Babies and Children
Allergies and Anaphylaxis
Allergy (Allergic Reaction) occurs when a person’s immune system reacts to substances in the environment that are harmless to most people.
Anaphylaxis is a severe, potentially life-threatening allergic reaction.
Atopy is the genetic tendency to develop allergic diseases
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Why an Allergic Reactions Happens.
The immune system plays a crucial role: it protects your body from harmful invaders like bacteria and viruses. However, when it mistakenly attacks harmless substances, it results in an allergy. Common triggers such as peanuts, eggs, or pollen are known as allergens. During an allergic reaction, the immune system produces antibodies, which are proteins that instruct cells to eliminate the allergen. This leads to the release of histamine and other chemicals, causing the symptoms of an allergy. These antibodies are highly specific, each targeting a particular allergen, which is why an individual might be allergic to peanuts but not eggs. Allergens can be encountered in various ways: through the skin, eyes, nose, mouth, or stomach, leading to symptoms like congested sinuses, inflamed skin, breathing difficulties, or gastrointestinal issues.
Difference Between Allergy or Intolerance.
Sometimes intolerance can be mistaken for an allergy because many symptoms are alike. However, intolerance and allergy are distinct – an allergy involves the immune system, whereas intolerance does not. Food intolerance does not cause anaphylaxis.
An allergic reaction to food can occur with very small quantities. Intolerance means a person can handle a certain amount of the food trigger, but excess consumption leads to illness (such as diarrhea, bloating, headaches, rash, and mouth ulcers). Lactose and gluten intolerances are two common examples.
Common Causes of an Allergic Reaction.
Why do some people suffer from severe allergies while others do not? Experts don’t have all the answers, but they acknowledge the significance of family history when it comes to allergies.
Some common allergens include:
– Animal dander (tiny scales from hair, feathers, or skin)
– Bee stings
– Certain medications, like penicillin
– Dust mites
– Foods, especially peanuts, tree nuts, fish, shellfish, eggs, milk, wheat, and soy
– Insect bites
– Latex or other substances upon contact
– Mould
– Plants and pollens
– Grasses
Allergic Symptoms
The symptoms of allergies can differ based on the allergens and the type of exposure to the allergen. Allergens may enter the body through various routes:
– Inhaled through the nasal passages to the lungs
– Through ingestion, eating something that contains something the person is allergic
– Dermal contact, when the item a person is allergic to touches the skin
– By absorption following an insect sting or bite
The Symptoms, From Itchy Eyes to Sneezing
Allergy attacks can vary from mild and annoying to severe and potentially life-threatening, depending on your body’s response and the amount of allergen present.
Common symptoms of a mild allergic reaction include:
– Itchy, watery eyes
– Sneezing
– Itchy, runny nose
– Feeling tired or sick
– Rashes and hives
In contrast, a severe allergic reaction may cause:
– Abdominal pain
– Anxiety
– Tightness in the chest
– Coughing
– Diarrhea
– Difficulty breathing or swallowing
– Dizziness
– Swelling of the face, eyes, or tongue
– Paleness and limpness (in infants and young children)
– Anaphylaxis
Hay Fever
 Also known as allergic rhinitis, it can cause:
- Sneezing
- Runny or stuffy nose
- Itchy eyes, nose or roof of mouth
- Red, swollen, watery eyes — a condition known as allergic conjunctivitis
Food Allergies
Eczema:
Also known as atopic dermatitis, it is a skin condition. Most types of eczema are not allergies. But the disease can flare up when you’re around things that cause an allergic reaction. Your body’s immune system overreacts to substances, called allergens, that are usually not harmful. You might get hives, itching, swelling, sneezing, and a runny nose. You might have it if you have itching, redness, and peeling or flaking.
Medications
If you’re allergic to a certain drug, you may get a rash, facial swelling, or hives. You could also find yourself wheezing. In severe cases, you may develop anaphylaxis.
