How Do I Know if My Child Has Allergies?

Does Your Child Have Allergies?

By Daniel More, MD, About.com

The Progression of Allergies in Children

Allergies present in different ways in different age groups. In infants and young children, allergic disease occurs as atopic dermatitis or as food allergies. Children with atopic dermatitis are at increased risk of developing allergies and asthma, which are more likely to occur in the toddler years to school-age. This pattern of progression from one form of allergic disease to another is referred to as the “atopic march”. Atopic is a term that physicians use to mean that someone is allergic to various things (foods, environmental triggers such as pollens, molds and pet dander, for example).

Atopic Dermatitis

Typically this is the earliest manifestation of allergies, is seen in 10 to 20 percent of all children, and frequently seen during infancy. Atopic dermatitis, or eczema, is characterized by itching, with rash formation at the sites of scratching. The rash is typically red and dry, may have small blisters, and can flake and ooze over time.

In infants and very young children, this rash involves the face (especially the cheeks), chest and trunk, back of the scalp and may involve the arms and legs. This distribution reflects where the child is able to scratch, and therefore usually spares the diaper area. The location of the rash changes in older children to classically involve the skin in front of the elbows and behind the knees. Food and environmental allergies have been shown to worsen atopic dermatitis.

Food Allergies

Food allergies can also present in infants and young children, and usually occur after the introduction of solid foods. Almost all children with food allergies will have some form of skin symptoms as a result of eating the culprit food, such as hives, swelling, itching or redness of the skin. These symptoms typically occur within a few minutes of eating the food in question, although can be delayed up to a couple of hours.

Other symptoms of food allergies in young children can include nausea, vomiting, stomach aches, diarrhea, breathing difficulties (asthma symptoms), runny nose, sneezing, and lightheadedness. In some cases children can experience a severe allergic reaction, called anaphylaxis, which can be lifethreatening.

Nasal Allergies

Allergic rhinitis will occur in about 50 percent of those children with atopic dermatitis. While most children won’t start to experience allergic rhinitis until grade school age, some children develop it sooner. Most children with allergic rhinitis experience symptoms from pets, dust and mold at an earlier age and from pollens at a later age.

Symptoms of allergic rhinitis include sneezing, runny nose, itchy nose and eyes and nasal congestion. Some children may also experience post-nasal drip, allergic shiners (dark circles under the eyes), and a line across the nasal bridge from an upward rubbing of the palm of the hand on the nose, a sign called the “allergic salute”.

Asthma

Asthma occurs in about 8% of all people, and is the most common chronic disease in children. The majority of cases of asthma are due to allergies. In fact, 1 in 4 children with allergic rhinitis will develop asthma. Asthma can occur at any age, although is most often seen in males in the pre-teen years and in females in the teenage years. Sometimes asthma is difficult to diagnose in very young children, and may require a physician who is an asthma specialist.

Symptoms of asthma may include:

• Coughing. This can be the only symptom in some children who have “cough-variant asthma”. The cough is often dry, hacking, and worse at night and after exercise. Some children cough so hard that it causes them to vomit. Keep in mind that there are many causes of a cough, and not all coughing is due to asthma.

• Wheezing. This is a high-pitched, musical-like sound that can occur with breathing in and out in children with asthma. This usually gets worse with other asthma symptoms, and flares with exercise and other asthma triggers. Keep in mind that not all wheezing is due to asthma.

• Shortness of breath. Some children may get out of breath faster than their friends, and as a result become less active. Children with more severe asthma have shortness of breath at rest or wake-up with this during the night.

• Chest tightness. A child may describe this as a feeling of someone squeezing or hugging them. Other children say that the chest hurts or feels “funny”.

• Other symptoms that are not specific to asthma include infants with feeding difficulties, children who are tired all of the time or who avoid sports and other activities, and children who have difficulty sleeping.

If your child is experiencing any of the above signs or symptoms, he or she may have allergies. It is recommended to see your child’s doctor so that a diagnosis can be made, or a referral sent to an allergist/immunologist for specialized allergy testing.

The Basics of Atopic Dermatitis

By Daniel More, MD, About.com

Overview

Atopic dermatitis is a chronic, recurrent skin disease which commonly occurs in infancy and early childhood but can continue or start in adults. Like other allergies and asthma, atopic dermatitis tends to run in families. The skin rash associated with atopic dermatitis is called eczema.

It is important to note that atopic dermatitis is not a rash that itches. Rather, it is an itch, that when scratched, results in a rash. Therefore, if the itching can be controlled, and there is no scratching, there will be no rash (eczema).

Atopic dermatitis is very common in childhood, affecting up to 20% of kids, usually before the age of 5. The disease is less common in adults, affecting only 1 to 3% of the population, although can start at any age. It is rare to see atopic dermatitis in adults over 50 years of age.

