Allergy in children

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

An allergy in children is not uncommon: It is one of the most common chronic diseases in childhood. Adolescents often suffer from hay fever, allergic asthma or neurodermatitis. Read more on the topic: How can you recognize an allergy in a baby / child? When do allergies develop in (small) children? What can you and the doctor do about an allergic reaction in the child?

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. J45L23T78Z88L20J30

Brief overview

• Allergies in children - frequency: 20 to 25 percent of children and adolescents have hay fever, allergic asthma or neurodermatitis. Other allergies such as food, house dust and insect venom allergies are somewhat less common. Overall, allergies in children (and adults) are on the rise.
• How does an allergy manifest itself in children? Depending on the type and severity of the allergy, for example, with rash, itching, conjunctivitis, runny nose (allergic runny nose), paroxysmal constriction of the bronchi and shortness of breath (allergic asthma), vomiting, abdominal pain, diarrhea, constipation, flatulence.
• When do allergies develop in (young) children? The exact causes are unknown. Hereditary predisposition and various environmental factors (such as air pollutants, tobacco smoke) are considered risk factors.
• When to the doctor If you suspect an allergic reaction in your child, you should consult the pediatrician. Call an emergency doctor if there are signs of severe allergic shock (anaphylactic shock)!
• Allergy in children - therapy: avoid allergy triggers as far as possible, medication (such as antihistamines, cortisone), desensitization
• Allergy in children - prevention: including a balanced diet and smoking cessation during pregnancy; if possible no caesarean section; Breastfeeding fully for four months after the birth, no excessive hygiene, etc.

Allergy in Children: Description & Symptoms

No matter whether children are plagued by a food allergy, insect venom allergy, allergic asthma or hay fever - in all cases there is an overreaction of the immune system to actually harmless substances (mostly vegetable or animal proteins). It results in various symptoms, for example in the skin, eyes and / or respiratory tract. Sometimes those parts of the body that have come into direct contact with the allergen trigger are primarily affected. In the case of hay fever, for example, this would be eyes, nose and possibly bronchi. However, the more severe an allergy is in children (and adults), the more parts of the body show symptoms.

Allergy in Children: Skin Symptoms

An allergic reaction often affects the skin: for example, the child develops hives (urticaria), i.e. wheals on reddened skin. Red spots (erythema), skin swellings or inflammations with weeping spots and peeling of the upper layers of the skin are also possible. Typically, severe itching is a problem for children with allergic skin symptoms.

Neurodermatitis (atopic eczema) - a chronic inflammatory skin disease - is sometimes an allergic reaction of the skin. The child suffers from excruciating itching and a rash, the severity of which depends on the stage of the disease: A very itchy, red rash is typical of the acute stage. Some children scratch themselves all the time, for example on their face or other affected areas of skin. As the disease progresses, the affected areas become paler and dry, and the skin begins to peel. Finally, it can gradually thicken, become coarser and cracked.

The atopic dermatitis rash in a child in the first year of life preferably shows up on the face (cheeks) and on the outside of the arms and legs. In older children, adolescents and adults, the disease occurs primarily in the hollows of the knees, the crooks of the elbows and the neck, and occasionally on the palms of the hands and soles of the feet.

A red rash on the face or elsewhere in the (small) child can have many other reasons besides an allergy such as eczema, chickenpox, measles, scarlet fever or rubella.

Allergy in children: symptoms of the eyes and nose

Sometimes allergy in children is accompanied by conjunctivitis. Typical symptoms of such allergic conjunctivitis are itchy, watery, red eyes. The child may also have swollen eyelids and conjunctiva and light-sensitive eyes.

Red eyes in children (and adults) can also have many other causes, for example lack of sleep, dust or smoke, drafts or UV radiation.

Very often allergic conjunctivitis is accompanied by an itchy, runny nose, often combined with the urge to sneeze - the nasal mucous membrane is inflamed. Such an allergic rhinitis (allergic rhinitis) can swell the nasal mucous membrane, making it difficult to breathe through the nose.

