Most Common Childhood Allergies

Introduction to Childhood Allergies

According to Allergy UK, allergies are common, especially in children. 40% of children in the UK have a diagnosed allergy, the four most common being food allergy, eczema, asthma, and hay fever. Some may have childhood allergies that go away as they age; others will have them for life.

An allergy develops when a person’s immune system becomes sensitised and abnormally reacts to a harmless substance, such as food, pollen and animal fur (dander). When a child comes into contact with an allergen they are allergic to, and it enters their body, the immune system sees it as a threat and responds inappropriately.

During an immune system response, the body releases a flood of chemicals, including histamine, resulting in symptoms of an allergic reaction. It happens quickly and usually within a few minutes of allergen exposure, although some can occur after a couple of hours.

Allergy symptoms can be mild in some children, e.g. localised rash and itchiness. In others, it can cause a severe reaction known as anaphylaxis, which can be life-threatening if not treated promptly. According to Allergy UK, anaphylaxis-type reactions occur in approximately 1 in 1000 in the general population.

It can be difficult and distressing for an allergic child and their parents, caregivers and educators, as allergies can significantly impact their health, well-being, hobbies, education and day-to-day lives. They may become:

• Sleep-deprived if their symptoms disrupt their sleeping patterns.
• Isolated due to potential allergens at social events, e.g. food allergens at Birthday parties.
• Unfocused at school, affecting their grades.
• Anxious about possible allergic reactions and use of adrenaline auto-injectors.
• Food adverse and may even refuse food.
• Low and depressed if they have visible symptoms, e.g. rashes, eczema and hives.

This blog post will cover the most common allergies that affect children, their causes, symptoms, and strategies for management and prevention.

Food Allergies

Individuals with food allergies have immune systems that react abnormally to certain foods and are of particular concern in young children. According to the Natasha Allergy Research Foundation (NARF), more children than ever are being diagnosed with food allergies. Allergy UK estimates almost 1 in 12 young children suffer from a food allergy.

It is unknown why allergies are becoming more common in children, but it could be that their immune systems are still in development. However, they are at a higher risk of developing a food allergy if they have eczema as infants, especially if it started early and was severe, or if they suffer from other allergies, such as hay fever and asthma.

Children can be allergic to any substance in food, but there are 14 food allergens identified as being the top ones for causing allergies. These are:

• Celery.
• Cereals containing gluten.
• Crustaceans (shellfish), e.g. prawns, crab and lobster.
• Eggs.
• Fish.
• Lupin.
• Milk.
• Molluscs.
• Mustard.
• Peanuts.
• Sesame.
• Soybeans.
• Sulphur dioxide and sulphites.
• Tree nuts, e.g. almonds, walnuts, cashews, pistachio nuts, pecans, hazelnuts and Brazil nuts.

According to Allergy UK, children tend to be more susceptible to the following:

• Peanut allergy – affects around 2% (1 in 50) of children in the UK.
• Cow’s milk (protein) allergy – more common in babies and young children. Most will outgrow their milk allergy around five years old, but it can be lifelong in some. It is the most common cause of fatal food-induced allergic reactions in school-aged children (Imperial College London).
• Egg allergy – is more common in young children than in adults. However, most will outgrow it.

Tree nuts, cereals, soy, fish, shellfish and seeds can also be a problem in children.

If an allergic child comes into contact with a food allergen, the reaction tends to affect their skin, respiratory system and digestive system, and they may experience the following symptoms:

• Sneezing.
• A runny, blocked or itchy nose.
• Dizziness or lightheadedness.
• Swelling of the face, eyes, lips or other body parts.
• Wheezing, coughing, breathlessness, hoarseness or noisy breathing.
• A skin rash, hives (raised bumps), flushing and itchiness.
• Red, itchy, watery, swollen, sore eyes.
• Swelling or itching of the lips, eyes and face.
• Stomach pain, bloating, nausea, vomiting and diarrhoea.
• Worsening of asthma or eczema symptoms.

It is important to note that not every child will have the same symptoms, and they can come soon after eating food or develop over a few hours.

Some children may have a severe allergic reaction to food (anaphylaxis), which can cause the following symptoms:

• Other allergy symptoms, as above, but more severe. These tend to develop first.
• Swollen tongue and throat.
• Breathing difficulties, sudden onset wheezing or fast breathing.
• Throat tightness.
• Hoarse voice.
• Difficulty swallowing or speaking.
• Bluish or greyish tinge to the skin, lips and tongue.
• Pale, clammy skin.
• Dizziness or feeling faint.
• Sudden sleepiness.
• Confusion, tiredness, irritability and anxiety.
• Collapsing and unconsciousness.