In general, when atopic dermatitis occurs in infants, it usually is more severe, although many cases resolve or improve in later childhood. Children with atopic dermatitis are much more likely to have other allergic diseases, including allergic rhinitis and asthma.

Diagnosis

The diagnosis of atopic dermatitis is made by the history of the symptoms and the examination of the patient by a physician. There is no laboratory test to diagnose this condition.

There are three criteria that must be present in order to diagnose atopic dermatitis:

1. Atopy. The person must be atopic, or have a family history of allergic diseases in close relatives. There may be rare cases in which a person has atopic dermatitis without evidence of atopy.

2. Pruritis. Pruritis is the medical term used for itching. The patient must have itching and scratching in order for the rash to occur. If the skin or areas of the rash do not itch or have not been scratched, then the person does not have atopic dermatitis.

3. Eczema. Eczema refers to the appearance of the rash in patients with atopic dermatitis, and occurs in other skin diseases as well. The rash appears red, with small blisters or bumps present. These may ooze or flake with further scratching. Over the long-term the skin appears thickened and leathery.

Location of Eczema

The location of eczema is dependent on the area of the body that is scratched. In infants and very young children this rash involves the face (especially the cheeks), chest and trunk, back of the scalp and may involve the arms and legs. This distribution reflects where the child is able to scratch, and therefore usually spares the diaper area.

In older children and adults, the location of the rash changes to classically involve the skin in front of the elbows and behind the knees. Eczema can also involve the face (especially the eyelids), and may be limited to the palms of the hands and soles of the feet in certain people.

Triggers for Itching

Itching of the skin can be caused by irritants, infections, allergies and stress. Irritants cause itching through direct stimulation of the skin, and include harsh soaps, chemicals, wool fabrics, heat and sweating. Avoidance of these irritants through use of gentle soaps, wearing cotton clothing, and keeping cool and dry can help prevent itching.

People with atopic dermatitis are more susceptible to skin infections by various bacterial, fungal and viral infections. Many are have large amounts of a common skin bacterium, called Staphylococcus aureus, which can worsen the itching and eczema. Herpes infections (similar to the kind that causes cold sores) and the virus responsible for chicken pox and shingles can cause severe skin infections in people with atopic dermatitis.

Allergies can be a significant trigger for itching in people with atopic dermatitis. Usually allergens that come in direct contact with the skin, such as animal danger and dust mites, cause the most problems, although pollens and mold spores in the air can also worsen the condition.

Food allergies can also be a major trigger for people with atopic dermatitis, particularly in children. Egg and milk allergy are the most common food allergies in children worsening eczema, although other food allergies are also common.

Allergy testing is an important part of the evaluation of patients with atopic dermatitis, and avoidance of these triggers, both environmental and food allergens, can significantly improve the disease.

Common Allergic Rashes

By Daniel More, MD, About.com

This person has atopic dermatitis on the arms. Red, scaly plaques can be seen on the inside of the elbows. In adults, atopic dermatitis usually involves the body creases, or flexural areas.

There are many types of itchy skin rashes. However, not all rashes that itch are related to skin allergies. The following are the most common types of allergic skin rashes.

Atopic Dermatitis (Eczema)

Atopic dermatitis frequently occurs in young children, although may start in young adults, and can continue into adult life.

The rash of atopic dermatitis, often called eczema, occurs where a person scratches. In infancy, the rash occurs on the chest, cheeks and scalp, where the child is able to scratch. Older children and adult typically have the rash in the skin folds of the elbows and behind the knees, although may also occur on the face, neck, hands, feet and back.

The rash is red, often flakes or oozes, and has small blisters or bumps. There are often excoriations, or areas of broken skin, from aggressive scratching.

Urticaria (Hives) and Angioedema (Swelling)

Urticaria, commonly called hives, is an itchy rash that can occur at any age. This rash appears as raised red bumps of various shapes and sizes, and typically lasts for only minutes to hours. While it can be very itchy, a person will generally not excoriate (scratch to the point of breaking the skin and cause bleeding) themselves.

The swelling that sometimes goes along with urticaria is called angioedema, and often involves the lips, the eyes, and the hands and feet. Angioedema is usually not itchy or red, it tends to burn, sting or cause a tingling sensation. Severe swelling that blocks the ability to breathe can be dangerous and even life-threatening.

Contact Dermatitis

Contact dermatitis is caused from skin contact with a substance that causes a rash-like reaction. People react to a variety of chemicals, including cosmetics, hair dye, metals, topical medications and dental materials. An example of a contact dermatitis is a rash from poison ivy, which is an extremely itchy and appears as blisters that ooze and crust after contact with plants of the Toxicodendron family.

