Allergies and children: Questions you may have
Allergies can be the bane of a parent’s existence. They can change the way your child experiences his or her childhood, be it in the precautions that need to be taken or the discomfort of an allergy in full swing.This week we speak with Dr. Neelika Malavige, Senior Lecturer and Immunologist, University of Sri Jayewardenapura who answers some of the most common questions put to her by anxious parents.
What effect do allergies have on a child – can it affect their intellectual or physical development? What are some of the challenges parents must face?
Allergies should not affect intellectual or physical development but in most cases this does tend to occur because of improper management and beliefs. For instance, withholding nutritious food from a child’s diet in the absence of a true food allergy can lead to nutrition deficiencies and can affect physical development. In addition most children with poorly controlled asthma may frequently miss school which can have very serious affects.
Also some children with allergies are discouraged by both parents and teachers from engaging in sports which again can lead to poor physical development. It is very important that a child with allergies is encouraged to lead a normal life. Some children however, do have very severe multiple food allergies to common food such as eggs, cow’s milk and wheat which then would lead to nutritional deficiencies. However, fortunately such cases are extremely rare in Sri Lanka.
Are some children predisposed to developing allergies?
Yes. Those who have first degree relatives with any disease due to allergies (asthma, allergic rhinitis and eczema) are at a much higher risk of developing such diseases.
How do you find out if you are allergic to something?
In the case where asthma occurs due to aeroallergen exposure such as house dust mite it is difficult to find out from the patient’s history itself what the patient is allergic to. Therefore, allergy tests can be carried out in the form of skin prick tests or blood tests to find out the allergen. Some people might know what triggers their asthma. For example someone who is allergic to cats may experience these symptoms when they touch cats or go to households with cats. Allergies to food and insect venom allergy is more straightforward as the allergic symptoms usually occur immediately following exposure. These can be confirmed by testing.
Can allergies be dangerous? What qualifies as an emergency and what steps should be taken?
Yes. Asthma, food allergies and insect venom allergies can lead to life-threatening reactions (anaphylaxis) and death and unfortunately all these diseases are on the rise. Therefore, there are more individuals who get severe life-threatening reactions. Proper asthma control and management can reduce the incidence and severity of asthma. However, Sri Lanka is reported to have the highest asthma mortality rates in the South East Asian region.
Currently the only method available for the prevention of anaphylaxis in those with severe food and insect venom allergies is avoidance. Although it is not that difficult to completely avoid certain types of food, those who are severely allergic to cow’s milk, sesame and nuts may find it difficult to completely avoid these foods and can have accidental exposure with grave consequences.
Insect venom allergy is extremely dangerous as well as it is impossible to avoid being stung by insects. The insects that are responsible for most of the insect venom allergy are big black ants (Kadiya), wasps and bees. Many deaths have occurred in Sri Lanka because of this. I believe it is important to educate the teachers and the school authorities on how to suspect a severe allergic reaction and what should be done in those instances as the number of children with life threatening allergies is on the rise.
Can allergies be the underlying cause of a more serious disease?
Asthma, allergic rhinitis, atopic dermatitis, food allergies and insect venom allergies are the main diseases that occur due to allergies. Allergies are responsible for asthma and allergic rhinitis in around 70% of patients. The number one allergen resulting in asthma, allergic rhinitis and atopic eczema all around the world including Sri Lanka is allergy to house dust mite. For reasons still unknown to us, all types of diseases due to allergies are on the rise.
What are the allergens that are mainly responsible for asthma?
Aeroallergens, which are allergens present in the environment such as house dust mite, cockroach, fungal spores, cat and dog dander and pollen are the main allergens causing asthma and allergic rhinitis. Although foods such as cow’s milk, king coconut, banana, brinjals etc… can cause asthma or allergic rhinitis, this is not very common. Therefore, avoidance of nutritious food such as cow’s milk in all patients with asthma is not recommended as food allergies themselves rarely cause asthma. They should only be avoided in those with proven food allergy as indiscriminate avoidance can lead to nutritional deficiencies. As the main cause of asthma and allergic rhinitis are aeroallergens, environmental modification may help to reduce severity of symptoms.
Do food allergies cause chronic urticaria?
The simple answer is that food allergies are an extremely unlikely cause of chronic urticaria. Chronic urticaria is the occurrence of itchy bumps, on most days of the week for a period that lasts over 6 weeks. The commonest causes of chronic urticaria are infections followed by other causes excluding food allergies. Very extensive studies carried out in other countries and in Sri Lanka have shown that food allergy is an extremely unlikely cause of chronic urticaria. Therefore, it is not recommended for patients with such diseases to avoid any foods as it will not improve their symptoms. However, certain food additives such as monosodium glutamate, certain preservatives, and flavourings can cause chronic urticaria and these should be avoided.
Do children outgrow allergies?
Yes. Most of them fortunately do. Especially most of the children with food allergies (excluding nut allergy) outgrow them by 6 years of age. Most of them outgrow allergy to aeroallergens such as house dust mite etc… as they grow older too.
What types of treatment methods are available?
For asthma, allergic rhinitis and atopic eczema, the most important aspect would be to seek treatment from your paediatrician, respiratory physician or dermatologist and to adhere to the management plan. For those with food allergies (proven and not assumed), complete avoidance is very important and fortunately children tend to outgrow it. So it is a matter of waiting till this happens. Depending on the type of food the child is allergic to, allergy testing is carried out in yearly or two yearly intervals to see if the child has outgrown the allergy. It is dangerous to make the child eat the food to see if the child has got better in a child who has had severe reactions to food. For those with insect venom allergy, desensitization treatment is available in other countries but unfortunately, still not available in Sri Lanka.
What lifestyle measures can help parents manage allergies better?
This would depend on the disease caused by the allergy. If a child has asthma the best management strategy would be to seek treatment from your paediatrician or respiratory physician regarding optimum asthma management. If a child has atopic dermatitis due to allergy, seeking proper advice from the dermatologist is very important. What parents should keep in mind is that these are long term illnesses and miracle cures cannot be expected in a day or a week.
If the allergen is identified and is found to be house dust mite in the case of asthma or allergic rhinitis, proper cleaning of the house would be important. The bedroom should be well ventilated and the windows kept open during most hours during the daytime. Putting out the mattress and the pillows in the hot sun two or three times a month and using a wet cloth to clean surfaces are important measures. A properly ventilated house prevents overgrowth of mould and also reduces the house dust mite and cockroach load.