October 2021

Kids’ Allergies

Are allergy shots safe for kids?

In the last two decades, kids’ allergies have become a leading cause of chronic pediatric illness in the United States.

Nearly 40% of children in the US suffer from allergies. While a cure for kids' allergies is still yet to be discovered, effective treatments may lead to fewer days of missed school.

Of course, the safety of any children’s treatment is always a concern for parents.

Childhood Allergies and the Atopic Triad

The main allergic conditions that affect children are eczema (or atopic dermatitis), food allergies and asthma (or allergic rhinitis). Combined, these are typically referred to as the atopic triad.

You may see all three allergies or just one of them during a child’s life, and some cases are milder and others more severe.

Genetics

Genetics plays a role in the atopic triad because atopy (or the predisposition to develop allergies) is often inherited. Studies have shown that parents’ history of allergic disease can lead to a 40% or more increased risk of allergy in a child, particularly if more than one parent suffers from allergies.

Atopic March

The atopic march describes the phenomenon of the atopic triad and how it unfolds in the life of a child.

While there are no hard and fast rules about how childhood allergy presents, the atopic triad classically begins with atopic dermatitis presenting first — as early as newborn years — followed by food allergies and later allergic rhinitis and asthma.

Throughout, these conditions remain related and may become triggers for worsening disease.

Atopic Dermatitis

Atopic dermatitis (also known as eczema) is marked by dry itchy skin patches.

As a newborn, eczema can affect the face and entire body. In childhood, it shifts to just the extensor surfaces, including the knees and elbows. Later in life, this type of dermatitis remits, and other allergic diseases may become more prevalent.

In approximately 30% of eczema cases, food allergy can be a trigger. Atopic dermatitis may also be linked to allergic rhinitis especially sensitization to dust mite and roach, which can lead to eczema flares when exposure is uncontrolled.

Food Allergies

Food allergies have a variety of symptoms and can start in infancy with cows milk formula intolerance that often presents as eczema.

Later, as simple foods are introduced, children may present with their first episode of an allergic reaction to one of the common childhood food allergens, including milk, soy, peanut, tree nut, fish, eggs, sesame and shellfish.

Common childhood reactions can include a simple rash and itching to more severe anaphylaxis with lip or tongue swelling and vomiting among the spectrum of allergy symptoms.

In the last two decades, childhood food allergies have nearly tripled.

This is multifactorial in nature and may be due to earlier restrictive guidelines regarding when to introduce foods, as well as the hygiene hypothesis, the theory that our increasingly hyper-clean culture has led to overactivity of the allergic immune system.

Progress has been made with the LEAP trial, which led to revised guidelines about the introduction of foods in infants, specifically that no foods should be restricted when food is started in infancy. The LEAP trial has shown that this practice can lead to a decrease in the incidence of food allergy.

Allergic Rhinitis

Allergic rhinitis is seasonal hay fever to pollen or year-round allergy to perennial triggers like animal dander, mold and dust mites. Allergic rhinitis tends to present later in childhood after exposure to several seasons.

For perennial allergies, symptoms can occur earlier because exposure is constant. Itchy watery eyes, chronic nasal congestion, chronic ear infections can all be symptoms of allergic rhinitis in kids.

Asthma

Asthma is inflammation of the small airways of the lungs that over time leads to obstruction and symptoms like chest tightness, cough, nocturnal cough and wheezing.

It can begin with reactive airway or childhood wheezing and coughing, caused by specific triggers, such as a viral infection or seasonal pollen and later develop into perennial asthma requiring daily asthma medication like an inhaler.

Kids’ Allergy Symptoms

Depending on the allergic reaction, your child may exhibit a wide variety of symptoms. Yet, some of the most common allergy symptoms in children may include:

  • Coughing
  • Gastrointestinal issues
  • Hives
  • Itching
  • Rashes
  • Runny nose
  • Shortness of breath
  • Sneezing

Common Children’s Allergy Triggers

Allergies may be triggered by a wide variety of triggers, including seasonal allergens, environmental allergens, food allergens and poor air quality. If you already know which allergens your child is allergic to, you may simply want to avoid these allergens.

Environmental Allergies

Environmental allergens may cause symptoms any time of year. These types of allergens have more to do with the environment than a particular season (such as spring, summer or fall allergies).

Some of the most common environmental allergens include animal hair, fur and dander, mold and fungus and dust. Some children are allergic to insect dander (such as dust mite and cockroach dander), while others may be allergic to the insect’s venom or saliva (such as with bee stings and cockroach bites).

Seasonal Allergies

Seasonal allergies may strike particularly hard during a specific season, such as spring, summer or fall.

Summer allergens may include plant pollen (including tree pollen in the spring and ragweed pollen in the summer and fall).

Another common fall allergen is also an environmental one: mold.

Although mold can grow anywhere in the right climate, it’s particularly prone to grow during the fall, as wet and humid weather may accelerate mold growth.

Food Allergies

Foods are another major allergy trigger. Some of the most common food allergens may include peanuts, tree nuts, dairy, eggs and shellfish.

Risk Factors

Certain risk factors may also increase the likelihood of allergy symptoms. Poor air quality, high levels of pollution and chemicals may also lead to more frequent allergy flare-ups.

If you live in a large city, such as New York or Los Angeles (especially a city with higher-than-average pollution levels), your child’s allergy symptoms may be triggered more, and symptoms may also be more severe.

Environmental pollutants such as nicotine and cannabis smoke may also trigger allergy symptoms. Cleaning chemicals, perfumes and pesticides are also other risk factors that may increase the likelihood and severity of allergy symptoms.

