Major allergic diseases in childhood

Assoc. Dr. Mahmut Doğru / Child Immunology and Allergy Diseases Specialist

The health of their children comes first for parents. Unfortunately, some of those innocent little puppies can get the allergies that are among the most common diseases of our time. To learn about ways to overcome allergic diseases of different varieties, how about getting to know them closely?

Major allergic diseases in childhood; asthma, allergic rhinitis, atopic dermatitis, food allergies, urticaria (hives), drug allergies, angioedema and anaphylaxis (severe allergic reaction). Apart from these, in addition to classical IgE-mediated allergic diseases, especially in the gastrointestinal system, non-IgE-mediated allergic diseases are also common in childhood. (Ige-mediated means: Allergic reactions mostly occur with IgE-type antibodies and are called IgE-mediated allergies.)

• Asthma

Asthma is a heterogeneous disease that usually has chronic (chronic) inflammation (inflammation) in the airways. Many cells and cell products in the body play a role in this inflammatory process. Clinically; chronic airway inflammation and associated bronchial hyperresponsiveness lead to worsening breathing, shortness of breath, chest tightness and / or coughing, especially at midnight or in the morning. Along with these complaints, there is usually a varying degree of airway narrowing. The intensity of the clinical picture and symptoms may change over time. Although its incidence varies from society to society, it is between 1-18%. It is more common in countries with a western lifestyle. In studies conducted in our country, the frequency of asthma in childhood varies between 6-15%. Asthma is a disease caused by both genetic and environmental factors. Asthma is more common in people with the following risk factors.

• Risk factors in asthma

There are two types of personal and environmental risk factors.

Personal risk factors

• Genetic predisposition: If one of the parents has asthma, the risk of asthma in the child increases to 20-30%; This risk reaches 50-60% if both parents are asthmatic.

• Obesity: Obesity is a factor that increases airway inflammation in children. Obesity is effective in both asthma formation and non-response to asthma treatment. Obese asthmates have lower respiratory functions compared to normal-weight asthmatics.

• Gender: In the period before 14 years of age, the frequency of asthma is seen as twice as much as girls.

Environmental risk factors

• Allergens: They are effective both in the formation of asthma and in the development of asthma symptoms.We can divide allergens into indoor and outdoor allergens:

• Indoor allergens: House dust mites, pets (cats, dogs), cockroaches and mold fungi.

• Outdoor allergens: Pollen and mold fungi.

• Microorganisms: It has been shown in various studies that the numerical deficiencies or the imbalances in some bacteria in the normal environment of the airway and intestine are effective in the formation of asthma. There are many studies on this subject in recent years.

• Infections: Lower respiratory tract infections in childhood are effective in possible asthma development in later years.

• Occupational sensitizers: Although not very common in childhood, it is an important factor in asthma in adults.

• Smoking: Exposure to cigarette smoke both during pregnancy and later periods is a risk factor for asthma. In the first year of life, the probability of bronchiolitis in babies whose mothers smoke is 4 times higher than babies whose mothers do not smoke. Smoking, especially during adolescence, is effective in both asthma attacks and adulthood.

• Air pollution: Indoor and outdoor air pollution.

• Diet: Nutrition with increased rates of ready-to-eat food, low intake of antioxidants (fruit and vegetables), increased intake of omega-6 polyunsaturated fatty acids (found in margarine and vegetable oils) and inadequate intake of omega-3 fatty acids (found in fatty fish) It is claimed to contribute to the increase in asthma and atopic disease.

• Diagnosis of asthma

 The patient's history is very important in the diagnosis of asthma. Diagnosis can be made with symptoms such as shortness of breath, wheezing, cough and chest tightness, whose frequency and severity may change over time, and the presence of variable airflow restriction. These children have wheezing attacks, especially after upper respiratory infections. Although these episodes heal with treatments, recurrent wheezing attacks can be seen. Reversible airway narrowing during these attacks can be evidenced by pulmonary function tests. However, pulmonary function tests can usually be applied to children who can perform respiratory maneuvers. Respiratory function tests are usually done after the age of 6. However, normal pulmonary function tests do not exclude the diagnosis of asthma. Also, asthma is often associated with airway inflammation and hypersensitivity; The presence of these features is not necessary or sufficient to make a diagnosis. Evaluation of allergy is important in children with asthma. Allergy skin tests are often done for this. Knowing what an allergy is is important in preventing symptoms. In addition, immunotherapy (vaccine) treatment can be made against the allergic substance.

