before the activity. Also, 2 g of ascorbic acid (Vitamin C), given one hour before exercise, has been shown to have protective effects for such children. 

House dust mixed with mites in the room in which the child sleeps should be specially taken care of. Keep cockroaches away. The room should be kept scrupulously clean and have minimum furniture in it. Old books, clothes, blankets and musty bedding may trigger the attacks. Sun these frequently. Make sure no dust remains on fans, in corners, behind or underneath the furniture or on curtains. Thin curtains, which can be washed frequently, are better than thick or heavy curtains. Mop the room with a wet cloth rather than dust it. Avoid using wool blankets and carpets in the bedroom.

Also avoid keeping stuffed toys and plants in the room. Since pets can also be a source of allergy (cat hair can linger for 2 years after the animal has left the house), do not have them in your house.

If you have a vacuum cleaner, use it only while the child is away from home. 

Let the child avoid all types of talcum powder, strong perfumes, scented soaps, cold drinks, as well as sudden variations of temperature (for instance, entering a very cold air-conditioned room from outside where the temperature was very high), sudden exertion and foods that he is allergic to.

To find out whether a child is allergic to the foods listed above, first introduce an item into his diet when he is perfectly well. Watch for a week. If the child remains well (without medication), he is probably not allergic to that item of food. Avoid offering any suspicious item for 6 months and then try again. If the child reacts severely to any food, do not offer it for at least a year.

Bananas are often blamed for bringing on attacks of cold and asthma. This is probably not true. If the child who is given a banana gets an attack on certain occasions and not on others, he is probably not allergic to it. A banana, especially when given on an empty stomach (at least half an hour to one hour before meals) is a healthy fruit and should not be easily discarded from the child’s diet.

The good news about asthma is that if the attacks start in early childhood, they are more likely to disappear with age. Also, in children without a history of heredity and other factors mentioned above, and in whom the attacks always start with a viral cold rather than coming up suddenly, the diagnosis of asthma should never be made in a hurry. Such children may temporarily react to a cold with a wheeze but may not have asthma. Half the children with definite attacks of asthma are likely to be free of symptoms within 10 to 20 years. However, recurrences are known in adulthood. Also, those who have severe attacks in early childhood are more often found to continue getting attacks in adulthood. 

At times, children with asthma may have a persistent cough that worsens at night. These children may not have any attacks of wheezing, but they do benefit from drugs prescribed for asthma. 


Eczema

SYMPTOMS: If your 2 or 3-month-old baby develops red patches of itchy dry skin on his face, forehead and the back of the ears, he is probably heading for an allergic skin condition called eczema. Itching makes the rash worse and the skin starts oozing. As the secretions dry up, scaly patches may be noticed. If the broken-down skin becomes infected, pus-like discharge is observed and the child may develop fever.

In older children, eczema presents as itchy, dry skin. The front of the elbows and the back of the knees are more commonly affected.

Eczema is more common in babies given artificial milk. Babies exclusively breastfed for the first 6 months of life are less prone to it. In families with a strong history of allergy, exclusive breastfeeding is therefore advisable for 6 months. An older infant may get this allergy with an egg or wheat preparation.

Another similar condition termed as contact dermatitis may develop because of contact with an irritating substance like woollen clothing, certain soaps or oils, besan (gram flour paste), a bubble bath, disposable diapers or certain plants.

TREATMENT: The treatment of eczema remains more or less symptomatic. The principles are to keep the skin moist, minimise itching and to try to find the possible allergen. Avoid frequent washing of the skin (specially with soap); it is likely to dry it more. Linseed oil may be applied over the itchy patches. Apply an ointment (ung. emulsificans aquosum, B.P.), available from your chemist, instead of soap. Pat the skin dry with a soft towel and do not rub. Avoid applications of besan (gram flour) paste on the skin. Some children may also get a rash from using certain expensive soaps (including baby soap) and oils. Applications of milk cream may also cause rash.

Keep the child’s nails short. Do not use mittens (as hand gloves) at night unless the itching is severe. If you must use them, check inside the mittens that they are smooth and do not have any loose threads that may get entangled with the child’s fingers.

Your doctor may prescribe an oral antihistamine drug like chlorpheneramine. Cold compresses on the rash may be found to be soothing. Soothing ointments containing corticosteroid should be used only in consultation with your doctor, since they are absorbed into the body through the skin and may cause side effects. If applied, they should be used in very small amounts. If the skin gets infected, your doctor may prescribe an antibiotic. In very severe cases, cyclosporine, a potentially toxic drug, has been found to be helpful.

A mother who is breastfeeding may try omitting possible allergens (see the list of foods at the beginning of this section) from her diet. 

If you need to be on a prolonged milk-free diet, consider taking some calcium preparation and Vitamin B12. A diet that includes fruits, vegetables and sprouts is essential. (Also see the chapter on PREGNANCY.)

Some babies who are allergic to cow milk may tolerate soya milk better, though some children are also allergic to soya milk.


Urticaria

SYMPTOMS: This condition manifests as itchy, pink or reddish raised patches of skin that tend to come and go, to reappear on other parts of the body. The size of the patches may vary from 1 millimetre to a few centimetres (giant urticaria). Itching may be severe or mild. 