Anaphylaxis is a severe allergic reaction affecting the whole body (systemic reaction). It requires emergency treatment, as it is potentially fatal. Around one in 1,333 in England has experienced anaphylaxis at some point (NARF). However, according to Imperial College London, deaths from anaphylaxis are rare; approximately less than ten fatalities occur due to food per year in the UK.

To manage children’s allergies and reduce the risk of food allergic reactions in schools and childcare settings, always:

• Take food allergies seriously.
• Ensure all staff have up-to-date allergen awareness training.
• Read food packaging and labels carefully before giving children food, as they have to emphasise any of the 14 allergens by law.
• Avoid foods if you are unsure whether they contain an allergen a child is allergic to.
• Provide allergen-free meals where possible.
• Avoid cross-contamination when preparing and handling food.
• Keep track of allergens in meals.
• Follow a child’s allergen management plan.
• Understand the actions to take in an emergency.

Further guidance:

• Allergy guidance for schools – GOV.UK.
• Guidance for Early Years Settings – Allergy UK.
• Allergy information for nurseries – Anaphylaxis UK
• At School Guidance – Allergy UK.
• Allergy information for schools – Anaphylaxis UK.

Seasonal Allergies (Hay Fever)

Some allergies can be seasonal, meaning they occur at specific times of the year. Hay fever, or seasonal allergic rhinitis, coincides with pollen grains released from trees, grasses and weeds, usually in spring and summer. Each type of pollen comes out at different times, for example:

• Grass pollen – May-July.
• Tree pollen – February-June.
• Weed pollen – June-September.

Seasonal allergies are common, with 1 in 4 people in the UK allergic to pollen (Patient Info) and hay fever affecting 10 –15% of children in the UK (Allergy UK).

Hay fever is usually worse when the pollen count is at its highest and when it is warmer, humid and windy, usually between March and September.

When pollen comes into contact with a child’s nose, mouth, throat or eyes, their body produces specific antibodies resulting in symptoms, such as:

• Sneezing.
• Coughing.
• Runny, blocked or itchy nose.
• Itchy, red and watery eyes.
• Loss of smell.
• Itchy throat, mouth, nose and ears
• Headache.
• Earache.
• Fatigue and feeling tired.
• Difficulty sleeping.

Hay fever can have a significant impact on a child’s daily life. While there is no cure, there are some strategies to help children manage their seasonal allergies, such as:

• Monitor pollen forecasts for high pollen counts.
• Keep them indoors, especially during very high pollen counts.
• Wash their face, hair and clothes after playing outside.
• Give them sunglasses to wear to stop pollen from entering their eyes.
• Keep windows and doors closed where possible, especially during pollen season, early mornings and early evenings.
• Give them cool compresses for their eyes when irritated.
• Avoid drying clothes and bed linen outside during high pollen counts.
• Use Vaseline or pollen barrier balms around the nose to trap pollen.
• Give them antihistamines and other medications, e.g. nasal sprays to relieve symptoms – always check with a GP or pharmacist first, as some are unsuitable for children.
• Keep car windows closed when driving around and use pollen filters for the air vents.
• Buy an air purifier to trap pollen and filter the air.

Insect Sting Allergies

Despite the media hype, not many insects sting in the UK, and when they do, it is because they feel threatened or their nests are disturbed. Also, it is only females that sting and not males.

The insects that do sting belong to a specific group and are typically social. Here are some examples:

• Wasps – tend to be the insect responsible for most stings, but usually in late summer when they are attracted to sweet foods and drinks after their nests finish.
• Hornets – are not particularly common, so stings are uncommon. Even though they are much larger than wasps, they are less aggressive.
• Bumblebees – rarely sting unless provoked. They will usually lift their legs in a certain way as a warning first before stinging.
• Honeybees – are more likely to sting than bumblebees, but stings are still uncommon unless you get close to their hives.
• Ants – not all ants sting, but the ones that do and are more common are red ants. These are found in gardens and will readily sting if disturbed, especially if someone stands close to a nest.

Insect stings are not usually serious, even though they can be painful. Stings are more common in children but appear less likely to experience severe reactions (Allergy UK).

All children will have some response to an insect sting, but not all will have an allergic reaction. After a sting, they may have:

• Pain at the sting site.
• A mark where the stinger entered the skin.
• Small, swollen lump on the skin.
• Redness and itchiness around the sting.

When an insect stings, it injects venom, which contains proteins some children can be allergic to. If a child has a mild allergy to the venom in insect stings, they will have the symptoms above and more localised swelling around the sting site, i.e. >10cm.

