The number of children with allergic disorders is increasing in Europe.
Major allergic diseases in children
Allergists speak of “the allergic march” to designate the evolution that atopic children usually undergo throughout their lives. Atopic children are those who are genetically predisposed to suffer from allergic diseases. We will mention, in chronological order, the problems usually posed by these atopic children, although an allergic disease can start at any time of life, without the patient having manifested any signs until then.
First year:
Many atopic children manifest allergic symptoms from the first months (even days of life) if they become sensitized to the foods they ingest. Food allergy in infants of a few months of age may cause the following manifestations:
At the digestive level: intestinal colic, vomiting, diarrhea, malabsorption of food, which can lead to growth retardation.
At the skin level:
– Urticaria: lesions with the appearance of wheals or hives, usually of sudden onset, of variable size and relatively well demarcated, which can affect any point of the body. They are accompanied by intense pruritus (skin itching).
– Angioedema: swelling and edema of the skin, especially of the soft tissues: eyelids, pinnae, lips, etc.
– Atopic dermatitis or atopic eczema: children with very intense itching of the skin that leads to compulsive scratching, which can cause scratches and wounds. The main clinical manifestation is eczema: reddened areas of the skin on which small blisters appear which, when broken, release a liquid (exudation) that favors the formation of scabs. The location of eczema varies with age, affecting in infants the face and the surface of arms and legs. In older children it tends to be located in elbow and knee flexures.
Children suffering from atopic dermatitis have genetic alterations that result in a delicate, easily irritated skin that responds in an exaggerated manner.the foods to which children of this age are most allergic are: cow’s milk, eggs, cereals and fruits, which are the most commonly used foods in baby food. In most of the occasions these children come to tolerate the food completely if, once the responsible food is known, a diet free of that food is carried out, but it does not happen in all cases. One must be very careful with the reintroduction of the eliminated foods and it should always be done under the indication and control of the allergist. In addition, these patients, in the future, may become sensitized to other types of allergens and may develop allergic respiratory diseases such as asthma or rhinitis, so their evolution should be monitored.
First to fifth year of life:
At this age the so-called obstructive bronchitis or non-allergic childhood asthma usually occur. Many atopic children, due to the exaggerated reactivity of their skin and, as well as other non-atopic children who have suffered during the first months of life damage to the bronchial mucosa for various reasons (tobacco smoke, prematurity, need for oxygen treatment, bronchiolitis …) may present during the first 4-5 years of life episodes of respiratory distress (fatigue and choking sensation) usually accompanied by noises in the chest, coinciding with viral infections or catarrhal episodes, so it is usually accompanied by fever.
Some physicians call these episodes obstructive bronchitis or spastic bronchitis. Others call them non-allergic bronchial asthma. The important thing to know is that, although distressing, they are usually not allergic problems and usually evolve into spontaneous remission (cure) around 5-6 years of age. If the child does not become allergic, this type of symptoms will not recur. This favorable evolution usually occurs in 80% of the cases. If the child becomes allergic he/she will have a worse prognosis and sometimes, after a partial improvement, his/her obstructive bronchitis often evolves into asthma or allergic rhinitis.
Sixth to tenth year of life:
At this age, allergic diseases of the respiratory tract typically begin:
– Allergic Rhinitis: this is the most common allergic disease and may be present in more than 10% of school-age children. It is an inflammation of the nasal mucosa that thickens and produces:
– Nasal obstruction: the air is hindered in its passage producing a very uncomfortable sensation that forces to breathe through the mouth.
– Fluid and mucus secretion through the nostrils, forcing the use of an infinite number of handkerchiefs.
– Sneezing: Series of several sneezes in a row.
– Nasal Pruritus: Intense itching at the level of the nostrils, which requires repeated rubbing of the nose. The itching may extend to the throat, palate, and also to the eyes and ears.
If the child has become allergic to allergens that are always present in his environment (house dust mites, molds, animal hair, etc.) he will suffer from these symptoms throughout the year (Perennial Rhinitis). If you are allergic to pollens, you will suffer the symptoms only during pollination seasons (Seasonal Rhinitis), different according to the pollens.
Allergic rhinitis can be maintained for many years with little clinical significance, but rarely there is spontaneous improvement and if left to evolve without adequate treatment, it usually evolves into bronchial asthma.
– Bronchial Asthma. Bronchial asthma is a situation characterized by transient episodes (reversible) of airway narrowing, which obstructs the normal passage of air into the pulmonary alveoli. It manifests as attacks (crises) of respiratory difficulty (fatigue or choking sensation) accompanied by cough and chest noises (whistling and whistling). It is not usually accompanied by fever. It is a relatively common disease and is estimated to affect 5% of school-age children.
Not all asthmatic children are allergic but allergy is the cause of most cases of asthma. More than three quarters of people with asthma suffer from an allergy. Left to their spontaneous evolution, children with allergic asthma do not usually improve but experience progressive worsening. However, with correct diagnosis and adequate treatment, the majority of cases are controlled and can lead a completely normal working and sporting life and even in a significant percentage of cases remissions of their symptoms are achieved for years or permanently.
Ten years onwards:
In addition to the aforementioned diseases, atopic patients may develop sensitization to a new food or drug at any time in their lives, which may cause urticarial reactions and/or angioedema. Unlike food allergy that occurred in the first months of life, children who become sensitized to foods at later ages tend to do so more frequently to fruits, vegetables, fish, seafood, nuts, etc. They improve their symptoms with food exclusion diets but rarely become tolerant.
Two infrequent allergic situations in children but which, when they occur, can be very serious, are drug allergy and allergy to bee or wasp stings. If both are suspected, an urgent allergy test should be performed. Both types of allergy usually cause quite alarming clinical manifestations that doctors call anaphylaxis or anaphylactic shock:
– Generalized urticaria outside the site of the sting, in case of insect sting.
– Respiratory symptoms: sneezing, coughing, wheezing, difficulty in breathing.
– Loss of consciousness
In such cases, an allergist should be consulted urgently. A new administration of the drug or a new sting in an allergic child can even lead to death, which can be avoided, in most cases, with an allergy vaccine.