Allergies, in children, can cause mild to significant limitations in their activities of daily living. Both, the parents and their affected child need significant psychological support. Some allergies are familial (hereditary or genetic). But some allergies occur secondary to various environmental factors. The aim of this article is to discuss how some of them can be prevented. This article is about the allergies that originate during infancy and ways to prevent them.
Before we go ahead, we must understand the following concepts:
- Allergy: hypersensitivity reaction due to exposure to some substance (allergen). Exposure can be in form of inhalation, ingestion (e.g. food allergy), direct contact (e.g. eczema, conjunctivitis / red eye etc.). It could be mediated by antibodies or due to other mechanisms. It may develop instantaneously after the exposure or may develop slowly over time.
- Atopy: personal or familial (hereditary or genetic) tendency to produce antibodies or immunoglobulin in response to low-dose allergens. It can usually be confirmed by a positive skin-prick test result (a low dose allergen is injected into the skin and the reaction is observed).
- Food allergy: hypersensitivity reaction to any food item.
- Atopic dermatitis (eczema): a skin condition, where the skin is itchy, red and inflamed. It commonly presents during early childhood and is often associated with a personal or family history of other atopic diseases. It can be secondary to contact allergen or food allergy.
- Family history: an increased risk of allergic disease in your child if at least one first-degree relative (parent or sibling) have been affected themselves. Thus, with a slightest doubt of allergy, it is worthwhile to get evaluated by a doctor. Proper diagnosis will not only help you but also your future child in preventing development of allergy.
Some common symptoms of allergy are the following:
Atopic eczema, hives, rhinitis/running nose, conjunctivitis/red watery eye, asthma, or constant ‘tummy’ upset.
Following are the interventions that can help prevent development of allergy (atopic dermatitis and food allergies) in babies with positive family history:
Interventions during pregnancy:
- Avoidance of tobacco smoke (active and second-hand smoke) exposure during pregnancy and after birth is strongly recommended. This would not only help prevent exacerbation of your allergy but also help reduce the chances of your baby developing any allergy.
- Keep your own allergies well controlled during pregnancy.
- Elevated stress may increase allergic risk in your baby.
- Vitamin D Supplementation: Deficiency of vitamin D has been linked to allergic diseases. Hence regular sun exposure will help to supplement vitamin D supply.
- Regular exercise and healthy diet.
- Dietary restrictions during pregnancy do not help in preventing atopic disease.
Interventions just after delivery:
- After your baby is born breast milk is the best option regardless of any hereditary risk of allergy. Breast feeding may also help prevent development of allergy to food items.
- If breast-feeding is insufficient or not possible, only high-risk infants (with positive family history) should receive a ‘special’ (hydrolysed) formula for the first 4 months, whereas other infants should receive standard formula milk. Infants with positive family history should not receive standard formula milk before 4 months of age. Please consult your doctor before starting any formula milk to your baby, as breast milk still remains the best!
- After the age of 4 months, a standard cows’ milk-based formula is recommended according to standard nutrition recommendations also in children at risk.
- You should never give your child solid foods before 4 months of age. But you must introduce them by 6 months of age.
- ‘Highly allergenic’ foods such as cow’s milk, hen’s egg, and peanuts should not be withheld irrespective of atopic heredity, once food other than breast milk has commenced.
- Full-body emollient (e.g. sunflower seed oil) application from birth till 6 months can prevent atopic dermatitis.
- Varicella infection is more common in eczematous skin. Hence your child must receive varicella vaccine.
- Obesity in infancy may be associated with later asthma. Thus, avoid giving your baby excessively high calorie diet.
If your baby is diagnosed, by a doctor, to be suffering from any allergy, then do not try the above interventions. In general, early and aggressive treatment of any allergic disease represents another possible secondary prevention strategy that could interrupt the progression of disease. Hence you should consult a doctor as soon as possible and get reliable information about your disease condition.
If a doctor is suspecting allergy to cow's milk protein in your baby, he/she may offer you:
- Food avoidance advice, if you are breastfeeding mothers
- Information on the most appropriate (hypoallergenic) formula or milk substitute, if your baby is formula-fed.
If food avoidance is advised as part of the diagnostic process, ask for more information on:
- What specific foods and drinks to avoid
- How to interpret food labels
- Alternative sources of nutrition to ensure adequate nutritional intake
- The safety and limitations of an elimination diet
- The proposed duration of the elimination diet
- When, where and how an oral food challenge or food reintroduction procedure may be undertaken
- The safety and limitations of the oral food challenge or food reintroduction procedure
It may be helpful for you to seek advice from a dietician with appropriate competencies.
Signs and Symptoms of Possible Food Allergy
- Antibody Mediated
- Other mechanism
- The Skin
- Persistent Itching
- Persistent Itching
- Erythema / redness
- Erythema / redness
- Acute urticaria – localised or generalised
- Atopic eczema
- Acute angioedema (swelling) – most commonly of the lips, face and around the eyes
- The Gastrointestinal System
- Angioedema (swelling) of the lips, tongue and palate
- Gastro-oesophageal reflux disease (GERD)
- Oral pruritis (itching)
- Loose or frequent stools
- Blood and/or mucus in stools
- Colicky/cramping abdominal pain
- Abdominal pain
- Infantile colic
- Food refusal or aversion
- Perianal redness
- Pallor and tiredness
- The Respiratory System (usually in combination with one or more of the above symptoms and signs)
- Upper respiratory tract symptoms (nasal itching, sneezing, rhinorrhoea or congestion [with or without conjunctivitis])
- Lower respiratory tract symptoms (cough, chest tightness, wheezing or shortness of breath)
- Signs or symptoms of anaphylaxis or other systemic allergic reactions