House CallJune/July 2008 Issue

Pediactric Allergies Q & A - Seasonal Allergies

Pediatric allergist Harvey L. Leo, M.D., answers questions about allergies and food sensitivities.

Q.  Is it possible to be allergic to the sun? My teenage daughter breaks out in hives when she’s outside.

Solar Urticaria

A.  Yes. Solar urticaria is a rare type of allergy that people can develop to certain wavelengths of light, particularly sunlight. The condition can affect anyone, but usually is seen in people aged ten and older. Solar uticaria is normally a persistent, chronic condition in which hives appear on sun-exposed skin after less than 30 minutes or so of direct sun exposure. Very rarely, a person may also experience additional symptoms, such as headache, nausea, fainting or swelling of tongue or lips. Once sun exposure is removed, the rash disappears within a few hours.

The best way to manage solar urticaria is to avoid the sun, or at least minimize exposure. This means wearing adequate sunscreen and protective clothing and limiting time spent outdoors during daytime hours.

Several other diseases can mimic symptoms so always check with your doctor to ensure an accurate diagnosis.

Q.  I live in Florida and there’s a problem with fire ants in my back yard. My son was bitten by the ants and developed a severe reaction, including hives, wheezing and rash, after only ten bites. Can you have an anaphylactic reaction to fire ants?

A.  Yes. There are many documented cases of individuals becoming sensitized to fire ant bites and having anaphylactic reactions like those seen from honeybee or yellow jacket stings. Fire ants (Solenopsis invicta), now common in the southeastern United States, were brought to this country from South America, reportedly in shipping containers. An invasive species, these ants have now spread extensively throughout the warmer states. They build mounds which they defend by swarming and inflicting very painful bites. Young children and animals are more prone to attacks. The ants tend to bite repeatedly around the ankles and legs. The bites form into small pustules which can last for several days. 

Anaphylactic Reaction

Avoidance is always the best solution. Barring that, immunotherapy (allergy shots) can be an effective way to prevent anaphylaxis in people allergic to the bites. These people should carry self-injected epinephrine (an EpiPen) and know how to use it. Immunotherapy does not reduce the discomfort from the bites.

For treatment of mild reactions, apply a cool compress to the bite and administer an oral antihistamine. Some doctors also recommend a topical corticosteroid.

Q.   My family went swimming at our lake home and my son developed hives all over his body. We’ve been told he may have cold-induced hives. Is it dangerous for him to go swimming?

A.  Cold-induced urticaria or hives can manifest with exposure to any cold stimulus, such as wind, ice or cold water. In the summertime, sensitive people can develop this condition from jumping into large bodies of cold water. The shock of the sudden, dramatic temperature change causes an outbreak of hives and a decrease in blood pressure that can become life threatening, particularly if it happens when the person is in deep water. Medications can help control the hives, but I suggest caution. Watch your son carefully whenever he swims in very cold water and have an EpiPen handy, just in case, as there’s a risk of symptom reoccurrence.

Q.  Our child has seasonal allergies, especially to grass, that worsen during the summer months. Are there things we can do to manage her symptoms other than the drugs the doctor is recommending?

A.  I can understand many parents’ hesitance to use pharmaceutical medications for their children’s allergy symptoms (although most of these drugs are considered safe when used appropriately). I’m reluctant to recommend herbal supplements because there’s limited oversight in terms of product quality and consistency.  
    
Seasonal allergies with accompanying irritated eyes, runny nose and itchy skin can make a child miserable. One way to manage symptoms is to bathe your child at the end of each day, including shampooing hair. Washing keeps all collected allergens out of the child’s bed. If your youngster is complaining of ocular pruritis (eye itching), use a cold compress, like a damp towel kept in the freezer, to reduce eye discomfort. Or try saline eye drops and washes to flush away pollens. Nasal washes with a netti pot or similar device can remove pollen from the nose and sinuses.

Close your windows during the summer months and run an air conditioner or air filter, especially at night, to reduce the pollen loads in your house.

Keeping an eye on local pollen counts and weather patterns can help you minimize your child’s exposure. Check with the National Allergy Bureau and The American Academy of Allergy, Asthma and Immunology at www.aaaai.org/nab. In addition, local weather stations often report the daily pollen count.

Heavy loads of pollen and mold spores are released into the air as strong summer fronts pass through. Trees tend to bloom and pollinate more during the early morning hours. Grasses and weeds (like ragweed) drop pollen more in the afternoon as the day warms and the wind picks up. Keeping your child indoors during these periods, when it’s practical, can help reduce symptoms.

Q.  Are organic or home-grown vegetables and fruits less allergenic?

A.  Fresh, naturally grown foods are best and you can’t go wrong by choosing organic produce. However, there’s no evidence to suggest that organic or home-grown fruits and vegetables are less allergenic than their conventional cousins. Some people have sensitivities to certain chemicals, pesticides or other substances used on conventional produce. Thorough washing and rinsing, as well as peeling when appropriate, helps remove most surface irritants. LW

Harvey L. Leo, M.D. is a pediatric allergist with Allergy and Immunology Associates in Ann Arbor, Michigan. He also holds an academic position at the University of Michigan School of Public Health.

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