Allergic diseases are not just disorders of an organ system. Allergic diseases in children should be evaluated as a whole, and treatment planning should be done not only to save the day, but also for a long term.
The evaluation, follow-up and treatment of allergic children with allergic complaints by a pediatric allergy specialist affect the course of allergic diseases in children in the future. After the evaluation of the patient, laboratory tests or allergy skin tests are applied for the diagnosis and the responsible allergen causing allergic diseases is determined and appropriate recommendations are made.
What Are Allergic Diseases?
Allergic Asthma:
Asthma is a disease in which the small airways (bronchi) are red, swollen and tender. Although it affects all ages, complaints begin mostly in childhood. In asthma, when sensitive bronchi are exposed to house dust, animal hair, pollen, smoking, exercise and cold air, an increase in the production of mucus in the bronchi, redness and swelling in the bronchus and contraction of the muscles surrounding the bronchi occur. As a result of all these, the child has cough, shortness of breath, wheezing. It is aimed to eliminate the allergen and conditions that cause the treatment, and drugs that reduce the sensitivity in the bronchi are applied.
Allergic Rhinitis:
Allergic rhinitis is the occurrence of allergens such as house dust, animal hair, dampness, sneezing, nasal congestion, nasal itching, nasal itching, itching and watering in the eyes, bruising under the eyes, most often with pollen. In the treatment, protection from the allergen causing allergies, drugs that eliminate existing allergic complaints and allergen immunotherapy called allergy vaccine are applied when necessary.
Eczema (Atopic dermatitis):
Atopic dermatitis causes long-lasting skin itching, dryness, redness, burning and cracks, which are more common in children. As it can affect any part of the body, it is mostly seen in the hands, behind the knee and inside the elbow, face and scalp. Food allergens, detergents, soaps and weather changes cause these lesions to become more pronounced. In the treatment, the food allergen that increases eczema should be revealed, especially in babies under 1 year old, and it should be ensured that this food is avoided completely with diet, and these lesions should be eliminated with treatments and moisturizers to be applied to the skin.
Food allergy:
Food allergy occurs when the immune system perceives the normally harmless food proteins as a threat. As a result, various chemicals, especially “histamine”, are secreted and allergic reactions occur after food intake. The most common foods that cause allergic reactions in children are milk, eggs, peanuts, nuts, fish and shellfish. After food intake, itching in the mouth, hives (urticaria), swelling of the face, mouth, throat, difficulty swallowing, wheezing or shortness of breath, dizziness, nausea or vomiting, abdominal pain or diarrhea, sudden sneezing, runny nose, nasal itching may occur. Some findings may occur within days after food intake. Eczema lesions that occur with dryness and redness of the skin within days after food intake, mucus and bloody stools, constipation, excessive crying that cannot be stopped in babies and growth retardation are the other symptoms of food allergy. Finding the food that causes these complaints and avoiding exactly that food is the basis of the treatment.
Drug allergy:
It can occur most frequently against beta lactam antibiotics, as well as rash in the form of urticaria, itching, swelling of the lips and eyes, sudden sneezing, runny nose, hoarseness after the use of painkillers, antipyretics (paracetamol ibuprufen), shortness of breath, sudden onset of weakness and dizziness, vomiting and diarrhea may be seen. It is necessary to reveal the drug that is thought to cause an allergic reaction after being evaluated by the pediatric allergist and to determine the alternative drug that can be used safely.
Hives (Urticaria):
Hives (urticaria) is the appearance of pale pink, swollen, itchy plaques on the skin. It can occur anywhere on the body. It begins in one body area and another. While it is most common in children during infections, food allergens, bee stings, and additives can also cause these rashes. In the treatment, it is important to find out the cause and eliminate the rash with medication.
Contact Allergies:
Contact allergy or dermatitis is redness, watering, drying or cracking of the skin after exposure to irritant (detergent, soap) or allergen. Although it affects any part of the body, it is most commonly seen on the hand and face. It is necessary to eliminate the causative effect and treat the existing lesion.
Metal allergies:
Metal allergy is an immune allergy disease that affects 10-15% of the society. It is more common in women than in men. It is the occurrence of redness, swelling and pain on the skin after contact with various metals (cobalt, copper, chromium), most commonly nickel. Generally, the diagnosis should be made with a patch test, and the metal that causes these rashes should be avoided.
