Severe Allergies in Kids

SneezeHigh on the list of challenges related to parenting is managing the life of a child with severe food allergies. That's because the stakes are high: such children can experience the very extreme reaction to exposure to their allergen (that's the food to which they're allergic) by developing anaphylaxis. And in this issue of Pediatrics, we learn that one in eight children need not one, but two doses of a medication needed to interrupt anaphylaxis.

Anaphylaxis, of course, is medicalese for a constellation of symptoms that progresses past itching, hives and perhaps swelling of the tongue and face, to difficulty breathing, more swelling of throat and tongue, pallor, loss of consciousness, and death due to the child's inability to breath. Yikes.

Why does all this stuff happen? The allergen invokes a huge release of a body chemical called histamine. This in turn produces leakage of fluids into the tongue, throat and other vital passages for air, closing them off. Here's the bad news: such reactions are increasing as food allergies as well as other types of allergies are increasing dramatically. And this study shows some rather disturbing issues. The way to counteract the effects of histamine is to administer epinephrine, and when parents know their child has such a problem they keep a prefilled syringe on hand so they can give the drug when an emergency arises. Now we learn that a sizable percentage of kids need two doses, not one.

Other issues revealed by this study include the fact that when they were discharged from the hospital following their severe allergic reaction, only 43% of kids were prescribed epinephrine. And a paltry 22% were referred to an allergist. That's also problematic because there are treatments for food allergy, including incremental exposure to the food over time by an allergist to induce tolerance, which is potentially life saving. Yet if a child doesn't go to an allergist this strategy will not be employed. Rick and I conclude in the podcast that parents need to keep two doses of epinephrine on hand and ask for a referral for their child.

Topics we also discuss this week include exercise and avoiding weight gain in middle aged women in JAMA, the impact of one measure of kidney function in JAMA, and a heart hormone as an indicator of heart failure in Archives of Internal Medicine. Until next week, y'all live well.

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Annmarie March 5, 2013 at 4:12 am

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smilinggreenmom April 1, 2010 at 2:57 pm

I know first hand how hard it can be to manage food allergies. I have found that it does get easier along the way, and that reading food labels and knowing which foods are safe gets easier. One thing that I have found to be hard is the hard break I feel for our little boy when he longs for something that the other kids have. I usually try to make special substitutes though. I want to share the one thing that has helped our son during all of this, and that is his probiotics. He was covered with severe Eczema and food intolerance since he was a baby and nothing and no one was really able to help him until we gave him Belly Boost children's chewable probiotics! They have been such a blessing and he now looks so good and feels even better 🙂

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