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How to deal with childhood allergies

06 June 2017

Childhood allergies have become a challenge for health services. So what more can be done to spot, treat and control them?

Childhood allergies: iStock

Allergies are a growing problem all around the world. According to the World Allergy Organization (WAO), the prevalence of allergic diseases has been rising in the industrialised world for more than 50 years. Children are suffering, too, as their sensitisation rates to one or more common allergens are 40% to 50% (WAO, 2011).

Here in the UK we are especially prone to allergies, which are now one of the most widespread conditions encountered by primary healthcare services. According to Mintel research (2010), around 44% of adults in the UK suffer from at least one allergy and almost half of those have two. What’s more, the prevalence is growing year by year: again according to Mintel (2010), the number of people with allergies rose by two million between 2008 and 2009 alone.

All this creates an extra burden for the health and care system, as Amena Warner, head of clinical services at Allergy UK, points out: ‘Asthma problems alone account for around 50,000 hospital admissions a year, over 1200 deaths and an annual medication bill of £800m.’ To make matters worse, it is an area that suffers from a lack of expertise. ‘Allergy is a public health issue that needs to be addressed as there are not enough specialists in this area to deal with the growing problem,’ says Amena. ‘It is a worrying situation.’

Children suffer

Allergy rates for children in the UK are also among the highest in the world. Up to 50% of children and young people in the UK have at least one diagnosed allergy before the age of 18 (Punekar and Sheikh, 2009). The percentage diagnosed with hay fever and eczema have both trebled since the 1970s (Gupta, 2007).

Food allergies are also a big problem for children. Latest figures suggest that at least 6% to 8% of children in the UK currently have at least one food allergy (BSACI).

‘Food allergy can impact dramatically on quality of life,’ says Amena, ‘and trying to feed a family of food allergic children can be a challenge.’

Food labelling legislation in 2014 has helped, but is not foolproof, she adds. ‘It recognises 14 allergens that need to be labelled but others are emerging as a cause of allergic reactions, such as kiwi, that this legislation does not cover.’

The common food triggers are cow’s milk, eggs and nuts. Most children go on to develop a tolerance of milk and eggs and eventually grow out of their allergy. But the one in 50 or so who have an allergy to peanuts or tree nuts will not be so fortunate – their allergies will likely be with them for the rest of their lives (NHS Choices, 2016a). Some children are even worse off and have multiple allergies. Punekar and Sheikh (2009) found that 16% of children have two diagnosed allergies, while an unfortunate 2.5% have eczema, asthma and hay fever.

What’s the cause?

Quite why the rate of allergies among children has become so high is a puzzle.

Genetic factors play a part in that they predispose a child to a particular allergy. So if a parent suffers from eczema or a nut allergy, the child will also be susceptible to developing that particular allergy. Certain physical and lifestyle characteristics among children are also linked to allergies – for example, high birthweight, not being breastfed, obesity and lack of exercise.

Environmental factors may also be partly responsible. Tobacco smoke and other air pollutants can exacerbate certain conditions and symptoms, while another theory suggests that children’s lack of exposure to dirt and micro-organisms means their immune systems do not get a full work out and so become sensitised to what would normally be fairly minor irritants.

What does a reaction look like?

Mild or moderate allergic reactions have tell-tale signs, as do more severe cases. Recognising the symptoms is the first step towards diagnosing, treating and managing the condition. Pennine Care NHS Foundation Trust put together a guide to identifying the signs of allergic reactions (see table).

How are allergies managed?

While spotting an allergic reaction can be straightforward, identifying the trigger and then controlling a child’s exposure to that allergen is another matter.

Even so, the first step to managing an allergy is to avoid and remove the irritant if possible. This is more easily achieved with some substances than others. Avoiding foods, such as cow’s milk or nuts, or materials such as latex, is at least feasible. Packaging labels can help here, especially since legislation has standardised how manufacturers label common allergens. But other substances, such as pollen, pet hair and air pollutants, are a much greater challenge. The best course of action is to limit exposure to the allergen as far as possible and make sure the appropriate therapeutic aids are close to hand to treat the symptoms – so inhalers, and steroid and anti-histamine tablets and ointments.

The potential for a severe reaction calls for a more robust precaution, so any child at risk from anaphylaxis should always carry an adrenaline injector (see 'Dealing with anaphylactic shock' below).


Eat nuts or not?