There is a risk of life-threatening anaphylaxis in children with insect sting allergies, where the allergic reaction affects the whole body. According to Anaphylaxis UK, these serious symptoms are often called ABC symptoms, which are as follows:

• A – AIRWAY –throat, tongue or upper airway swelling (tightening of the throat, hoarse voice, difficulty swallowing).
• B – BREATHING – sudden onset wheezing, breathing difficulties (especially in asthmatics), noisy breathing.
• C – CIRCULATION – dizziness, faintness, sudden sleepiness, tiredness, confusion, pale/clammy skin, loss of consciousness.

There may also be swelling and itchiness away from the sting site, severe abdominal (stomach) pain, nausea, vomiting or diarrhoea. In extreme cases, the child may become weak, floppy and anxious due to a dramatic fall in blood pressure.

If a child has any of the above ABC symptoms, it is essential to seek emergency medical treatment, as they can collapse and become unconscious, which can be fatal. Anaphylaxis UK has guidance on what to do in an emergency here.

Children with known insect allergies should carry two in-date epinephrine auto-injectors, as these can be life-saving if they have a severe allergic reaction to an insect sting. They contain the correct adrenaline dose to lessen the symptoms of anaphylaxis while waiting for emergency medical treatment.

Children are at a higher risk of anaphylaxis if they are stung multiple times or have been stung many times previously. Therefore, it is vital to avoid insect stings by keeping a safe distance from stinging insects and moving away calmly if one approaches. Further information on prevention is on Allergy UK.

Allergic Dermatitis (Atopic Eczema)

There are various types of dermatitis, which is inflammation of the skin. When it involves allergen sensitivity, it is known as allergic dermatitis or atopic eczema.

According to the NHS, atopic eczema is the most common type in children and typically develops before their first birthday. However, it can develop later in life or disappear as a child ages. According to the British Skin Foundation, up to 1 in 5 children will be affected by eczema at some point.

The cause of atopic eczema is unknown, but it often occurs in children with other allergies, such as hay fever, asthma and food allergies. It can also run in families; if one or both parents have eczema, children are more likely to develop it.

Like any allergic reaction, when a child comes into contact with a particular allergen, their immune system overreacts and triggers specific symptoms, affecting the skin. It can affect any part of a child’s body, but it is more common on the hands, insides of the elbows, backs of the knees, face (cheeks) and scalp.

The symptoms of atopic eczema include:

• Itchy, dry, scaly, cracked and sore skin.
• Redness on white skin and darker brown, purple or grey on brown and black skin.
• Swelling.
• Bumpiness.
• Scratch marks and bleeding from scratching.
• Clear fluid oozing from the affected areas.
• Skin thickening.
• Tiredness and irritability if it disturbs their sleep.

Many things can trigger allergic dermatitis, such as pollen, detergents, soap, other chemicals, stress, weather, skin infections, etc. Therefore, identifying and avoiding a child’s triggers is key in managing their condition and reducing the risk of severe symptoms (flare-ups).

Unfortunately, there is no cure for atopic eczema. It can increase a child’s risk of skin infections and significantly impact their daily life, especially if their condition is severe. Anyone responsible for their care can help them manage their symptoms by:

• Teaching them not to scratch and how to avoid triggers.
• Giving them anti-scratch gloves.
• Keeping their nails short and clean to prevent scratching and infections.
• Applying wraps soaked in moisturisers to reduce itchiness.
• Using soap substitutes and bath oils for washing.
• Applying unperfumed moisturisers, such as emollients, daily to help with dry skin.
• Using topical medications, e.g. steroids, on their skin to reduce inflammation and itching (must be prescribed by a GP).
• Giving them antihistamines (as directed by a GP or pharmacist) to help with severe itching.

In severe cases, children may require further treatments from a skin specialist (dermatologist).

Pet Allergies

According to Allergy UK, allergies to cats and dogs are common, especially in children with hay fever or asthma. However, a child can be allergic to any animal, such as horses, birds, rodents (rats, mice, guinea pigs and hamsters) and reptiles. They can also be allergic to bedding materials used for some pets, such as shredded paper, shavings, straw and moulds.

When a child has a pet allergy, their immune system produces an abnormal response to proteins found in animal skin flakes (dander), saliva, body oils, fur and urine. Cats and dogs have many proteins, especially dander during shedding and saliva during grooming. Dander, in particular, sticks to clothes and furniture and can remain in the house for months after a pet has gone.

If a child has a pet allergy, their symptoms will depend on their level of exposure and sensitivity to the allergen but may include:

• Sneezing.
• Runny, blocked and itchy nose.
• Watery, itchy, red, swollen eyes.
• Rash/hives.
• Worsening eczema, e.g. skin irritation.
• Worsening asthma symptoms, e.g. coughing, breathing difficulties and wheezing.

Symptoms can start soon after exposure or may be delayed.