A contact dermatitis rash may look like atopic dermatitis, but the rash is typically located only in the area of contact with the offending chemical. Common locations include the face, especially the eyelids, neck, hands and feet. Contact dermatitis to metals, such as in jewelry or snaps/buttons/zippers on clothing, commonly occurs on the neck, wrists/hands, earlobes and at the waistline.

Itching Without a Rash

It is a relatively common problem for people to have itching without a rash being present. The medical term for itching is pruritus, and this symptoms can represent a skin problem, or even an internal disease within the body.

When the itching is limited to a certain area of the body, the most likely reason is a disease process limited to the skin. The area of the body that itches often gives a big clue as to the cause of the itching.

Pruritus the involves the entire body may still represent a disease of the skin, or may be caused by metabolic problems such as thyroid disease or iron deficiency. Many medications can cause itching, particularly pain medications like codeine and morphine.

Atopic Dermatitis Treatment With Medications

By Heather Brannon, MD, About.com
Treating atopic dermatitis often requires a combination of home measures and medications, or other treatments. Because the skin in atopic dermatitis is "leaky," the foundation of treatment is improving the barrier function of the skin.
Basic Treatment of Atopic Dermatitis
Because the atopic dermatitis rash can come and go, different medications are often prescribed and used for various stages of the rash. The following are medications that may be prescribed to help manage the condition.
Topical Steroids
Topical steroids are still the first-line treatment for atopic dermatitis flares because they are effective at reducing the inflammation caused by this disease. Topical steroids come in 7 different strengths, and it is important to use the correct strength for the affected part of the body.
High-strength steroids are typically reserved for use on the arms and legs. Atopic dermatitis on the face and skin folds (armpits, groin, etc.) are usually treated with a low-strength steroid. More potent steroids are generally avoided when treating these areas, though limited and brief use -- prescribed by a dermatologist -- may help produce rapid results; patients can then be switched to a milder steroid.
Calcineurin Inhibitors
The calcineurin inhibitors are Protopic (tacrolimus) and Elidel (pimecrolimus). They are known as immunomodulators because they change some of the functions of the immune system that cause atopic dermatitis without suppressing the whole immune system. They should only be used during flare-ups.
Antihistamines
Oral antihistamines, such as Benadryl (diphenhydramine) or Atarax (hydroxyzine), can be used to treat itch associated with atopic dermatitis. It's important to note, however, that they can cause sleepiness and may not help in all cases of atopic dermatitis. Antihistamine creams should not be used on atopic dermatitis rashes because they contain chemicals that can actually worsen the rash.
Oral Antibiotics
Atopic dermatitis reduces the skin's natural defenses, making it easier for skin to become infected. If a person's atopic dermatitis is not improving as expected, this may be because the skin is infected. In this case, antibiotics are often prescribed. Antibiotics, such as Duricef(cefadroxil) or Keflex (cephalexin), are often prescribed at the first sign of infection.
Oral Steroids
Oral corticosteroids, such as prednisone, prednisolone, and medrol, may be used for more severe flares of atopic dermatitis. They are used if the rash covers a large part of the body and face. Oral steroids used long term have numerous side effects, including weight gain, thinning of the bones, and suppression of the immune system. Though they may clear atopic dermatitis well, the side effects are too risky to warrant using them as a first-line treatment. To avoid these side effects, but still benefit from the medication, oral steroids are often prescribed for a short course (5 days) to calm the rash. Topical steroids can then be used on the remaining rash.
Coal Tar
Coal tar, actually made by melting coal, has long been a treatment for a variety of skin conditions. Shampoos and soaps containing coal tar can help with mild cases of atopic dermatitis. Coal tar tends to work better on thickened skin that is not scaly, or to ease very early symptoms of itching. However, coal tar can be very irritating to already inflamed skin. It is OK to try coal tar for mild cases of atopic dermatitis, but use should stop immediately if there is any increase in itching or redness of the rash.
Leukotriene Inhibitors
Leukotriene inhibitors, such as Singulair (montelukast) or Accolate (zafirlukast), are medications that may help reduce the inflammation that leads to atopic dermatitis. These medicines are often used to treat other allergy-related diseases, such as asthma and allergic rhinitis (seasonal allergies). Though they may be recommended by some, there is currently no good data that shows that leukotriene inhibitors improve atopic dermatitis.
Other Immune-Suppressing
MedicationsMany medications are being investigated to see if they can be used to treat atopic dermatitis. Most of them are used to treat other related diseases, such as psoriasis or allergic rhinitis. These medications include:
Cyclosporine
Interferon
Methotrexate
Azothiaprine

