House CallDec/Jan 2010 Issue

Pediatric Questions & Answers: Children with Allergies

Questions and Answers about Allergies and Food Sensitivities

We’re about to take our peanut-allergic child on an airplane for the very first time. Frankly, I’m worried. Can you help me?
Dr. Leo Unfortunately, many airlines continue to serve peanuts on flights, causing significant concern for families travelling with highly allergic children. Since minute traces of peanuts can be deadly for anyone who has anaphylaxis to them, parents must take precautions to decrease the chances of a reaction. Well before you leave, work closely with your pediatrician to develop a plan for your child’s safety.

Here’s what I advise: Contact the airlines ahead of time and talk with the appropriate person about your child’s allergy. Some airlines are much better at dealing with allergies than others and you’ll soon determine which will work with you. Collecting this information before you make your reservations is important. Stick with the airline that listens to you and follows up with good service.

Children and Food Allergies

Reserve your family’s seats together to minimize contact with other passengers. Request that an announcement be made before boarding, asking passengers within the vicinity of your seats to avoid eating the offending item. Ask for early boarding so that you can thoroughly check your seats and front pockets for residual wrappers and trash. Wipe down tray tables and arm rests. If you’re traveling with a very young child, bring a car seat or booster seat to avoid contact with upholstery and to keep your child securely buckled in and not wandering the plane. For an older child, cover the seat with a clean towel or sheet. Pack plenty of safe snacks in case of delays. Be certain to carry prescribed medication that’s up-to-date and clearly marked with your child’s name. Bring a signed letter from your doctor in case you’re questioned while going through security. Once on board, alert your flight personnel. Be friendly but firm; avoid being confrontational.

Given the number of flights and food-allergic passengers, reactions that require full medical intervention are rare. Take the necessary precautions for your child. Then take a deep breath and enjoy your trip.

Our little boy is allergic to dogs. We’re traveling to my parents’ home and they have a large dog they’d rather not kennel. Any advice?
Dr. Leo The treatment of choice for your son is, of course, avoidance. In this case, that’s easier said than done since canine dander and saliva remain present in the home for some time even when the dog is removed. Depending on the severity of your son’s allergy, your parents can reduce the risk by isolating their pet to a portion of the house or to the garage, away from where your son will be. They should bathe the animal before your visit, as well as thoroughly vacuum (using a HEPA filter) and steam-clean rugs and upholstery, particularly in the room where your child will be sleeping. For your son’s benefit, run an air filter/purifier in his bedroom with the door closed to reduce airborne dander. Giving your son an antihistamine just before and during the visit might be reasonable; consult your health care provider. Bathe the boy nightly to remove residual allergens from his hair and skin. For the same reason, wash his clothes every day. Unfortunately, if symptoms occur, especially wheezing, coughing and other breathing issues, leaving the environment may be your only option.

I’ve just learned that my child, who’s allergic to peanuts and multiple tree nuts, is also allergic to sesame and mustard. Should I be worried about things like nutmeg?  What about cloves, ginger and cinnamon?
Dr. Jain Certain spices come from the same plant families and are related. That means that an allergy to one will predispose you to developing an allergy to the others. For example, coriander, caraway, fennel and celery are part of the Apiaceae family. Most people who are allergic to one of these items are also allergic to the others. In addition, they will likely be allergic to pollens in this same plant family, such as mugwort (a type of weed) and birch. Nutmeg is a seed that’s unrelated to sesame or mustard. The fact that your child is allergic to sesame  and mustard seeds doesn’t translate to a nutmeg allergy. Allergies to nutmeg and spices like ginger, cloves and cinnamon are uncommon. If you remain concerned, ask your child’s allergist to pursue further testing.

My allergies and asthma get worse during the winter. I’m beginning to think that stress may have something to do with it. Does stress worsen symptoms?
Dr. Jain Stress can definitely result in the worsening of both allergic rhinitis (hay fever and nasal allergies) and asthma. Studies have demonstrated that people who have anxiety, depression or are under a lot of stress tend to have more severe allergic symptoms than those without these confounding factors. Evidence suggests that specific changes actually occur in the immune system. That said, make sure there isn’t something in your environment that might be contributing to your discomfort. We’re exposed to a number of potential allergens during the winter months that we don’t normally deal with during other times of the year. These include Christmas trees (which can harbor a variety of pollens and mold), ornaments and decorations (stored in moldy basements or dusty attics), outdoor molds (on fallen leaves), scented candles, and more exposure to dust mites and animal dander as we spend more time indoors. It may be worthwhile to get tested for some of these “hidden” allergens if you haven’t already done so.

Is it possible to be allergic to the cold? My toddler gets large welts whenever I take her outside.
Dr. Leo Cold-induced hives (cholinergic urticaria) is a rare but well-known condition. These hives are the same as those that develop due to seasonal allergies or food reactions but they’re triggered by neurologic stimuli, i.e., exposure to cold. Often, parents will notice hives develop after their child plays in a cold swimming pool or, like you, they see hives appear on the skin (usually hands and face) when their child is out in wintry weather. An allergist can perform an “ice-cube” test under monitored conditions to confirm the diagnosis. Simple precautions, such as wearing appropriate clothing and covering exposed skin, can help. So can a long-acting antihistamine.

This type of urticaria is life long and doesn’t improve over time. Although the condition is generally harmless, there are reported cases of older individuals who’ve had significant reactions, even anaphylaxis with blood pressure changes, after jumping into icy-cold lakes.

These people should avoid swimming in cold water and keep an EpiPen handy. Generally, antihistamines help but some patients move to warmer climates to resolve their symptoms.
There’s a genetic disorder, Muckle-Wells syndrome, that’s defined by the presence of cold-induced urticaria (in addition to fever, chills, painful joints, hearing loss) but it’s very rare and treated differently. LW

Food allergies affect more than 12 million Americans, including 6 percent of children under the age of three. Allergic reactions can range from mild to anaphylaxis, a serious condition that can cause hives, swelling, nausea, closing of breathing passages and even death. There is no cure, just the strict avoidance of the offending foods. Ninety percent of all food allergies are caused by eight foods: wheat, milk, peanut, tree nuts, egg, soy, fish and shellfish.


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