Paediatric allergy treatment

The four most common paediatric allergies are food allergies, asthma, eczema, and hay fever. Other allergies include insect stings, medication, certain chemicals, and latex. 

Food allergies

Food allergies affect up to 8% of children in the UK. They often occur in combination with other allergies, particularly eczema. 

There are two types of paediatric food allergy:

• IgE-mediated allergy — symptoms occur 30 minutes to two hours after ingestion of the triggering food. Symptoms may include swelling of the face, lips or eyes, watery eyes, an itchy rash, abdominal pain, and vomiting. In severe cases, a life-threatening allergic reaction known as anaphylaxis may occur. 
• non-IgE-mediated allergy — symptoms occur several hours or days after ingesting the triggering food and may include abdominal pain, diarrhoea, constipation, reflux, poor weight gain, and a rash

Your child can be allergic to any food, but some foods are more likely to cause allergies than others. 90% of food allergies in children are triggered by the following foods: 

• Peanuts
• Cow’s milk
• Eggs
• Tree nuts (such as almonds, hazelnuts, and cashews)
• Wheat
• Fish
• Shellfish (such as prawns)
• Sesame seeds and sesame oil
• Soy

Asthma 

Asthma is a common respiratory disease that causes the airways in the lungs to constrict (tighten) making breathing difficult. Atopic asthma is a type of asthma that is triggered by allergens in the environment such as pollen, house dust mites, animal dander and mould. Most children with atopic asthma have some other form of allergy. 

Atopic asthma can be mild, moderate, or severe and life-threatening. It can result in school absences, disrupted sleep and missing out on activities such as sports. Many children grow out of atopic asthma as they enter adulthood. 

Eczema (atopic dermatitis) 

Atopic eczema is the most common type of eczema in children and commonly occurs in children with other allergies such as asthma and hay fever. It usually runs in families. Atopic eczema causes the skin to become dry, inflamed, itchy, cracked, and sore. It typically goes through periods of improvement and periods where the eczema is worse (a ‘flare-up.’) Common triggers for flare-ups include stress, soaps, detergents, and cold, dry weather. Food allergies can also trigger an eczema flare-up, especially in young children. 

Hay fever (allergic rhinitis) 

Hay fever is a common allergy that causes sneezing, coughing and itchy eyes. It is triggered by pollen (the fine powder produced by flowers and plants) and is most common when the pollen count is highest between late March and early September. Symptoms may be particularly severe when the weather is warm, humid, and windy. 

Allergy symptoms in children vary depending on the type and severity of the allergy your child has. Symptoms may be mild, moderate, or severe and may be present all or most of the time, at certain times of the year or occasionally, depending on what is triggering the allergy. 

Common symptoms of allergies in children include: 

• Sneezing 
• Coughing 
• Runny or blocked nose
• Itchy nose, eyes, ears, or roof of the mouth 
• Red, itchy, watery eyes
• Reddening of the skin/rash (may be itchy) 
• Hives (urticaria) — a red raised itchy rash that develops on the skin 
• Shortness of breath
• Wheezing (noisy breathing) 

Anaphylaxis 

Anaphylaxis is a severe, life-threatening allergic reaction that needs immediate treatment. Symptoms can come on quickly and may include: 

• Itchy skin or hives
• Swelling of the face, eyes, lips, mouth, throat, and tongue 
• Difficulty breathing
• Difficulty talking or swallowing 
• Wheezing
• Dizziness
• Abdominal pain
• Nausea and vomiting
• Diarrhoea 
• Collapse and loss of consciousness

If your child has a previous history of anaphylaxis, your consultant will prescribe an injection of adrenaline (adrenaline autoinjector). This should be given as soon as possible after the anaphylaxis starts. 

Call 999 immediately if your child experiences an anaphylactic reaction whether you have administered their adrenaline autoinjector or not. 

Paediatric allergies have increased in recent years, and although there are several theories, the reason for this remains unclear. Some possible explanations include a lack of exposure to germs and a ‘too clean’ environment, not being exposed to certain foods in early childhood, genetic factors, or more time spent indoors resulting in low levels of vitamin D. 

Risk factors for developing an allergy in childhood include: 

• Family history — you are far more likely to develop an allergy in childhood if a close family member has allergies 
• Environment — there is a theory that not being exposed to allergens like pollen or having respiratory infections early in life can make developing allergies more likely
• Maternal smoking — smoking during pregnancy and exposure to second-hand smoke in infancy has been shown to increase the risk of developing an allergy in childhood 
• Asthma or chronic lung disease — having asthma or a chronic lung condition increases your risk of developing an allergy 

At your first consultation, your child will be seen by a consultant paediatrician, a doctor specialising in conditions affecting children, or a consultant paediatric Ear, Nose and Throat (ENT) surgeon. 

Your consultant will ask you some questions about your child’s symptoms, general health, family, and medical history. These may include questions about: 

• What symptoms your child experiences
• When the symptoms start
• What (if anything) makes symptoms worse or better 
• If they have any other allergies
• If anyone else in the family has allergies
• What, if any, medications your child takes and how effective it is 

Will my child need tests?

Sometimes, your consultant can diagnose your child with an allergy by assessing their symptoms. If a diagnosis is uncertain, or what your child is allergic to is unclear, your consultant may order allergy tests such as a skin or blood test. In some cases, a test called a provocation (challenge) test may be performed under controlled conditions to assess how severe your child’s allergy is. 