Allergy in children: symptoms on the bronchi

If an allergy manifests itself in the area of ​​the bronchi in children, this is usually first indicated by a whistle when exhaling. It arises because the bronchi become spasmodic. Chest tightness and shortness of breath can also occur. Doctors speak of an allergic asthma attack (allergic asthma).

Allergy in children: symptoms in the digestive tract

In particular, an allergic reaction caused by food can lead to itching / burning and swelling in the oral cavity and / or throat in children. Such an allergy can also cause problems in deeper parts of the digestive tract in children, for example in the form of vomiting, abdominal pain (e.g. colic), flatulence, diarrhea or constipation.

Extreme case - anaphylactic shock

In extreme cases, an allergy in children (and adults) affects several organ systems or the entire body. Doctors call this an anaphylactic shock: This is the most severe form of an allergic reaction. Within minutes of coming into contact with the allergy trigger, the child can develop shortness of breath, a drop in blood pressure and cardiovascular failure, among other things. There is danger to life!

Read here what other signs of anaphylactic shock and how to properly provide first aid in such an emergency.

Allergy in Children: Causes & Risk Factors

An allergy in children (and adults) occurs when the immune system regards an actually harmless substance (e.g. proteins from certain pollen) as dangerous and fights it with an excessive defense reaction. The whole thing takes place in two phases:

• 1st phase (sensitization): The immune system falsely classifies a substance (allergen) which is harmless in itself as dangerous and develops specific antibodies of the immunoglobulin E (IgE) type against it. Allergic symptoms do not yet appear in this phase.
• 2nd phase: Usually after repeated (symptomless) contact with the supposedly dangerous substance, the next "encounter" suddenly triggers the excessive defense reaction - the IgE antibodies bind the allergens, which sets off a cascade of defense and leads to allergic symptoms.

What this defense cascade looks like in detail depends on the type of allergy a child has. Immediate type allergies (type I allergies) are the most common (e.g. hay fever, allergic asthma, neurodermatitis, insect venom allergy):

Here the IgE antibodies sit on the surface of certain immune cells (mast cells). As soon as an antibody "captures" (binds) an antigen, the mast cell releases inflammatory messenger substances (especially histamine). These solve the allergic symptoms (e.g. an allergic reaction on the child's skin or an allergic runny nose). The whole thing happens very quickly - the symptoms appear within seconds to minutes after contact with the allergen. Hence the name immediate type allergy.

Read more about the different types of allergies here.

Allergy in Children: Risk Factors

It is not yet known exactly why the immune system in some children is overly sensitive to harmless substances. It is certain that a genetic predisposition plays a role here: If one of the parents is allergic to something, the risk of an allergy in the children is 20 to 40 percent. If both parents have the same allergy, there is a 60 to 80 percent probability that their offspring will also be allergic.

Various environmental factors also increase the risk of allergies in children, including:

• Air pollutants (such as fine dust)
• Tobacco smoke
• excessive hygiene
• unhealthy diet (regular consumption of fast food)

Last but not least, psychological factors such as stress can also promote allergies in children.

Important allergy triggers in children

Common triggers (allergens) of allergies in children are:

• Dust mite droppings
• certain foods
• Pollen
• certain animals
• Insecticide

Other allergens can be detected less frequently in children. Occasionally, chemical substances from toys, paints, floor coverings or furniture are the reason for an allergy in (small) children. Molds or their spores can also trigger excessive immune reactions. In some children, certain drugs (such as antibiotics) cause allergies. If a baby / child develops a rash and possibly other symptoms, a contact allergy can also be considered, triggered for example by a care product. For example, a rash on the hands of children can be caused by a skin cream - but it can also have many other causes (e.g. hand, foot and mouth disease).

Influence of age

Different allergies occur in children differently depending on the age group. For example, an allergic reaction in babies in the first two years of life (infancy) is usually triggered by certain foods. Of all food allergies, cow's milk, hen's egg, fish, soy, wheat and nut allergies (e.g. peanut allergy) can be observed most frequently in infants and toddlers.

Most often, an allergy in young children and primary school age is due to indoor allergens (house dust mites, cats), but often also to pollen. The latter are the most common allergy triggers in adolescents.