• Asthma treatment

2 types of drugs are used in the treatment of asthma.

1. Breath openers (relaxing): Used when there is shortness of breath, cough, chest tightness and wheezing. By expanding the airways, they provide shortness of breath.

2. Controlling medicines: They are drugs that reduce asthma attacks and suppress inflammation in the airways when used regularly. The most common of these are cortisone, which is taken by inhalation. In addition, oral chewable tablets or powder medicines are used for this purpose. In older children, combined drugs with inhaled corticosteroids and long-acting breath openers are also used for this purpose.

These treatments are additive treatments used in resistant, severe asthmatic adolescents and adults. For this purpose, a drug containing anti-IgE antibody is used.

Allergic diseases are chronic, that is, long-term, chronic diseases. Regular follow-up is very important in these diseases. Therefore, patients with asthma should be followed up with an interval of 1-3 months depending on their severity. These follow-up intervals can be opened up to 6-12 months depending on the condition of the patient.

• ALLERGIC Rhinitis

 It is a disease that causes symptoms such as itching in the nose, sneezing, discharge, congestion, nasal discharge, itching in the throat. It is seen in 20-40% frequent rates all over the world. Its frequency in studies conducted in our country is between 3-39%. These symptoms can be intermittent or continuous depending on the severity of the disease. In these patients, upper respiratory tract infections such as sinusitis, ear infection, adenoid infection are common. In addition, respiratory infections last longer. Male gender, family history of allergic diseases, detection of sensitivity to airborne allergens in the child, food allergy, living in a humid and moldy home environment, especially the number of older siblings, the child's being born in spring and summer, living in the green area and excessive air pollution Living in the region is an important risk factor for the development of allergic rhinitis. The diagnosis is made with clinical findings. It is important to carry out allergy skin tests to identify the allergic substance.

• Allergic Rhinitis Treatment

The treatment has 3 stages.

1. Prevention: Avoiding sensitive allergens and irritants

2. Drug treatments: For this purpose, treatments such as allergy syrups, nasal sprays with cortisone, chewable tablets / powder decongestants (nasal spray, syrup), saline washes with saline are used according to the severity of the disease.

3. Immunotherapy (vaccine treatment): By applying the sensitive allergen to the body at certain intervals, the hypersensitivity response to the allergen is reduced. It is the only treatment that changes the course of the disease, reduces the development of new allergic sensitivities and prevents the development of asthma.

Patients with mild symptomatic hay fever can perceive these symptoms normally. But allergic rhinitis is a disease that significantly impairs quality of life, learning and productivity capacity.

• ATOPIC DERMATITIS (eczema)

The most common (chronic), itchy, non-infectious and childhood

(inflammatory) skin disease. It is seen in 10-20% in childhood and 1-3% in adulthood. It usually starts in infancy. 85% of the symptoms of atopic dermatitis occur under the age of 5. It is a multifactorial disease caused by genetic and environmental factors like other allergic diseases. It may be the initial sign of other allergic diseases such as asthma and allergic rhinitis. Itching is the main finding. Typical settlements / appearance, chronic / repetitive and a family history of atopic disease are important in diagnosis. Apart from these, there are many minor signs (dryness of skin, susceptibility to skin infections, nonspecific dermatitis of the hands and feet, sensitivity to wool, prominence of palm lines, keratosis pilaris, increased serum IgE level). The diagnosis is made with clinical findings. As with other allergic diseases, allergy skin tests are also important in this disease.

• Factors That Trigger Eczema

 While allergens coming from the airway are more important in asthma and allergic rhinitis, especially allergy to food is important in this disease. There are many trigger factors in atopic dermatitis. These; food allergens (cow's milk, eggs, fish, peanuts, soy, wheat), airway allergens (house dust mites, pollen, animal hair and rash), microorganisms, irritants (bathing with hot water and soap, sweating, detergents, synthetic wool clothes) are climatic conditions (hot, dry climate), emotional stress (panic, anxiety).

