Allergic Child
Allergic Child: Excerpt from The 5-Minute Pediatric Consult
Matthew Fogg, MD
Allergic Child - BASICS
Allergic Child - description
- The allergic child tends toward IgE-mediated reactions in response to pollens, molds, environmental allergens, drugs, insect stings, and foods.
- Reactions may manifest as:
- Eczema
- Allergic rhinitis
- Asthma
- Angioedema
- Hives
- Anaphylaxis
- Children may have dark circles under their eyes (allergic shiners) or a nasal crease from the “allergic salute” (upward rubbing of the nose to relieve itch).
- Careful history of symptoms and environmental exposures is essential.
Allergic Child - risk factors
Allergic Child - genetics
Children inherit the tendency to be allergic, but do not inherit specific allergies.
Allergic Child - DIAGNOSIS
Allergic Child - signs & symptoms
Allergic Child - history
- Seasonal or year-round symptoms
- Questions best asked systematically in a review of systems format:
- Ears:
- Otitis
- Myringotomy tubes
- Hearing loss
- Nasal:
- Frequent upper respiratory infections
- Sinusitis
- Polyps
- Epistaxis
- Snoring
- Sneezing
- Rhinitis
- Deviated septum
- Obstruction
- Itch
- Mouth breathing
- Nasal discharge
- Throat:
- Sore throat
- Throat clearing
- Postnasal drip
- Palate itch
- Tonsillitis
- Tonsillectomy
- Croup
- Chest:
- Day cough
- Night cough
- Sputum production
- Pain
- Wheeze
- Shortness of breath
- Cyanosis
- Eyes:
- Itching
- Tearing
- Discharge
- Swelling
- Redness
- Rubbing
- Skin:
- Eczema
- Hives
- Angioedema
- Contact dermatitis
- Seborrheic dermatitis
- Skin infections
- Pruritus
- Other important questions include:
- Does the child have food or drug allergies?
- What type of reaction does the child have? Allergy (IgE-mediated reactions resulting in wheezing, allergic rhinitis, hives, angioedema, eczema, or anaphylaxis) or intolerance (nonspecific rash, diarrhea, gas, headache, or hyperactivity)?
- Ask about food allergy and anaphylaxis (food allergy or history of anaphylaxis is an indication for an EpiPen and lifelong avoidance).
- Has the child ever been stung by a bee, and, if so, what was the reaction? (Systemic reactions are an indication for referral to an allergist for venom desensitization. Venom desensitization can be potentially lifesaving.)
- Does anyone in the family have hay fever (allergic rhinitis), asthma, or eczema? (Familial history of atopy increases the likelihood of atopy in other family members.)
- Questions to ask regarding the environment:
- Does the child’s home have a basement, damp areas, or a humidifier (sources of mold spores; humidity also increases dust mite population)?
- Is there forced air heat (tends to blow allergen-laden dust around the home)?
- Is home cooled by opening windows (lets pollens into the house)?
- Are there any smokers in the home (airway irritant, can exacerbate respiratory difficulties)?
- Are there any pets in the home, at school, or in day care (animal dander is a common aeroallergen)?
- Are there many stuffed animals or books in the bedroom (dust mites)?
- Does the bedroom have carpeting (dust mites)?
- Is bedding washed frequently?
- What type of pillow is used?
- Is the mattress encased in plastic?
- Where does the patient spend most of his time?
- Does the patient attend day care? (Upper respiratory tract infections can mimic allergies and exacerbate reactive airway disease.)
Allergic Child - physical exam
A complete physical examination is essential to rule out systemic disease that can mimic allergies.
- Ocular allergic signs:
- Allergic shiners due to passive congestion in the nose, which impedes the venous return to the vessels under the eyes
- Cobblestoning of the conjunctiva
- Dennie-Morgan line, infraorbital folds associated with suborbital edema secondary to atopy
- Clear stringy discharge
- Nasal allergic signs:
- Pale edematous nasal mucosa
- Nasal crease across the bridge of nose secondary to repeated upward rubbing of the nose
- Clear nasal discharge with or without occlusion
- Ear allergic signs:
- Fluid in the middle ear or retracted tympanic membranes may be associated with eustachian tube dysfunction seen with allergic inflammation
- Throat allergic signs:
- Cobblestoning of posterior pharynx secondary to submucosal lymphoid hyperplasia
- Lung allergic signs:
- Wheezes, rhonchi, decreased air entry, and chronic obstruction can be secondary to allergic responses.