Severe allergic reactions and anaphylaxis are uncommon. However, it can cause an asthma attack in children with asthma.

It is hard to prevent pet allergies, but it may be possible if a child is exposed to animals regularly in their first year or if a pet is already in the house. In most cases, it does not mean that a child cannot have any pets, but it will depend on the proteins they are allergic to.

If a child has a pet allergy, the following could help manage their symptoms:

• Use medication, e.g. antihistamines, preventer (steroid) inhalers, nasal sprays and decongestants suitable for children (a GP or pharmacist can advise).
• Avoid exposure to the animal they are allergic to.
• Have pet-free zones in the house, especially in their bedroom. In schools, keep animals out of classrooms where possible.
• Replace carpets with hard flooring and soft furnishings with textile-free options, e.g. blinds and not curtains.
• Wear clothes not made of wool (which can trap allergens).
• Vacuum regularly with a vacuum cleaner with a HEPA filter.
• Wash hands regularly.
• Opening windows every day for at least one hour.
• Groom pets regularly outside of the home.
• Wash pet bedding regularly.
• Have regular asthma reviews for children with asthma.
• Carry two prescribed adrenaline auto-injectors (AAIs) at all times (if at risk of anaphylaxis).

Managing and Preventing Allergies

Having an allergy can be difficult for children and their parents/caregivers. It can also be a bit of a minefield for school personnel, especially if a child has a severe allergy.

It is not always possible to prevent allergies, especially if they and associated medical conditions run in the family. There may be some actions parents can take during infancy to reduce the risk of their children developing allergies. The NHS has further advice here.

If a child has a suspected allergy, they should see a GP who will organise allergy tests or refer them to a specialist allergy clinic. Some examples of the tests are:

• A skin prick or patch test – a small amount of the suspected allergen is put on the child’s skin to see if there is a reaction.
• Blood tests – a blood sample is taken from the child to measure the amount of IgE (allergy) antibodies in their blood.
• Special diets for suspected food allergies – a child avoids or eats less of a suspected food allergen to see if their symptoms improve.

Home allergy tests are available, e.g. test kits that give instant results and hair sample tests sent to laboratories. Healthcare professionals do not recommend them, as they can be unreliable, and only a blood test can identify an allergy. If a parent or caregiver suspects a child has an allergy, they should keep a diary of symptoms and see a GP.

If a child is diagnosed with an allergy, it will require appropriate management to reduce the risk of allergic reactions and significant impacts on their lives. Some examples of management strategies include:

• Allergen avoidance – children should avoid the allergen they are allergic to wherever possible. Allergy UK, Anaphylaxis UK, the Natasha Allergy Research Foundation and the NHS have guidance on this on their websites.
• Medicines – children with mild allergies may be able to take medicines to help with mild allergic reactions and symptoms, such as antihistamines, steroid tablets and steroid creams. Check with a GP or pharmacist before giving any medicines.
• Allergy management and action plans – allergic children usually have an individualised written allergy management plan detailing how to manage their allergy. Children at risk of serious allergic reactions may also have an allergy action plan detailing what to do in an emergency.
• Carrying emergency medicines – children with severe allergies will typically need adrenaline auto-injectors, such as EpiPens, due to the risk of life-threatening anaphylaxis.
• Immunotherapy – children with severe allergic reactions may have immunotherapy, a desensitisation technique only conducted by healthcare professionals. It involves exposing a child to small amounts of an allergen over a specific period to allow their body to get used to it and reduce the severity of allergic reactions.

If a child attends nursery or school, educators and other staff must be made aware of their allergies and given a copy of their allergy management and action plans. They should also have any medication the child needs. Schools and nurseries should have allergy policies and procedures, and staff should have regular training.

Communication between all parties involved with a child’s care, education and socialisation is essential. Parents/caregivers and school/nursery personnel must communicate internally and externally to reduce the risks of allergic children having allergic reactions. Unfortunately, there have been fatalities where a lack of communication and understanding regarding allergies has cost children’s lives. One tragic example is here.

Conclusion

Allergies can significantly impact children’s day-to-day lives and health, education, socialisation and well-being. They can also be fatal in certain circumstances. Therefore, those responsible for children must be aware of common childhood allergies and how to manage them.

If you suspect a child has an allergy, it is essential to seek prompt advice from a healthcare professional so it can be accurately diagnosed, treated, controlled and managed. If a child has any symptoms of a severe allergic reaction, dial 999 or take them to A&E.

Having a community that understands childhood allergies and getting advice from those with lived experience can help others, especially parents, caregivers and educators who are newly caring for and supporting a child with an allergy.

Please share your experiences or additional tips for managing childhood allergies in the comments section to help and support others. Being part of an informative community can help improve the lives of allergic children and those caring for them.