General principles of treatment in atopic dermatitis; training of patients and their relatives (obtaining information that the disease will continue with repetitions, other allergic diseases may be added in the future, regular monitoring is important), taking general precautions (especially avoiding trigger factors), detecting allergens and avoiding allergens, moistening the skin, treatments that reduce inflammation and psychosocial provided with an approach. The most effective drugs in treatment are cream / ointments with cortisone. However, long-term and widespread administration of these drugs can lead to undesirable side effects (skin thinning, streaking, vasodilation, acne, osteoporosis, cataracts, glaucoma, growth retardation, suppression of the adrenal axis). Therefore, it should be used carefully. Apart from these, there are other treatments applied by skin and mouth.

• ANJIOEDEM

Hives are itchy bumps that appear on the skin surface, reddened, often pale, with a size ranging from a few millimeters to several centimeters. If these swelling grabs the lower layers of the skin and causes more pronounced swelling, especially in the eyelids, lips and ears, this is called angioedema. The hives that last less than 6 weeks are called acute hives. Infections mostly occur due to nutrients and nutritional additives, drugs and insect bites. It is seen in the community with a frequency of 15-25%. It is important that it lasts less than 24 hours and there is no bruising when healing. Generally, it is not necessary to conduct an examination with additional examination.

If the hives last longer than 6 weeks, it gets the name (chronic) urticaria. Advanced examinations are required for its diagnosis. Allergy syrups and other treatments are applied in the treatment of hives. Patients who are only angioedema with no hives should be evaluated by allergy doctors. Angioedema is a more serious condition and needs to be examined.

• ALLERGIC SHOCK

Allergic shock (anaphylaxis) is a serious life-threatening systemic allergic reaction. Another definition is a serious allergic reaction that starts suddenly and can lead to death. Many factors can cause anaphylaxis. The most important cause of allergic shock in childhood is food. While the most common allergic shocks in our country are milk and eggs, peanuts in America. Apart from these, every food causes anaphylaxis, but nuts, sesame, fish and shellfish are the foods that cause anaphylaxis most.

The most important cause of anaphylaxis in adults are drugs. Especially penicillin-derived drugs, aspirin-like drugs and anesthesia drugs cause anaphylaxis. As with foods, all kinds of drugs can cause anaphylaxis. Other common causes of anaphylaxis; bee stings, vaccines, allergens, hormones, latex. Respiratory system (cough, wheezing, shortness of breath, bruising, low oxygen), cardiovascular system (low blood pressure, fainting), neurological system (weakness (hypotonia) , fainting, incontinence) and gastrointestinal tract (cramping abdominal pain, vomiting) should be one of the symptoms. In case of anaphylaxis, help should be sought immediately (call someone, call emergency if someone is nearby). The child who had anaphylaxis is laid on his back and his feet are raised. If available, ready-to-use autoinjectors (PENEPIN) containing adrenaline should be administered to the child. Allergy syrup and cortisone medications can be given. While doing all these, you should go to the health center as soon as possible.

• HOW TO PROTECT ALLERGY?

If the allergy is proven by skin tests and allergic findings occur after contact with the allergic substance, that substance should be avoided. Of course, this is not always possible. While it is easier to avoid allergens in food and drug allergies, it is difficult to protect from airborne allergies (aeroallergens).

resources

1-Child Allergy and Asthma Academy, Allergy Terms Dictionary

2- Turkish Thoracic Society Asthma Diagnosis and Treatment Guidelines 2016. http://toraks.org.tr/book.aspx?list=2212

3-Global Intiative for Asthma. http://ginasthma.org/wp-content/uploads/2016/01/wms-gına-2017-main-report-tracked-changes-for-archive.pdf

4-Mahmut Doğru, İlknur Bostancı. Anaphylaxis and advances in anaphylaxis. Children's magazine 2011; 11 (2): 43-53.