Stings
If you’re allergic to bees or other insects you may get:
- A large area of swelling, known as oedema, at the site of the sting
- redness, and pain at the site of the sting
- Itching or hives can be local to one area or all over your body
- Shortness of breath, wheezing, chest discomfort or tightness, or a cough
As with some other allergies, such as food and medication, a severe reaction to a sting can lead to anaphylaxis and medical attention should be seeked immediately.
Treatment for allergic reactions
 Mild to moderate allergic reaction
Most mild to moderate episodes of food allergy will respond well to an oral antihistamine medication. If your child has a known allergy, you should carry an antihistamine medicine with you at all times. Talk to your pharmacist or GP on the antihistamin that is appropriate for your child. Antihistamines are available over the counter at your chemist and it is recommended to use a antihistamine that doesn’t cause drowsiness.
If the allergic reaction is due to coming into contact with the allergen, it is recommended to have a cool shower. It will wash the allergen off the skin whilst, the cool of the water can sooth the symptoms.
If it is local to an area like a bee sting, remove the stinger as soon as possible.Â
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Antihistamines
Antihistamines are medicines that relieve symptoms of allergies or hayfever, including itchiness, sneezing, swelling or rashes.
Antihistamines can sometimes cause a dry mouth, upset stomach and drowsiness.
Some antihistamines are less likely to cause drowsiness. They include cetirizine (Zyrtec) and loratadine (Claratyne). These might be more suitable for your child, especially if they take them during the day. Children over the age of 6 months can be give a non-drowsy antihistamines.Â
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Antihistamines that are more likely to cause drowsiness include promethazine (Phenergan) and trimeprazine (Vallergan). Should not be given to children under 2 years of age.
Antihistamines generally aren’t recommended for long-term use, so check with your doctor if your child seems to need them a lot.
Antihistamines and sleep
Antihistamines like promethazine (Phenergan) or trimeprazine (Vallergan) aren’t recommended for helping children sleep. These medicines cause daytime drowsiness, which might affect your child’s ability to learn.
Antihistamines can also have the opposite effect, causing some children to become hyperactive. This might make any sleep problems worse.
Corticosteroids
Corticosteroids are used to treat inflammation, swelling or itchiness from problems and conditions like allergies, asthma, insect bites, eczema and croup.
You can buy mild corticosteroid creams, ointments and nasal sprays over the counter at your pharmacy.
Only doctors can prescribe oral corticosteroids or stronger corticosteroid creams and ointments.
Prednisolone, prednisone and hydrocortisone are types of corticosteroids.
Ticks
Queensland is know for ticks due to our perfect climate for them. If you notice a tick on your child it is recommended to remove them immediately with a pair of tweezers. Use the tweezers to grab the tick as close to the skin as possible and pull it out. If some of the mouth remains in the skin try to remove it with the tweezers. If your child is know for allergies and you find the area is swollen and inflamed it is recommended not to remove the tick and to take them to your GP for removal. Sometimes a tick will inject more toxin during the removal from the skin.Â
Hives
Hives are slightly raised, red patches of skin called wheals (or welts). They occur in groups on any part of the body, and can look like mosquito bites. They are often itchy, but sometimes also sting. The medical word for hives is urticaria (er-tuh-care-ia).
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Hives can be a sign of an allergic reaction to things like food or an insect sting. Hives are very common – one out of every five people will have hives at some time in their life. It is common for hives to occur in children where there is no identifiable cause, this is called idiopathic urticaria.Â
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Treatment includes medicines and avoiding known triggers. The triggers may be different for each child, and it is common that a trigger cannot be identified.Â
Signs and Symptoms of Hives
If your child has hives, they may have raised round wheals that look like mosquito bites. The wheals are red on the outside and can be white in the middle.
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- Hives are normally very itchy, but can also sting.
- AÂ single wheal often lasts several hours before fading without trace.
- The wheals appear in batches or clusters. New batches may develop as old areas fade away.Â
- Often the wheals join together to form larger swellings. The area of affected skin can vary in size from quite small to as large as a dinner plate.Â
- Depending on the trigger, hives usually settle over hours. When there is no identifiable cause (idiopathic urticaria), hives will usually go away within a few days, but may last weeks.
