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.
