Allergy in Children
The bulk of allergic disease occurs in childhood, with asthma, allergic
rhinitis, eczema and food allergy comprising a significant
percentage of the workload of doctors dealing with children in primary
care and hospital paediatric departments. In a recent large UK
survey, 20% of children were reported to have had asthma in the
previous year, 18% had allergic rhino conjunctivitis (hay fever) and 16%
had eczema. This represents a massive increase in prevalence compared
with similar studies in the 1970s where prevalence rates were 3 fold
lower. Of these children 47% had at least two co-existing conditions
e.g. asthma and eczema.
Prevalence rates for food allergy have similarly increased with peanut allergy now affecting 1 in 70 children in the UK. This is reflected in a documented increase in admission rates of children with very severe (anaphylactic) reactions.
Allergic diseases are not static. The distribution and pattern of
disease changes as the child matures. Infants are more likely to present
with atopic eczema, food allergy, gastrointestinal symptoms and
wheezing, whilst older children typically present with asthma and
allergic rhinoconjunctivitis. These observed differences are frequently
referred to as the allergic march, which recognises the association
between these diseases and the tendency for children to “outgrow” certain aspects of their allergic disease e.g. eczema or milk allergy.
Important associations are recognised between eczema and respiratory
allergy, between eczema and food allergy and between rhinitis and asthma.
70% of infants with eczema are at risk of developing either asthma or
allergic rhinitis. Infants with moderately severe or severe eczema have
a 30-50% risk of being food allergic.
The risk can further be quantified by the presence or absence of
specific IgE (allergy antibodies) to relevant inhalant or food
allergens- positive tests to house dust mite and grass pollen at 2 years
strongly predicts the development of asthma and allergic rhinitis.
It is important that doctors caring for children with allergic disease
recognise these longitudinal developments. As early life events appear
to be critical to the programming of an individual to develop subsequent
allergic disease, the management of a child in early life may have far
reaching consequences. For this reason there are a number of research
programmes underway looking at early intervention strategies for the
prevention of asthma and allergy.
Central to the optimum management of any child with allergic disease is
an understanding of the impact of disease on their lives at school and
at home and the consequences of allergic disease on their growth and
development. As many children will be multiply allergic with
co-existing respiratory, gastrointestinal or skin disease, good allergy
management requires a holistic, structured approach with a co-ordinated
treatment strategy aimed at maximising the child’s quality of life
whilst minimising the potentials side effects of treatment.
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