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Hives can look or feel unpleasant, but usually they are harmless.
What Causes Hives?
Hives are a skin rash which can be caused by an allergic reaction, when the immune system responds to a substance such as a food or insect venom. Hives in this case commonly last for a few hours once the trigger has been removed. Hives can commonly occur without a trigger, and may be the immune system responding to a viral illness/cold. These hives commonly come and go for a few days to weeks. Hives occur when a chemical called histamine is released.Â
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If hives are present for over a few days with no obvious cause, allergy tests are not needed, in these cases there is generally no external trigger and the hives with gradually improve with time. Sometimes these cases may also have associated swelling of the lips/eyes.
If hives appear soon after a certain food, medicine or insect sting, and resolve within a few hours after no further exposure to this trigger, then allergy testing may be indicated. Â
Care at Home for Hives
Most of the time, hives as the only symptom can be safely managed at home, without the need to see a doctor. A pharmacist might provide you with some non drowsy antihistamine medication for relief of symptoms during an episode. These are safe to use from six months of age and can be used once or twice daily if needed. The best treatment for hives is to avoid the cause or trigger, however this is not always possible.
You can help treat your child’s hives by:
- avoiding known triggers for your child
- avoiding things that make the rash worse, such as sunshine, heat and hot showers
- applying cool compresses (a face washer, cloth nappy or clean tea towel soaked in cool water), which may help relieve the itching and stinging
- using non drowsy antihistamines (Cetirizine, Loratadine).Â
When to see a Doctor for Hives
 If your child continues to have hives for more than six weeks, take them to see your GP.
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Treatment for severe or frequent hives may include:
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- checking that the rash isn’t caused by an underlying disorder
- medications such as corticosteroids, which can reduce the immune system’s response to the triggers
- prescribing ongoing non drowsy antihistamines to provide relief from itching – these can be very useful if taken at bedtime.
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If at any time the hives are associated with other symptoms (high fever, bruising, purple skin discolouration or joint pains), your child should be seen by a doctor.
If your child presents signs of anaphylaxis, then call an ambulance.Â
Medical Advice
Effectiveness of antihistamine medications
Antihistamine medication won’t treat existing hives, but it will prevent hives from getting worse and prevent new hives from erupting. If your child is exposed to a known trigger, it is best to give them antihistamine medication as soon as you can.
Creams for children’s hivesÂ
Talk to your local pharmacist about creams and lotions that may help reduce the intensity of the itching. The most effective creams will include antihistamine.
Allergy specialist
If you are unable to determine the trigger, it is useful to keep a food and activity diary. An allergy specialist can also perform further testing to determine the most likely triggers for your child’s hives.
Key Points to Remember with Hives
- Hives are very common and are usually harmless.
- Hives are a skin rash involving red, raised wheals that are usually very itchy.
- This type of skin rash can be an allergic reaction, which means the immune system responds to a substance as if it were toxic, but it can also have no known triggers and is the immune system responding to a viral illness.
- Treatment options include avoiding known triggers and medications such as antihistamines which can be used daily and rarely corticosteroids.
- Call an ambulance if your child has symptoms of anaphylaxis.
Anaphylaxis
Anaphylaxis is a severe, life-threatening allergic reaction. It can happen seconds or minutes after you’ve been exposed to something you’re allergic to. Peanuts or bee stings are examples. In anaphylaxis, the immune system releases a flood of chemicals that can cause the body to go into shock. Blood pressure drops suddenly, and the airways narrow, blocking your breathing. The pulse may be fast and weak, and you may have a skin rash. You may also get nauseous and vomit. Anaphylaxis needs to be treated right away with an injection of epinephrine. If it isn’t treated right away, it can be deadly.
Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to something you’re allergic to, such as peanuts or bee stings.