CAUSES: Urticaria may follow intake of certain foods like fish, eggs and nuts, or some drugs, or certain infectious agents. Contact with some plants may also be responsible. At times, no obvious cause can be determined.

TREATMENT: Most cases respond to antihistamines. As the patches tend to recur, treatment must be continued for as long as the doctor advises. At times, an injection of adrenaline is given for immediate relief, especially if the patches are also associated with oedema or swelling. If the cause is known, the same should be taken care of.


Anaphylaxis (Severe Allergic Shock)
CAUSES: This is a serious, though rare reaction following injection of certain drugs like penicillin and antitoxins that are made from horse serum for the treatment of tetanus or for poisoning following snake or scorpion bites. Occasionally, the sting of an insect may also cause it. Such a reaction can sometimes also be seen with an oral medication. 

SYMPTOMS: The patient with anaphylaxis complains of a constricting sensation in the throat and chest, develops urticaria and has difficulty in swallowing. He may become unconscious and stop breathing.

TREATMENT: This is a serious condition needing immediate medical attention. An injection of adrenaline and mouth-to-mouth breathing with cardiac (heart) massage may be needed.


Hay Fever
CAUSES: This is a seasonal condition related to allergens present in the child’s environment like pollens from trees or grass.

SYMPTOMS: It presents as itching in the nose and palate, and frequent sneezing and watery discharge from the nose, with or without redness of eyes. The attacks only appear in a certain season of the year and respond dramatically, though temporarily, to antihistamines. The child becomes completely free of symptoms once removed from the offending environment.

Similar symptoms are seen all through the year in some children. In such cases, the underlying cause is an allergen at home like house dust or animal hair. This has been discussed under the management of asthma.

TREATMENT: Antihistamines.


Diarrhoea Due To Allergy To Foods

CAUSES AND SYMPTOMS: Diarrhoea, with or without abdominal distension, and pain in the abdomen can occur in some children following ingestion of artificial milk, certain food additives or preservatives and other foods mentioned under the heading of asthma. The symptoms may be related to allergy or to some other mechanism. Some children with allergy to artificial milk (liquid as well as powder) may also develop skin rashes, vomiting, and get bleeding from the intestines. Their lungs may also be affected.

TREATMENT: Avoid the allergens. Your doctor may prescribe an antihistamine.




7 March, 2016

 
Part 4
The A-Z of Childhood Illnesses

Abdominal Pain
Abrasions or Scratches
Acute Glomerulonephritis
Acute Nephritis
Acute Watery Diarrhoea
Addictions
Adenoids
AIDS
Allergies
Anaemia
Anorexia (Poor Appetite)
Asthma
ADHD
Autism
Backache
Bed-Wetting (Enuresis)
Birth Deformities
Bites and Stings
Bleeding
Bone, Joint and Muscle Injuries
Bowlegs and Knock-Knees
Breathlessness
Bronchiolitis
Burns
Calcium Deficiency
Cancer
Cardiac Pulmonary Resuscitation
Cerebral Palsy (CP)
Chickenpox
Choking
Circumcision
Cleft Lip and Palate
Common Cold
Congenital Heart Disease
Constipation
Convulsions or Fits or Seizures
Cough
Croup
Crying
Cuts
Dengue Fever
Diabetes Mellitus
Diarrhoea, Dysentery ...
Diphtheria
Down's Syndrome
Earache, Ear Infections ...
Electric Shock
Encephalitis
Eye Problems
Fears
Foot Problems
German Measles (Rubella)
Glands in the Neck ...
Headache
Head Injury
Hepatitis
Hydrocephalus
Hypertension
Hypospadias
Influenza (Flu)
Jaundice
Joint Disorders
Kala-Azar
Leptospirosis
Limp and Pain in the Legs
Malaria
Malnutrition (Undernutrition)
Measles
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Menstrual Problems
Mental Retardation (MR)
Mouth To Mouth Breathing
Mumps
Nephrotic Syndrome
Nose-Related Problems
Obesity
Pneumonia
Poisoning
Poliomyelitis
Premature Baby
Prolapse of the Rectum
Rabies
Rheumatic Fever
Rheumatoid Arthritis
Rickets
Short Child
Skin Conditions
Sleep and Sleep Problems
Sore Throat (Pharyngitis)
Splinters
Stammering
Stridor (Noisy Breathing)
Teething and Care of Teeth
Tetanus (Lock Jaw)
Thrush
Thumb-Sucking
Tics
Torticollis
Tracheoesophageal Fistula
Tropical Eosinophilia
Tuberculosis (TB)
Typhoid
Umbilical Problems
Undescended Testis
Urinary Infection
Vaginal Discharge
Vomiting
Wheezing
Whooping Cough (Pertusis)



Part 4
Keeping Your Child Healthy
Choosing A Paediatrician
Proper Use of Medicines
Home Remedies
A First Aid Kit
The A-Z of Childhood Illnesses
Psychological Concerns
Managing A Hospital Stay
Emergencies
Prayer And Your Child's Health
The Role of Nature Cure
Homoeopathy
Ayurveda and Child Care
Congenital Heart Disease FAQ
 
Guide to Child Care
Home
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1 Pregnancy, Childbirth ...
2 The Growing Years
3 Feeding Infants, ...
4 Keeping Your Child Healthy
5 Keeping Your Child Happy
About Dr. R. K. Anand
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