- Skin allergic signs:
- Eczema, hives, angioedema, and dermatographism
Allergic Child - tests
Allergic Child - lab
- Immediate hypersensitivity:
- Skin prick tests to suspected allergens based on history (study of choice)
- Intradermal skin tests for patients who have a negative prick test and a suspicious history pose a greater risk of systemic reactions.
- Radioallergosorbent (RAST) tests measure free serum IgE to a specific antigen to which a particular patient may be sensitized. Primarily for patients at risk for a severe systemic reaction from skin testing or in whom skin testing is not feasible
- Skin tests are preferable to RAST tests in most cases.
- Do not screen for food allergy with RAST tests without a significant history of reaction. Many false positives will show up leading to inappropriate dietary restriction and parental anxiety.
- Eosinophils in the blood or respiratory secretions may be indicative of an allergic diathesis.
- Baseline pulmonary function studies should be obtained on asthmatic children or in children with an allergic history to evaluate for obstructive disease.
Allergic Child - differencial diagnosis
- Eyes:
- Physical and chemical irritants
- Viral or bacterial infection
- Nose:
- Recurrent upper respiratory tract infections
- Rhinitis medicamentosum—reaction to nasal sprays
- Drugs that cause nasal congestion:
- Oral contraceptives
- Reserpine
- Guanethidine
- Propranolol
- Thioridazine
- Tricyclic antidepressants
- Aspirin
- Airway irritants:
- Smoke
- Environmental pollution
- Cold air
- Kartagener syndrome—sinusitis, bronchiectasis, immobile cilia
- Cystic fibrosis
- Sinusitis
- Lungs:
- Airway irritants
- Smoke
- Environmental pollution
- Cold air
- Gastroesophageal reflux
- Foreign body aspiration
- Anatomic defect in airway
- Cystic fibrosis
- Kartagener syndrome
- Immune deficiency
- Skin:
- Viral exanthems
- Autoimmune disorders
- Physical and chemical irritants
Allergic Child - TREATMENT
Allergic Child - general measures
Specific environmental control (as determined by skin testing)
- Pets should be kept out of the bedroom if a child has allergic stigmata.
- If a child has severe allergies or asthma related to pet exposure, the animal should be removed from the home.
- To keep the dust mite population under control, the bedding should be washed in hot water at least once every 2 weeks, the pillow should be fiber filled, and the mattress should be encased in plastic.
Allergic Child - medication
- Antihistamines
- Topical steroids
- Immunotherapy
Allergic Child - FOLLOW UP
Allergic Child - prognosis
- In general, environmental allergies that cause rhinitis and asthma persist into adulthood.
- Most children outgrow food allergies to milk, egg, soy, wheat, and other foods.
- Children may rarely outgrow peanut, tree nut, or shellfish allergy.
- Allergic children have the biologic potential to become sensitized to many environmental allergens; limit exposure to prevent sensitization.
Allergic Child - bibliography
- Fireman P. Diagnosis of allergic disorders. Pediatr Rev. 1995;16:178–183.
- Hopkin JM. Asthma and allergy-disorders of civilization? Q J Med. 1998;91:169–170.
Middleton E, Reed CE, Adkinson NF, et al. Allergic Principles and Practice. 4th Ed. Philadelphia: Mosby; 1993.
Sites DP, Terr AI, Parslow TG. Basic and Clinical Immunology. 8th Ed. Englewood Cliffs, NJ: Prentice Hall; 1994.
Allergic Child - CODES
- 692.3 Allergy due to drugs and medicine
- 995.3 Allergy unspecified
- 215.02 Allergy to milk products
Book Source Details
- Book Title: The 5-Minute Pediatric Consult
- Author(s): M. William Schwartz MD; et al.
- Year of Publication: 2008
- Copyright Details: The 5-Minute Pediatric Consult, Copyright © 2008 Lippincott Williams & Wilkins.
More About Allergic bronchopulmonary aspergillosis
More Medical Textbooks Online about Allergic bronchopulmonary aspergillosis
Review other book chapters online related to Allergic bronchopulmonary aspergillosis:
Medical Books Excerpts
- Anaphylaxis
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
|
|
More About This Book:
Title: The 5-Minute Pediatric Consult
Authors: M. William Schwartz MD; et al.
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7577-9
|
|
» Next page: Aspergillosis (The 5-Minute Pediatric Consult)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
