Pediatric Allergic and Immunologic Disorders

Allergy and asthma are among the most common health problems, with more than 50 million people afflicted with asthma, seasonal hay fever, or other allergy-related conditions each year.

Allergies can affect anyone, regardless of age, gender, race or socioeconomic class. Generally, allergies are more common in children; however, a first-time occurrence can happen at any age, or recur after many years of remission. There is a tendency for allergies to occur in families, although the exact genetic factors that cause it are not yet understood.

• Food allergies are seen in 8% of children under age 6.
• According to the Allergy and Asthma Foundation of America, if only one parent has allergies, chances are one in three that each child will have an allergy. If both parents have allergies, it is much more likely (7 in 10) that their children will have allergies.

According to the latest available statistics from the American Academy of Allergy, Asthma, and Immunology and the National Institute of Allergy and Infectious Diseases:

• Allergic problems in the United States are the sixth leading common cause of chronic disease.
• Approximately 20.3 million people in the United States have been diagnosed with asthma, with at least 6.3 million of them children under the age of 18.
• Asthma is the most common cause of childhood hospitalizations under the age of 15.

Specific treatment for allergies will be determined by your child's physician based on the following:

• Your child's age, overall health and medical history
• Severity of the allergic reaction
• Your child's tolerance for specific medications, procedures or therapies
• Expectations for the course of the allergic reaction
• Your opinion or preference

The three most effective ways to treat allergies are avoidance, immunotherapy and medication.

If allergy injections are appropriate for management of allergic rhinitis or asthma in children at least 6 years of age with allergy to pollens, molds or dust mites, Children’s National Hospital's team can prepare vaccines and administer the initial injections of vaccines. Patients can then take to these initial injections to their referring physician for continued administration once or twice each week until reaching maintenance dosage in 6-7 months, after which treatment continues usually once each month. Treatment usually continues for three to five years, during which the Children’s National team sees the patient for renewal of vaccines once or twice each year.

Diagnostic tests for allergy may include any and/or all of the following:

• Skin tests. The skin test is a very accurate test that measures your child's skin reaction to IgE antibodies to certain allergens. Using small amounts of solution that contain different allergens, your child's physician will apply the allergens with a small prick. A reaction would appear as a small red area. A reaction to the skin test does not always mean your child is allergic to the allergen that caused the reaction but indicates that possibility. This will be determined by your child's physician.
• Blood tests. Blood tests for allergies measure IgE antibodies to specific allergens in the blood. The blood test most commonly used is called RAST (radioallergosorbent test). Blood tests may be used when skin tests cannot by performed. As with skin testing, it is important to remember that a positive blood test does not always mean your child is allergic to that allergen.

Avoidance is staying away from a substance that causes an allergic reaction.

Suggestions for avoiding (some) allergens:

• Remain indoors when the pollen count is high and on windy days.
• Dust-proof the home, particularly your child's bedroom.
  • Eliminate, when possible, wall-to-wall carpet.
  • Wash bedding, including blankets and quilts, weekly in hot water to eliminate dust mites.
  • Keep bedding in dust covers, when possible.
• Use air conditioning instead of opening the windows.
• Consider putting a dehumidifier in damp areas of the home, but remember to clean it often.
• Have your child wear a face mask if playing outside when the pollen count is high.
• Take vacations in areas where pollen is not as prevalent – such as near the ocean.

Your child's physician will also have suggestions for avoiding the allergens that cause reactions.

Immunotherapy is a type of treatment for allergic children with hay fever and/or asthma. It is also called desensitization, hyposensitization and allergy shots. A mixture of the various pollens, mold spores, animal danders and dust mites to which your child is allergic is formulated. This mixture is called an allergy vaccine. This vaccine contains no medication such as antihistamines or corticosteroids.

Immunotherapy is given by injection under the skin usually into the fatty tissue in the back of the arm. It is not painful like an injection into the muscle, such as a penicillin shot.

Injections may be given weekly or twice a week until a maximum dose is tolerated. This is called the maintenance dose. It may take 6-7 months to reach the maintenance dose. At this point, the frequency of injections may be decreased to every other week and finally to once a month. Your child's physician will establish the appropriate schedule of injections to meet your child's medical needs.

About 80 to 90% of children improve with immunotherapy. It usually takes from 12 to 18 months before definite reduction in allergy symptoms is noticed. In some children, a reduction in symptoms is evident in as soon as six to eight months.

Immunotherapy is only part of the treatment plan for allergic children. Since it takes time for immunotherapy to become effective, your child will need to continue the allergy medications, as prescribed by his/her physician. It is also important to continue eliminating allergens (such as dust mites) from your child's environment.

There are two types of reactions to immunotherapy: local and systemic. The local reaction is redness and swelling at the injection site. If this condition occurs repeatedly, then the vaccine strength or schedule is changed.

A systemic reaction is one that involves a different site, not the injection site. The symptoms may include nasal congestion, sneezing, hives, swelling, wheezing and low blood pressure. Such reactions can be serious and life threatening. However, deaths related to immunotherapy are extremely rare. If a systemic reaction occurs, your child may continue taking shots, but at a lower dosage.

If you have any questions concerning immunotherapy, always consult your child's physician or allergist.

For children who suffer from allergies, there are many effective medications. This is a brief overview of the most commonly used types of medications. Always consult your child's physician before giving your child any over-the-counter medications.

Antihistamines are used to relieve or prevent the symptoms of allergic rhinitis (hay fever) and other allergies. They prevent the effects of histamine, a substance produced by the body during an allergic reaction. Antihistamines come in tablet, capsule, liquid or injection form and are available both over-the-counter and by prescription.

• Bronchodilators. These medications are used to help open the narrowed lungs and may relieve coughing, wheezing, shortness of breath or difficulty in breathing. These are usually considered rescue medications for acute attacks of asthma. Types of bronchodilators are beta-agonists, theophylline and anticholinergics. These medications come inhaled, in pill form, liquid or injectables. The short-acting bronchodilators are used as needed, as symptoms occur. Longer-acting bronchodilators may be used for maintenance or on a daily basis to help control flare-ups from occurring.
• Anti-inflammatory medications. These medications help to decrease the inflammation that occurs in the airways with asthma. These include two types of medications:
  • Nonsteroidal anti-inflammatory medications. Cromolyn and nedocromil are two types of nonsteroidal medications that are usually inhaled.
    
  • Corticosteroids. These medications can be given in a variety of ways. Some of them are inhaled, while others may be taken as a pill or liquid or even injected. The steroids taken by mouth can have more side effects than those that are inhaled. Consult your child's physician regarding the best choice for your child.
• Leukotriene antagonists. These medications are used to help control the symptoms of asthma or allergic rhinitis. These medications help to decrease the narrowing of the lung and to decrease the chance of fluid in the lungs or the nose. These are usually given by mouth.

Consult your child's physician for more information concerning allergy medications.