Atopic Dermatitis Home Treatment

By Heather Brannon, MD, About.com
Atopic dermatitis is a persistent, itchy skin condition that comes and goes. Even though there is no cure for atopic dermatitis, with the right knowledge, it can be managed. This means that you can:
- Reduce itchiness, redness and scaling
- Go longer with normal, non-itchy skin
- Take care of flare-ups before they get worsen
First, Keep in Mind that Avoiding Allergens May Not HelpWe have long recommended various strategies to reduce exposure to certain allergens such as reducing dust mites, waiting to give solid foods to infants until they are older, restricting certain foods in the diet for moms who are pregnant or breastfeeding, breastfeeding as long as possible and avoiding pollen.
While these strategies seem to make sense based on our knowledge of what causes atopic dermatitis, recent medical studies do not clearly show that they actually help.

But Avoiding Known Triggers Is Helpful

Of course, if certain triggers have caused flare-ups in the past, it makes sense to avoid these triggers. Examples of common triggers include:
- Perfumes or scented skin care products
- Exposure to cats or dogs
- Known food allergies -- especially to milk, eggs, peanuts and shellfish
- Heat, perspiration, or low humidity
- Rough clothing, especially wool
- Viral skin infections such as herpes simplex
- Stress and anxiety

How to Minimize Scratching

To break the itch-scratch cycle, you have to stop scratching. For some people this may seem like an almost impossible goal, but here are some things that can help:
- Taking antihistamines like Benadryl or Zyrtec can help control itchiness and prevent scratching during sleep
- Cut your nails short
- Wear mittens at night to keep from scratching
- Use loose gauze wraps to protect the skin
- Slather on the right moisturizers to help with itching

Atopic Dermatitis Skin Care

Good skin care for atopic dermatitis is one of the most important measures you can take to keep flare-ups from starting. And if you do have a flare and need to use medication, if you've taken good care of your skin, it will heal faster.

Eczema Skin Care

How to Take Good Care of Your Skin if You Have Eczema

By Heather Brannon, MD, About.com
It is important for people with eczema and their loved ones to understand how to take care of their skin because using the wrong soap or moisturizer can cause flare-ups that are itchy or painful. On the other hand, using the correct soap or moisturizer can calm down inflamed skin or prevent flare-ups.
Eczema - "Leaky Skin"
In general people who have eczema have "leaky skin," meaning the barrier function of their skin does not work well. Practically this means:
- Anything that goes on the skin soaks in to the deeper layers that activate the immune system.
- The skin loses water and the natural oils that normally moisturize it and keep it supple. These changes cause the skin to be drier than normal skin and more sensitive to anything that comes in contact with the skin.
Water - Good or Bad?
You would think that putting water on the skin would moisturize it more, but the opposite is true. Plain water that comes in contact with the skin evaporates and takes with it many of the skin's natural oils called natural moisturizing factor (NMF). The more often the skin has contact with water, the drier it gets unless those natural oils are replaced. But your skin has to come in contact with water when you bathe and wash your hands. Is it more important to bathe to clean the skin or avoid water to keep the skin moisturized? The following are some guidelines to follow when it comes to water contact:
- Water temperature should be tepid -- hotter water takes more oils away than cooler water.
- The length of contact should be short -- no long, hot showers especially if you have a flare-up.
- Using antibacterial gels for hand-washing does not cause the skin to dry out because the alcohol does not bind to NMF taking them away when it evaporates.
- When drying off, pat the skin dry with a towel until the skin is not dripping -- do not rub the skin vigorously.
- Use a good moisturizer on the skin immediately after any contact with water.
Soaps for Eczema
The effect of soap on the skin is not good for people with eczema. Most soaps, especially bar soaps, dry the skin out. Liquid cleansers are much less damaging to the skin than bar soaps. Using an emollient-rich liquid cleanser that leaves a moisturizer on the skin when the soap is washed off is the best choice for people with eczema. For specific product recommendations, see the best soaps for eczema.
Moisturizers for Eczema
Not only is it important to use a moisturizer often (up to three times a day), it is important to use one that does not contain perfumes, fragrances or essential oils, because these are all potentially very irritating to eczematous skin.
Moisturizer Recommendations
I don't have one moisturizer I would recommend over the others -- they all have pros and cons. The following are different types of moisturizers to consider:
The moisturizers for scaly eczema would be a good choice if you have a lot of flaking without a flare because they can sting if applied to open areas on the skin.
The emollient moisturizers are a low-cost option, especially if you are in the middle of a flare-up, because they are not irritating.
The new ceramide moisturizers help the skin heal faster during a flare, but the only low-cost option does not have published data proving it is effective. If you can afford them, these moisturizers would be a great choice with or without a flare.