• Skin test — This test measures if IgE antibodies are produced in response to certain allergens such as pollen, foods, or animal dander. During the test, a small amount of the diluted allergen is placed on the skin and the area is pricked or scratched. If a person is allergic to the allergen, a small, raised bump will appear after about 15 minutes. Testing for many allergens may be done at the same time. 
• Patch Tests —this test is used to see if a skin reaction, for example, eczema, is caused by contact with a specific chemical or substance. During patch testing, small amounts of possible allergens suspended in petroleum jelly are taped to the skin for 48 hours. 
• Blood test — Blood tests measure IgE antibodies to certain allergens in the blood. They may be performed if your child cannot have skin tests, for example, if they have certain skin conditions or are likely to have a very severe allergic reaction.  
• Provocation test — This test measures the severity of an allergy and involves exposing your child to a very small amount of the allergen under the supervision of your consultant. 

How is a diagnosis made?

Your consultant will make a diagnosis based on your child’s symptoms, medical and family history, physical examination, and the results of any tests. 

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it’s where your consultant will ask you about your child’s symptoms, perform a physical examination, order any necessary tests, provide a diagnosis, and discuss possible treatments. 

Your first consultation is also where we get to know you and your child, discuss your expectations for treatment and encourage you to ask any questions you may have. 

After making a diagnosis, your consultant will discuss possible treatment options with you and decide on the best option based on your child’s age, general health, symptoms, and diagnosis.

There are three main approaches to treat paediatric allergies; avoiding the allergy trigger, medication, and immunotherapy. Your consultant will recommend the most suitable treatment depending on your child’s age and general health as well as the type and severity of their allergy and the impact it has on your child’s day-to-day life. 

Avoidance

In some cases, it may be possible to prevent or reduce the risk of an allergic reaction by avoiding the allergen that triggers it. 

Some things you can do to avoid allergens include: 

• Stay indoors with the windows closed when the pollen count is high and on windy days
• Control dust in the home, particularly your child’s bedroom
• Put dust-proof covers on pillows and mattresses 
• Wash your child’s bedding frequently in hot water (above 50ºC) 
• Avoid bedding stuffed with foam rubber or kapok
• Clean floors and dust furniture with a damp cloth or mop
• Use a dehumidifier in your child’s bedroom and damp areas of the home
• Have your child take a bath or shower, wash their hair, and change their clothes after playing outside 
• Have your child wear wraparound glasses or sunglasses when outdoors to reduce the amount of pollen coming into contact with your child’s eyes 
• Don’t hang clothes outside  to dry
• Keep your pet out of your child’s bedroom
• Have your child wash their hands after touching your pet 
• Bathe your pet frequently to reduce dander
• Avoid exposing your child to irritants such as cigarette smoke, perfume, hair spray, cleaning products, air fresheners and insecticides 

Medication

Medications for allergies include antihistamines, decongestants, and steroids. These medications don’t cure your child’s allergy but can help relieve unpleasant symptoms and make your child’s condition more manageable. 

Antihistamines

Antihistamines work by blocking histamine, the chemical produced by the body during an allergic reaction. They can be used to relieve symptoms of allergies including hay fever, hives, and allergic reactions to insect bites or stings. There are two main types of antihistamines; drowsy, meaning they may make you feel sleepy after taking them, and non-drowsy, which are less likely to cause drowsiness. You can buy some antihistamines over the counter at pharmacies, but stronger varieties require a prescription. Antihistamines come in several forms including tablets, capsules, liquids, creams, lotions, eye drops and nasal sprays. 

Decongestants

Decongestants work by constricting (narrowing) the blood vessels in the nose which helps to relieve allergy symptoms such as a blocked nose, sinus pain or pressure and headache. Decongestants are available over the counter in tablet or liquid form or as a nasal spray. They are often used in combination with antihistamines. Decongestants are not suitable for children under the age of four. 

Steroids 

Steroids or corticosteroids work by suppressing your immune system and reducing inflammation. Your consultant may prescribe steroids long or short-term to treat allergic conditions such as a severe pollen allergy, atopic dermatitis (eczema), or atopic asthma.  

Steroids can be prescribed as oral tablets or as a nasal spray to relieve nasal congestion. 

Asthma medication

Asthma treatment normally involves two types of inhalers, one containing a medication to prevent attacks from occurring and one to relieve asthma symptoms once they occur. Other treatments such as oral steroids may also be prescribed to treat asthma.

Immunotherapy

Immunotherapy is a long-term treatment that aims to ‘cure’ allergies for good. It works by gradually exposing your body to increasing amounts of the substance you are allergic to over time to allow your immune system to become less sensitive to the allergen and reduce or stop allergic reactions. Immunotherapy can be used to treat allergies such as grass pollen, house dust mites, animal dander and bee stings. It can also help to reduce the inflammation associated with hay fever and asthma.

Immunotherapy can be administered as injections (allergy shots) or as drops under your tongue (sublingually). 

Like all medications, allergy medications can cause side effects in some people. Your consultant will explain all the potential side effects of your child’s medication before starting treatment. Please ask your consultant any questions you may have, or to clarify anything you’re not sure about before your child starts treatment. 

Tell your consultant about any medical conditions your child has and any other medications they are taking. 

If your child experiences side effects from allergy medications, they are usually mild and improve within a few weeks. If your child experiences bothersome side effects, or their side effects are getting worse or not getting better, contact your consultant for advice. 

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including: 

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about paediatric allergy treatment, book your appointment online today or call a member of our team directly on 0808 189 5499.

Content reviewed by Circle in-house team in April 2024. Next review due April 2027.

Allergy in Children BSACI

Allergy in Childhood Allergy UK 

Treatment for Pediatric Allergies ENT Health