Bee allergy:
After being stung with a donkey or a honey bee, there is a sudden severe pain followed by a painful and itchy swelling that occurs within a few hours. Sometimes the rash and itching in the wider area of the skin area continues for up to 1 week. These are mild allergic reactions that do not need to be worried. However, sometimes a severe allergic reaction (anaphylaxis) can be seen within minutes after a bee sting, with symptoms such as shortness of breath, feeling of stuck in the throat, hives, dizziness, fainting, vomiting and diarrhea. In this case, the pediatric allergist should find out which type of allergy has developed with the bees and, when necessary, allergen immunotherapy called allergy vaccine should be started.
Eye allergies:
Eye allergy occurs with symptoms accompanied by burning and stinging in the eyes, itching, redness of the eyes and eyelids, and rarely blurred vision. Exposure to allergens such as house dust, dampness, cat and dog hair, mostly pollen, initiates or increases the complaints. It is important to determine the allergen in the treatment and to avoid it as much as possible, to reduce or correct the complaints with medications. Treatment with allergy vaccines may be required when necessary.
Hereditary angioedema:
It is often an inherited disease that is passed down in families. It is caused by a defect in the protein in the body called C1 esterase inhibitor. Although it varies according to the patients, angioedema attacks are seen, which can occur in complaints that usually manifest themselves with swelling in the body and sometimes cause swelling in the respiratory tract. In these patients, treatment for the protein defect should be given, not allergy-directed therapy.
Mastocytosis:
Mast cells are made in the bone marrow and when allergens are encountered in the body, it causes histamine and other substances to mix into the blood, causing complaints such as hives during allergic reactions. In childhood, these cells can be concentrated on the skin and red-brown rashes are seen on the skin. Mast cells can sometimes be collected in internal organs. The type of mastocytosis should be determined by the physician and families should be informed about the triggering factors that will cause the increase of chemicals released from mast cells.
Diagnosis and Treatment in Allergic Diseases
The most important way to detect possible allergies is to monitor your child’s reaction to food and different environments, but some allergies may be less obvious to identify. Allergic diseases such as nasal congestion and sneezing are similar to the common cold or sinus infection. Children with allergies may be more susceptible to more than one ear infection or nose and throat infections. Helping to control allergies can often lead to less infections and illnesses.
To diagnose allergies, the doctor will ask the patient about the symptoms, when they occur, how often they occur, and what they look like. They will also ask the person with symptoms if they have a family history of allergies and whether other household members have allergies.
The allergist may recommend some tests to find out which allergen is causing the symptoms.
Tests for Allergy Detection
Below are some examples of allergy tests:
Blood test: This measures the level of IgE antibodies released by the immune system. This test is sometimes called the radial orbent test (RAST).
Skin prick test: This is also known as puncture test or prick test. The skin is pierced with a small amount of a possible allergen. If the skin reacts and becomes itchy, red and swollen, it could indicate an allergy.
Patch test: A patch test can identify eczema. Special metal discs with very small amounts of suspected allergens are attached to the individual’s back. The doctor will recheck for a skin reaction 48 hours and a few days after the patch is attached.
What is the Skin Prick Test?
During allergy skin tests, your skin is exposed to suspected allergen-causing substances (allergens) and then observed for signs of an allergic reaction. Along with your medical history, allergy tests can confirm whether a particular substance you touch, breathe, or eat is causing symptoms.
When is it used?
In general, allergy skin tests are most reliable for diagnosing allergies to airborne substances such as pollen, pet dander and dust mites. Skin testing can help diagnose food allergies. However, as food allergies can be complex, additional testing or procedures may be needed.
Who does it apply to?
Skin tests are generally safe for children and adults of all ages, including babies. In some cases, however, skin tests are not recommended. Your doctor may not recommend a skin test if:
- You have ever had a serious allergic reaction. You may be so sensitive to certain substances that even small amounts used in skin tests can trigger a life-threatening reaction (anaphylaxis).
- You have taken medications that could interfere with test results. These include antihistamines, many antidepressants, and some stomach medications. Your doctor may determine that it is better to continue using these medications and to temporarily stop them in preparation for the skin test.
- You have certain skin conditions. If severe eczema or psoriasis affects large areas of skin on your arms and back – the usual test areas – there may not be enough clear, unresolved skin to perform an effective test. Other skin conditions such as dermatography can cause unreliable test results.
How is it analyzed?
Approximately 15 minutes after the skin puncture, the nurse will observe your skin for signs of allergic diseases. If you are allergic to one of the substances tested, you will develop a red, itchy bump that looks like a mosquito bite. The swell size will then be measured by a nurse.