Anaphylaxis causes the immune system to release a flood of chemicals that can cause you to go into shock — blood pressure drops suddenly and the airways narrow, blocking breathing. Signs and symptoms include a rapid, weak pulse; a skin rash; and nausea and vomiting. Common triggers include certain foods, some medications, insect venom and latex.
Anaphylaxis requires an injection of epinephrine and a follow-up trip to an emergency room. If you don’t have epinephrine, you need to go to an emergency room immediately. If anaphylaxis isn’t treated right away, it can be fatal.
Causes
Anaphylaxis is caused by a severe allergic reaction. It happens when the immune system mistakes a food or substance for something that’s harmful. In response, the immune system releases a flood of chemicals to fight against it. These chemicals are what cause the symptoms of an allergic reaction. Allergy symptoms usually aren’t life-threatening, but a severe reaction can lead to anaphylaxis. The most common triggers of anaphylaxis in children are food allergies like to peanuts, milk, fish, and shellfish. In adults, stings from insects, latex, and some medications can cause anaphylaxis.
The immune system produces antibodies that defend against foreign substances. This is good when a foreign substance is harmful, such as certain bacteria or viruses. But some people’s immune systems overreact to substances that don’t normally cause an allergic reaction.
Allergy symptoms aren’t usually life-threatening, but a severe allergic reaction can lead to anaphylaxis. Even if you or your child has had only a mild anaphylactic reaction in the past, there’s a risk of more severe anaphylaxis after another exposure to the allergy-causing substance.
The most common anaphylaxis triggers in children are food allergies, such as to peanuts and tree nuts, fish, shellfish, wheat, soy, sesame and milk. Besides allergy to peanuts, nuts, fish, sesame and shellfish, anaphylaxis triggers in adults include:
- Certain medications, including antibiotics, aspirin and other pain relievers available without a prescription, and the intravenous (IV) contrast used in some imaging tests
- Stings from bees, yellow jackets, wasps, hornets and fire ants
- Latex
Although not common, some people develop anaphylaxis from aerobic exercise, such as jogging, or even less intense physical activity, such as walking. Eating certain foods before exercise or exercising when the weather is hot, cold or humid also have been linked to anaphylaxis in some people. Talk with your health care provider about precautions to take when exercising.
If you don’t know what triggers an allergy attack, certain tests can help identify the allergen. In some cases, the cause of anaphylaxis is not identified (idiopathic anaphylaxis).
Symptoms
Symptoms of anaphylaxis include hives and itchy, pale, or flushed skin. Blood pressure may be low, it may be hard to breathe, and the pulse may be weak and fast. You may get nauseous, vomit, have diarrhea, feel dizzy, and faint. Symptoms usually happen minutes after you’ve been exposed to something you’re allergic to, but they might not appear for a half hour or longer.
Anaphylaxis symptoms usually occur within minutes of exposure to an allergen. Sometimes, however, anaphylaxis can occur a half-hour or longer after exposure. In rare cases, anaphylaxis may be delayed for hours. Signs and symptoms include:
- Skin reactions, including hives and itching and flushed or pale skin
- Low blood pressure (hypotension)
- Constriction of the airways and a swollen tongue or throat, which can cause wheezing and trouble breathing
- A weak and rapid pulse
- Nausea, vomiting or diarrhea
- Dizziness or fainting
Treatment for Anaphylactic reaction
The first-line treatment for anaphylaxis is adrenaline, which may be given as an injection. Your doctor will also prepare an Anaphylaxis Action Plan for your child. If your child has an anaphylactic reaction, follow the plan or do the following:
- Have your child lie down, but if breathing is difficult allow them to sit.
- Inject your child with the autoinjector, and call an ambulance immediately.
- A second autoinjector is sometimes needed while waiting for an ambulance.
If there is no autoinjector available, call an ambulance immediately.Â
An allergist will work with your child to find out what they are allergic to. Your child could also wear a medical alert pendant or bracelet to let other people know what may cause them to have an allergic reaction. Talk to your doctor about this.
When to see a doctor.