What about sun allergy?

Some (small) children seem to be allergic to the sun - the radiation triggers allergy-like skin symptoms. Usually, however, there is no real allergy behind it, but a different type of hypersensitivity. You can read more about this in the sun allergy article.

Allergy in children: treatment

The first thing you should do if you have an allergy in children (and adults) is to avoid the allergy trigger as much as possible. Certain medications can also reduce the child's allergic reaction, thereby relieving symptoms. In some cases, specific immunotherapy (desensitization) can be considered.

Avoid allergens

An allergy in children can often be brought under control by reducing allergen contact as much as possible. Some examples of this:

• In the case of a food allergy, the allergen in question must be removed from the menu - as well as ready-made products and meals that may contain the food in question as an ingredient (e.g. egg-containing dough and baked goods for egg allergy, pesto, nougat and marzipan for nut allergy).
• If a cream or ointment causes an allergic rash in the child (e.g. on the face), you should switch to another product. The pediatrician or pharmacist can advise you on this.
• If children have an allergy to house dust mites, allergen contact can be reduced with special bedding and a mite-proof mattress cover, among other things. If possible, remove dust traps from the home, such as carpets, pillows, heavy curtains, and open bookshelves.
• If a drug-related allergy causes a rash and other symptoms in children, you should discuss with the doctor whether there are alternative preparations that your child can use if necessary.

Medication

Drug treatment may not eliminate an allergy in children, but it can relieve symptoms. Different groups of active substances are available:

Mast cell stabilizers (Cromone)

Mast cell stabilizers such as cromoglicic acid can be considered if your child has an immediate type of allergy, such as an allergic runny nose from pollen, house dust mites or cat dander. They inhibit the release and regeneration of inflammatory messenger substances from the mast cells, which play an important role in mediating immediate allergic reactions (especially histamine).

Often these allergy medications are given topically, for example as a nasal spray and eye drops. But there are also dosage forms for ingestion, such as capsules. Such systemic preparations may be indicated for children with a food allergy if the allergen in question cannot be avoided.

Because mast cell stabilizers usually only take effect after several days of use, these medications should be used a few days before (presumed) allergen contact - for hay fever children, for example, before the start of the pollen season. In addition, the effect of the preparations only lasts a few hours, which makes it necessary to use them several times a day.

Decongestant nasal drops or sprays

The active ingredients contained are so-called alpha-1 sympathomimetics (such as oxymetazoline, tramazoline or xylometazoline). They cause enlarged blood vessels to contract (vasoconstriction). This effect is used when an allergy in children has caused the nasal mucous membrane to swell (allergic rhinitis) - the swelling is reduced by the narrowing of the vessels.

The decongestant nasal drops and sprays often lose their effectiveness if they are used frequently or repeatedly. In addition, prolonged use can damage the nasal mucosa. That is why experts recommend using such preparations for only a few days - you can find out how long at most from the package insert or from your doctor or pharmacist.

Find out beforehand from what age an allergic runny nose (such as hay fever) in children can be treated with a certain decongestant. These decongestant nasal drops and sprays are generally not suitable for small children.

Nasal sprays that only contain a physiological salt solution, on the other hand, can also be used on babies and over a longer period of time.

Antihistamines

Children with an allergy of the immediate type can also be treated with so-called antihistamines. These allergy medications inhibit the action of the messenger substance histamine and thus allergic symptoms such as allergic rhinitis, allergic conjunctivitis, allergic skin or mucous membrane swelling (angioedema), itching or hives (urticaria).

Children (and adults) are also given antihistamines as part of emergency therapy for severe allergic shock (anaphylactic shock).

There are antihistamines for topical use (nasal spray, eye drops) and for internal use (e.g. as tablets or juice). You can find out from your doctor which active ingredient in which dosage form and dosage is best suited to alleviate the symptoms of your child's allergy.

Many of the older representatives of this group of active ingredients (1st generation antihistamines such as Dimetinden) have a sedating effect as an undesirable side effect, i.e. they make you tired. The newer antihistamines of the 2nd generation (such as cetirizine, loratadine), on the other hand, have little or no sedating effect and are generally considered to be well tolerated.