Allergy Testing and Diagnosis

Getting your child tested for specific allergies is one of the first steps in allergy treatment.

Since allergies share symptoms with a long list of other conditions, you may want to rule out other medical issues before starting treatment. Your doctor may also require allergy testing before starting treatment plans, such as allergy immunotherapy.

In-Person Allergy Testing

Your doctor may recommend a skin scratch or blood draw to test for allergies. These tests may be performed at a doctor’s office or testing lab.

To perform a skin scratch test, your doctor or allergist may use small needles to insert small amounts of the allergen below the top layer of the skin. This type of testing may cause epidermal allergies to flare up.

Blood draws may be performed at a lab.

At-Home Allergy Testing

Curex’s at-home allergy testing can be performed in the comfort of your own home and only requires a few drops of blood for diagnosis. Simply follow the instructions included in the kit, and use the provided lancets to take a sample.

Mail your sample to the lab and get your results usually within a few days!

Treatments

There are myriad allergy treatments available for kids' allergies. Most of these require some level of daily medication to treat symptoms, as when the medication is stopped, the symptoms may return.  

Since there is no real cure for allergies, it remains a chronic condition. Allergen immunotherapy is one of the only treatments that may treat the root cause of symptoms.

Topical Treatments

Topical treatments are usually the starting point for atopic dermatitis therapy. This and following strict moisturizing routines at home are key.

Additionally, because children with atopic dermatitis tend to have significant itching, oral antihistamines can be helpful in the symptomatic treatment of atopic dermatitis as well.

Newer therapies in atopic dermatitis involve non-steroidal topicals and for more severe cases oral steroids, oral antibiotics and newer injectable biologics may help reduce symptoms, too.

New advances in food allergy treatments

The mainstay for true food allergy is avoidance.

Oral immunotherapy is gaining traction as a treatment for food allergies, with a new FDA-approved peanut allergy treatment that may help prevent life-threatening symptoms to accidental exposures.

Again, oral immunotherapy is not a cure, but it’s a step in the right direction.

Asthma Inhalers and Biologics

Asthma in children is treated with inhaled medications that can be delivered via different modalities.

Bronchodilators, such as Xopenex and albuterol, are often used in combination with different strength inhaled steroids. Nebulizers, metered-dose inhalers and dry powder inhalers are all commonly used devices in childhood asthma therapy.

For severe cases, oral steroids and injectable biologic therapies may also be prescribed by a doctor.

Asthma (like atopic dermatitis) is connected to allergic rhinitis with both seasonal and perennial allergens often triggering allergic asthma.

For this reason, allergen immunotherapy (especially in children) has been shown to be beneficial — not only to control allergic rhinitis symptoms but also asthma symptoms.

Allergic Rhinitis

Oral antihistamines, intranasal steroids, antihistamine sprays and eye drops are the mainstays of kids’ allergic rhinitis treatment.

Depending on the frequency of symptoms, these medications may need to be used seasonally or year-round.

For severe cases, steroids or antibiotics may be needed when sinusitis or allergic conjunctivitis symptoms arise. Like with asthma, allergic rhinitis may also be treated with immunotherapy for possible long-lasting disease-modifying effects.

Allergen Immunotherapy

Allergen immunotherapy may be used when a child’s symptoms are severe and not controlled with traditional medication or if daily medication is simply not doable or contraindicated.

Subcutaneous Immunotherapy

Subcutaneous immunotherapy or SCIT are allergy shots and one way to offer immunotherapy to kids. Allergy shots introduce the culprit allergens with weekly increasing doses given by a small injection into the fatty area of the arm.

The shots are always administered in a doctor’s office and then followed by an observation period of up to 30 minutes to make sure there is no reaction.

Allergy shots have been shown to be very effective in the treatment of allergic rhinitis and asthma, with continued use over 3-5 years leading to the most significant improvements.

The benefit of SCIT is that it may treat multiple allergens, leading to long-lasting efficacy and a possible easing of allergy and asthma symptoms.

The downside? Local side effects can occur when you start approaching higher and maintenance doses. These are most commonly itch or minor rash at the injection site which usually resolves quickly.

While SCIT safety is well-established, this treatment is also associated with rare severe allergic reactions, including anaphylaxis — hence the need to be monitored after treatment.

For kids with severe asthma, SCIT is not an option because of the higher risk of severe reactions.

Also, let’s face it, going to a doctor’s office and facing a needle every week can be scary for a lot of kids, which often leads to early discontinuation of shots.

Sublingual Immunotherapy

Sublingual immunotherapy (SLIT) exposes the body to gradually increasing doses of an allergen in order to increase tolerance. As with allergy shots, SLIT may reduce allergy symptoms over time.

SLIT may be administered orally, under the tongue. Curex’s allergy immunotherapy does not require a doctor’s observation and can be customized with multiple allergens specific to a child’s sensitivity.

The benefits to SLIT? Studies show significant safety and efficacy of sublingual therapy in improving allergy symptoms.

While this type of immunotherapy is prescribed by a doctor, patients may not need to visit a doctor’s office to receive treatment and may only need to schedule a telehealth appointment (at the doctor’s discretion).

Why? SLIT may not have the risk of severe allergic reactions like anaphylaxis. Side effects tend to be mild commonly including itching of the mouth or tongue.  

And by the way, no needles! No needles, no visits to the doctor’s office and ease of home administration may lead to greater compliance with SLIT.

Kids’ allergies and allergy therapies may seem like a lot to tackle. Connecting to an allergy specialist at Curex will help you determine what treatment options are right for your child.

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