Seek emergency medical help if you, your child or someone else you’re with has a severe allergic reaction. Don’t wait to see if the symptoms go away.
If you have an attack and you carry an epinephrine autoinjector, administer it right away. Even if symptoms improve after the injection, you still need to go to an emergency room to make sure symptoms don’t recur, even without more exposure to the allergen. This second reaction is called biphasic anaphylaxis.
Make an appointment to see your provider if you or your child has had a severe allergy attack or signs and symptoms of anaphylaxis in the past.
The diagnosis and long-term management of anaphylaxis are complicated, so you’ll probably need to see a doctor who specializes in allergies and immunology.
Food Introductory
Leading health organizations recommend introducing peanuts and other common food allergens early and often, once a baby starts solid foods? FDA HEALTH CLAIM: For babies with an increased risk of peanut allergy (babies with severe eczema, egg allergy or both), introducing age-appropriate, peanut-containing foods as early as 4 months may reduce the risk of developing a peanut allergy. Caregivers should check with the baby’s healthcare provider before feeding the baby peanut-containing foods
That may sound scary – but common food allergens are actually some of the most nutrient-dense foods and full of benefits for growing bodies!
Talk to your paediatrician about whether your baby is ready for early allergen introduction so you can get started and remember, never feed your baby a food to which they are already allergic.Â
Remember: early, often and ongoing is key! Once introduced, aim to keep these foods in the diet regularly.Â
Preventing Allergic and Anaphylactic Reactions
An important aspect of allergy and anaphylaxis management is prevention by avoiding the trigger.
If your child is allergic to food, teach them not to share or swap food with others, and to always wash their hands before eating. Teach your child to be very careful when eating take-away food or eating at restaurants and cafes. For parties and play dates, always notify the host of your child’s allergies and ensure they have access to your child’s autoinjector and know how to use it. Consider providing separate food for your child.
Schools, kindergartens and childcare centres will have policies in place to prevent reactions in children at risk of anaphylaxis, and staff will be trained in how to manage reactions if they occur. The policies will cover the following issues:
- food sharing and treats
- banning productsÂ
- food preparation and serving
- art/craft
- excursions and camps.
Talk to your school or childcare centre about your child’s allergies, and what allergy policies they have in place.
Asthma and Anaphylactic Reactions
For children with both asthma and anaphylaxis, it is very important to maintain good asthma symptom control. This will reduce the risk of severe breathing system involvement during an allergic reaction.
Preventing Allergic and Anaphylactic Reactions
An important aspect of allergy and anaphylaxis management is prevention by avoiding the trigger.
If your child is allergic to food, teach them not to share or swap food with others, and to always wash their hands before eating. Teach your child to be very careful when eating take-away food or eating at restaurants and cafes. For parties and play dates, always notify the host of your child’s allergies and ensure they have access to your child’s autoinjector and know how to use it. Consider providing separate food for your child.
Schools, kindergartens and childcare centres will have policies in place to prevent reactions in children at risk of anaphylaxis, and staff will be trained in how to manage reactions if they occur. The policies will cover the following issues:
- food sharing and treats
- banning productsÂ
- food preparation and serving
- art/craft
- excursions and camps.
Talk to your school or childcare centre about your child’s allergies, and what allergy policies they have in place.
Asthma and Anaphylactic Reactions
For children with both asthma and anaphylaxis, it is very important to maintain good asthma symptom control. This will reduce the risk of severe breathing system involvement during an allergic reaction.
Key points to remember
- Allergic reactions are common in children. Most reactions are mild.
- A severe allergic reaction (i.e. anaphylaxis) involves a person’s breathing and/or circulation.
- Anaphylaxis is the most severe form of an allergic reaction and is life threatening.
- An important aspect of allergy and anaphylaxis management is prevention by avoiding the cause.
- Treatment for anaphylaxis involves lying the child flat (or seated), giving an autoinjector and calling an ambulance.
- If your child experiences symptoms of anaphylaxis while they are in hospital, immediately inject them with their autoinjector and tell a staff member.