Glucocorticoids ("cortisone")

Glucocorticoids (also called glucocorticosteroids) are artificially produced derivatives of the natural hormone cortisol. They are used for various allergic and inflammatory diseases. Glucocorticoids can inhibit inflammation as well as glandular secretion, swelling and hypersensitivity of the mucous membranes. They also have an immunosuppressive effect, so they can suppress immune reactions.

Most often, glucocorticoids are used locally for allergies in children (and adults). If a child has an allergic rash on their face (e.g. from neurodermatitis), a cortisone ointment can help (e.g. with the active ingredient hydrocortisone). An allergic runny nose can be treated with a cortisone nasal spray, an allergic conjunctivitis with cortisone eye drops. Children with allergic asthma are usually given a cortisone preparation for inhalation (e.g. a metered dose aerosol) as long-term therapy.

The risk of side effects with topical cortisone supplements is low when used properly. Follow the doctor's recommendations exactly, for example with regard to dosage and duration of use.

Doctors rarely treat allergies in children (and adults) with cortisone preparations that are used internally (systemically) - such as tablets, suppositories, or cortisone injections. The reason for this is the risk of sometimes severe side effects. For example, long-term or high-dose systemic cortisone therapy in children can cause stunted growth. For this reason, a child with an allergy only receives systemic cortisone preparations when it is absolutely necessary, for example in the case of acute, severe allergy symptoms.

More medication

For some allergic diseases, other drugs are used depending on the individual case. Some examples:

The therapy of allergic asthma usually also includes bronchodilators (bronchodilators), including mainly beta-2 sympathomimetics and anticholinergics. They are mainly inhaled.

Children and adolescents with allergic asthma, in particular, often also receive leukotriene receptor antagonists if the disease cannot be adequately controlled with inhaled cortisone alone. The active ingredients, also known as antileukotrienes, are taken as tablets. It is usually used in combination with an inhaled beta-2 sympathomimetic.

The attending physician sometimes prescribes calcineurin inhibitors (calcineurin inhibitors) for children with neurodermatitis. Like cortisone, these have an immunosuppressive effect. They are usually applied externally (e.g. as an ointment), mainly when local cortisone preparations do not help or are not tolerated. Even if the eczema rash covers the child's face or neck, locally applied calcineurin inhibitors are a good option - these thin-skinned areas of the body should not be treated with cortisone ointments or creams, if possible.

Calcineurin inhibitors are suitable for treating children from the age of two.

Desensitization

Sometimes the cause of an allergy in children can be treated with desensitization, also known as "specific immunotherapy" (SIT). The child is given the allergen regularly over a long period of time in tiny, slowly increasing doses - either as an injection under the skin or as a tablet or solution under the tongue. So the body should slowly get used to the allergen until, in the best case, at some point it no longer reacts allergically to it.

But that takes time - desensitization usually takes about three to five years. It is mainly used for severe pollen allergies, house dust allergies or insect venom allergies.

Desensitization works best if the patient has not had the allergy for a very long time and is not sensitive to many different allergens.

Severe allergies: Emergency kit ready to hand

In the case of severe allergies (e.g. insect venom or nut allergy), children or their parents or caregivers should always have an emergency kit ready to hand. In the event of (threatening) anaphylactic shock, the rapid administration of the necessary medication can be life-saving under certain circumstances! Such an emergency kit contains the following emergency medication:

• a pre-filled syringe of cardiovascular adrenaline that is injected into a muscle
• an antihistamine (e.g. in the form of drops) against the inflammatory reaction,
• a glucocorticoid (e.g. as a suppository or liquid for ingestion) to take in order to prevent a renewed inflammatory reaction after the initial treatment,
• a bronchodilator that you inhale (in children with asthma)
• and / or inhaled adrenaline.

The emergency kit should always be accompanied by an anaphylaxis passport, which the attending physician fills out. It states exactly what the child is allergic to and what medication should be administered and how in an emergency.