To reduce the risk of childhood allergies, mothers were advised not to eat nuts during pregnancy and breastfeeding. But recent studies suggest that eating nuts might lower the likelihood of childhood allergies.

A study in 2012 by Maslova et al, looked at the diets of 60,000 pregnant Danish women and then checked their babies at 18 months for asthma or similar symptoms. It found that the children of mothers who ate nuts as least once a week had a 20% to 25% lower risk of having asthma.

A study from Frazier et al in the US in 2014 compared the health of 8205 children with the records of their mothers’ diets during pregnancy. It found that the children of mothers who ate the most nuts – five times a week or more – had the lowest risk of a nut allergy.

The researchers said: ‘Our study supports the hypothesis that early allergen exposure increases the likelihood of tolerance.’


What can schools do?

The prevalence of allergies among children means schools also need to have clear policies for managing allergies and the risks they pose.

Current advice is that children with allergies should not be isolated, and neither should the triggers – simple bans are not risk-free solutions and can end up creating artificial environments that do not reflect the real world. Instead, a whole-school awareness approach is recommended. This ensures all the staff and children are aware of what allergies pose a risk, the importance of avoiding the triggers, the signs and symptoms of reactions, and how to deal with them. With a clear policy and set of procedures, which include guidelines for controlling medicines, a school can minimise the risk and promptly deal with any situations in an appropriate way.

To find out more about how your school shapes up, head to the Allergy UK website and use its online self-audit. This will tell you how effective your current school policy is, and, if necessary, give you pointers for improving it.

In any case, good care for children suffering from allergies should always be carefully coordinated. Health visitors, school nurses, GPs, dieticians and pharmacists all need to work together to manage the potentially serious risks that allergic reactions can pose to children.


Dealing with anaphylactic shock

Anaphylaxis is a severe reaction to a trigger such as an allergen. Also known as anaphylactic shock, it is a medical emergency and needs to be treated quickly, as it can be fatal. If you encounter anybody experiencing anaphylaxsis, NHS Choices (2016b) recommends the following:

  1. Call 999 immediately and ask for an ambulance – say you think the person has anaphylaxis
  2. Remove any trigger if possible – for example, any wasp or bee sting
  3. Lie the person down flat – unless they’re unconscious, pregnant or having breathing difficulties
  4. Use an adrenaline auto-injector if the person has one
  5. Give another injection after 5 to 15 minutes if the symptoms don’t improve and a second auto-injector is available.

References

BSACI. (2017) Food allergy and food intolerance. See: bsaci.org/resources/food-allergy-and-food-intolerance (accessed 23 May 2017).

Frazier AL, Camargo CA Jr, Malspeis S, Willett WC, Young MC. (2014) Prospective study of peripregnancy consumption of peanuts or tree nuts by mothers and the risk of peanut or tree nut allergy in their offspring. JAMA Pediatrics 168(2): 156-62.

Gupta R, Sheikh A, Starchan DP, Anderson HR. (2007) Time trends in allergic disorders in the UK. Thorax 62(1): 91-6.

Maslova E, Granström C, Hansen S, Petersen SB, Strøm M, Willett WC, Olsen SF. (2012) Peanut and tree nut consumption during pregnancy and allergic disease in children – should mothers decrease their intake? Longitudinal evidence from the Danish National Birth Cohort. Journal of Allergy and Clinical Immunology 130(3): 724-32.

Mintel. (2010) Allergies and allergy remedies. See: reports.mintel.com/sinatra/oxygen/brochure/id=479826 (accessed 23 May 2017).

NHS Choices. (2016a) Food allergy. See: nhs.uk/conditions/food-allergy/pages/intro1.aspx (accessed 23 May 2017).

NHS Choices. (2016b) How to treat anaphylaxis. See: nhs.uk/Conditions/Anaphylaxis/Pages/Treatment.aspx (accessed 23 May 2017).

Punekar YS, Sheikh A. (2009) Establishing incidence and prevalence of clinician-diagnosed allergic conditions in children and adolescents using routine collected data from general practices. Clinical and Experimental Allergy 39(8): 1209-16.

Pumphrey RS, Gowland MH. (2007) Further fatal allergic reactions to food in the United Kingdom, 1999-2006. Journal of Allergy and Clinical Immunology 119(4): 1018-9.

World Allergy Organization. (2011) White book on allergy. See: worldallergy.org/UserFiles/file/WAO-White-Book-on-Allergy_web.pdf (accessed 23 May 2017).

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