Consultation

A true holistic consultation is required as the spectrum of conditions that paediatric allergy incorporates includes:

• Food allergies
• Hay fever
• Allergen triggered asthma
• Eczema where allergens may be contributing
• Skin problems such as urticaria (hives) and angioedema (swelling)
• Drug allergies
• Pet allergies
• Venom (bee/wasp) alllergies
• Other air borne allergens (e.g. moulds)

Investigations

There are two principle ways of looking for evidence of the antibodies (IgE) that are responsible for allergic reactions – skin prick testing or a blood test to measure the specific IgE to a food directly. Allergens that can be tested for are numerous and include foods, airborne allergens, stinging insects and drugs. Testing can be undertaken at any age (including young infants).

Skin prick testing involves placing a drop of a special solution on the forearm and then pricking it with a small lancet. The procedure is well tolerated and causes minimal discomfort. The response can be measured within 10-15 minutes.

If you suspect fresh fruits of causing symptoms (e.g. apple, pear, cherries, nectarine, peach, celery or kiwi) it is helpful to bring these along to the appointment to be used for skin prick testing as the commercial skin prick test solutions for these fresh fruits do not work as well.

Anti-histamine medications should be discontinued for at least 3 days prior to an appointment with Dr Perkin. Medicines that contain antihistamines include certain cough medicines, anti-itch medicines. If in doubt check with your pharmacist.Antihistamines do not affect blood specific-IgE testing. It is important not to stop any other medications your child maybe taking (e.g. asthma treatments).

Management

Children who are identified as having an allergy will be given clear instructions on how best to manage this. Those identified with a food allergy will be issued with an individualised treatment plan for schools/carers on what to do in the event of any accidental exposures. Where necessary, adrenaline autoinjector devices (e.g. Epipen or Jext devices) will be prescribed and family members trained in how to admisnter these.

Dr Perkin will also advice as to whether a subsequent referral to a dietician who specialises in paediatric allergy is indicated.

Management includes a discussion on the most appropriate therapies for your child. Allergy treatments have moved forward in recent years and novel treatments have emerged.

Immunotherapy

Allergic rhinitis can be severely debilitating whether seasonal (classic hay fever) or perennial (from animal danders or house dust mite).

Conventional treatment involves the use of: antihistamines, nasal steroid sprays and eye drops.

These are all effective treatments but none of them are what is termed “disease modifying”. All of them treat symptoms rather than the underlying disease itself.

In contrast immunotherapy is “disease modifying”. It works by altering the body’s immune response to allergens such as pollen or house dust mite.

Recent systematic reviews have shown that the effect of immunotherapy is as beneficial as the combined effect of the all the conventional treatments combined. The benefit is also cumulative, in that the conventional treatments can still be used for any break through symptoms whilst receiving immunotherapy.

Immunotherapy is now available for a wide range of allergens including: animals (cat, dog and horse), house dust mite, grass pollen, tree pollen, weeds and bee and wasp venom.

• A course of immunotherapy lasts three years. A longer term benefit after cessation of the three years has now been confirmed and appears to be long lasting.

• There are two ways of administering immunotherapy: under the tongue, known as sublingual (or SLIT) and injections under the skin, know as subcutaneous (or SCIT). Dr Perkin will discuss which is most appropriate for your child.

• Once commenced all three years should be completed.

• You will be seen in clinic before the allergen season commences to commence treatment and once during the allergen season (for seasonal allergens).

• Immunotherapy treatment for grass pollen commences in February and for tree pollens in December.