Parents should distribute an anaphylaxis emergency plan to the environment of a child with severe allergies (daycare center, school, relatives, friends, etc.). It contains a passport photo and the child's personal details. In addition, the typical early symptoms and the necessary remedial measures in the event of a severe allergic reaction are explained in a layman's way.

Allergy in children: when to see a doctor?

If your child has any signs of an allergic reaction (e.g. red eyes after a spring walk, rash on the face after eating, child cannot get rid of a cold), you should see a pediatrician. He can clarify whether your child actually has an allergy and, if so, what it is directed against. You can then discuss the necessary measures to treat and prevent allergic reactions in your child with him.

If your child shows severe allergic symptoms such as rapid heartbeat, shortness of breath, nausea, vomiting, pale skin, sweating or a drop in blood pressure, you should call an emergency doctor immediately!

Further first aid tips for suspected severe allergic shock can be found in the article Anaphylactic shock.

Allergy in Children: Investigations & Diagnosis

If it is suspected that your child has an allergy, the doctor will first take the medical history (anamnesis). To this end, he asks you as the parent or your child (if they are old enough), among other things, to describe the symptoms in more detail. He also asks if there is any suspicion of a possible allergy trigger. If, for example, the child gets red eyes and a runny itchy nose when they are out and about in the woods and meadows in spring, there is a suspicion of a pollen allergy. A rash with redness, wheals and itching, as well as indigestion after eating certain foods, indicate a food allergy.

Various test procedures can then help the doctor to find the right allergy trigger or the right ones from the list of possible allergy triggers. Possible allergy tests include:

• Skin tests (e.g. skin prick test): Various potential allergy triggers are applied or introduced in small doses on or into the skin to see whether one or more of these allergens is causing hypersensitivity reactions.
• Provocation test: The child is exposed to a specific allergen (e.g. by applying a birch pollen solution to the nasal mucosa) in order to provoke an allergic reaction if necessary. The whole thing takes place under careful medical supervision and usually only if other allergy tests are unclear.
• Blood test: Sometimes the doctor takes a blood sample to clarify an allergy in children, which is then examined for special antibodies or defense cells against certain allergens.

Allergy in children: course & prognosis

Unlike in adults, allergies in children often change in their course. In some offspring, the allergy disappears completely as they grow up. This can be observed particularly with early forms of food allergy (e.g. cow's milk allergy in infancy) as well as with neurodermatitis. Other allergies, on the other hand, often persist into adulthood, such as tree nut allergies (such as walnut allergy) and peanut allergy.

Over time, an existing allergic disease can be joined by another, such as hay fever: Children who suffer from it at school age often also develop asthma as the disease progresses. Conversely, many children with asthma also develop hay fever.

Cross allergies

It is also possible that a child with an existing allergy also develops what is known as a cross allergy: The immune system then not only reacts over-sensitively to the primary allergy trigger, but also to structurally similar allergens from other sources. For example, a strawberry allergy in children (and adults) can be due to a pre-existing birch pollen allergy: the immune system first developed an allergy to the proteins in birch pollen. Because strawberries contain similar proteins, the affected child may also be overly sensitive to the red fruits.

If the primary allergy in children is successfully treated by means of desensitization, the corresponding cross allergy often disappears.

Allergy in children: prevention

There are various recommendations how allergies in children can possibly be prevented - already during pregnancy, during childbirth and afterwards.

Allergy Prevention During Pregnancy

Regardless of whether the unborn baby is at risk of allergies due to an allergy in mom and / or dad or not - if you are pregnant, you should heed the following tips to reduce the risk of an allergic disease in your child:

• Refrain from eating particularly low-allergen food, as was previously recommended for allergy prevention during pregnancy. Today we know: It does not reduce the child's risk of allergies if the expectant mother avoids foods that are particularly susceptible to allergies (e.g. cow's milk, walnuts, peanuts, chicken eggs, soy, wheat).
• Rather, make sure you have a varied, balanced and nutrient-full diet, as is generally recommended during pregnancy.
• Eat sea fish regularly. This can lower the risk of an allergy in the child.
• Pay attention to a normal body weight, that means: Do not gain too much during pregnancy (among other things bad for the allergy risk of your child), but also not too little (risk of undersupply of the child).
• Do not smoke and also avoid secondhand smoke. Children of smoking parents are more likely to develop asthma than offspring of non-smokers.

Prevention of allergies in childbirth

The birth procedure also affects the risk of allergies in children:

When babies pass through the birth canal during natural delivery, many beneficial bacteria from the maternal vagina find their way onto the child's skin and into the child's lungs and intestines. This transfer of "good" bacteria stimulates the child's immune system. However, it does not apply if children are born by caesarean section. Scientists see this as the reason why cesarean section children are more susceptible to various health problems and diseases - including allergic diseases (especially asthma and neurodermatitis).

Therefore the advice to expectant mothers: Refrain from a desired caesarean section (caesarean section delivery without medical reason), but give birth to your child as naturally as possible via the vagina.

Prevention of allergies after childbirth

>> Diet

To reduce the risk of allergy in children, mothers should fully breastfeed their babies for the first four months of life.

However, some women cannot or do not want to (fully) breastfeed their child. Experts then recommend hydrolyzed baby food (hypoallergenic baby food, HA food) in the first four months of life for children at risk - in addition to or as an alternative to breastfeeding. However, if the child is not at risk of allergies (i.e. the parents do not have any allergies), they should be given normal baby food.

In order to meet the increasing nutritional needs of the child, mothers should feed them from the 5th month of life (from the 7th month at the latest). They should gradually diversify the child's menu - i.e. introduce new foods step by step. Food rich in allergens (such as cow's milk, wheat, etc.) does not have to be avoided, on the contrary: early contact with potential allergy triggers from the age of 5 months can even reduce the risk of allergies in children. According to information, for example, feeding fish in the first year of life can prevent allergic diseases such as hay fever, allergic asthma and neurodermatitis.

If a child has been shown to have a food allergy, parents must of course remove the relevant allergen from their menu. However, after a while you should have your doctor check whether the hypersensitivity is still there - a food-related allergy in toddlers often changes and can go away on its own.

Studies have shown that a Mediterranean diet high in omega-3 fatty acids could reduce the risk of allergies in children. This unsaturated fatty acid is found in fatty fish, linseed oil, rapeseed oil, flaxseed and nuts, for example.

Maintain a healthy weight for your child. Obesity can, among other things, increase the risk of asthma.

>> Contact with germs

To prevent allergies in children, you should refrain from excessive hygiene. The child's immune system is stimulated through contact with various microorganisms. It can reduce the risk of an allergic disease if, for example, the child grows up on a farm, visits a daycare center in the first two years of life or has several older siblings.

>> Pets

It is not necessary to do without pets to prevent allergies in children. However, if the child is hereditary because mom and / or dad have an allergy, the household should be cat-free. Dogs as pets, on the other hand, are allowed even with allergy-prone children - the four-legged friends seem to reduce the risk of allergies.

>> Smoking and other pollutants

What is true in pregnancy also applies after birth: a smoke-free environment reduces the risk of the child developing an allergy. You should not smoke in the apartment where your child lives. Even outside of this, family members, relatives and friends should take care not to smoke in the vicinity of the child.

As parents, you should ventilate your living space frequently. This lowers the concentration of indoor air pollutants (such as formaldehyde). Such pollutants can promote allergies in children (and adults) - especially with regard to allergic asthma.

A healthy room humidity is also advisable. If the air indoors is too humid, this promotes the growth of mold. And many mold spores in the room air can trigger an allergy to mold in the child.

Also, make sure that your child is exposed to as little car exhaust as possible. When looking for a new apartment, for example, keep in mind that studies have shown that living on busy streets can increase the risk of allergies.

>> Vaccinations

You should have your child vaccinated as normal according to the vaccination recommendations of the Standing Vaccination Commission (STIKO) of the Robert Koch Institute. Experts agree that vaccinations do not favor allergies; on the contrary, they can even reduce the risk of allergies in children.

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