Christopher C. Chang
Christopher C. Chang, M.D., Ph.D, Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Has your child ever told you that certain foods cause tingling and itching in and around the mouth and the back of the throat? Does this occur within minutes of eating the food?
If your child also has seasonal allergies, it’s likely that this reaction is oral allergy syndrome. These symptoms occur because the proteins in some fruits and vegetables are similar to proteins in some pollens. These proteins can confuse the immune system and cause an allergic reaction or make existing symptoms worse.
People who are allergic to any type of pollen have a 50 percent chance of developing oral allergy syndrome. One of the most common types of cross-reactivity involves birch tree pollen and apple. Other food triggers associated with this pollen include peach, pear, kiwi, plum, coriander, fennel, parsley, celery, cherry and carrot. When one makes antibodies to the pollen, they also become sensitized to these fruits and vegetables. The Philadelphia area has an abundance of birch pollen and oral allergy syndrome is quite common here.
Sensitivity to mold is similar to pollen allergies and affects both adults and children. While allergies associated with outdoor mold spores peak in warm weather, indoor mold can pose problems year round.
Mold is another name for fungi – unsightly patches of brown, black, green, or yellow fuzzy growths. Mold, unwanted and usually unpleasant, is associated with damp basements, walls and carpets, dirty bathroom grout and musty smells. But without mold, we wouldn’t have penicillin, blue cheese, bread, beer, wine or edible mushrooms! In other words, mold isn’t all bad.
Most people, no matter where they live, are exposed to mold to some degree. Dampness and humidity provide the perfect breeding ground for mold. Mold is fairly ubiquitous, thriving on dampness virtually anywhere. To demonstrate an allergy, you must first be exposed and sensitized to the allergenic substance.
By Christopher C. Chang, M.D., Ph.D.
A lot of children experience wheezing in response to weather conditions, allergens, air quality and exercise. For those who live in cities and industrial areas, the prevalence of wheezing and asthma increases. Big cities such as Philadelphia have air quality problems – all one has to do is drive down I-95 flanked by smokestacks with different colored gases pouring out of them to see evidence of air pollution. According to the American Academy of Pediatrics, children and infants are among the most susceptible to many air pollutants.
There are several pollutants that are deemed to be sufficiently hazardous to humans to merit their measurement by the Environmental Protection Agency (EPA). They include ozone, sulfur dioxide, nitrogen dioxides, carbon monoxide, particulate matters, and lead. Particulate matter varies in size. Those that are less than 2.5 micrometers in diameter are known as fine particles. Scientists have linked fine particle pollution with significant health problems, including aggravated asthma, decreased lung function and difficulty breathing. Although air pollution doesn’t necessarily cause asthma (this is still controversial), it can be a factor in making symptoms much worse.
A skin rash…itching…breathing problems…swelling. These can be warning signs that your child is having an allergic reaction to a medication he or she is taking. Some reactions -- like difficulty breathing, hives, fainting, dizziness or abdominal pain -- are a medical emergency that require a call to 9-1-1 and immediate action. But other times, drug reactions aren’t true allergies (in one Canadian study, just one in four reactions to antibiotics in children were allergies) -- but how can a parent tell the difference?
In this post, Healthy Kids expert panelist Christopher C. Chang, MD, PhD, of Nemours/Alfred I. duPont Hospital for Children explains the basics.
By Christopher C. Chang, MD, PhD
by Christopher C. Chang, M.D., Ph.D.
Editor’s note: Six million American kids have food allergies - and studies show that up to 18 percent of them have had a reaction to a food eaten at school. How can you keep your kid safe and stop worrying? Allergy expert Christopher C. Chang, M.D., Ph.D. of Nemours/Alfred I. duPont Hospital for Children has this advice.
Imagine your child bites into a French fry, only to feel that familiar upset stomach and itching sensation begin – a typical allergic reaction. You know she’s allergic to fish, but this is a potato! As it happens, the French fries had been cooked on the same equipment that was used to fry fish.
by Christopher C. Chang, M.D., Ph.D.
Your daughter pets a bunny and you notice her eyes get puffy. Your son eats shrimp dip and later complains of an itching sensation in his throat. Is it an allergy? Maybe, maybe not. In order to be certain, we perform allergy tests.
Rashes and hives worry parents. We look for triggers in substances which may have been ingested, inhaled or that have come in contact with the skin. When the culprit is poison ivy, for example, it is obvious and there’s no need to test for it. But environmental and especially food allergies can cause a variety of reactions, from the mild cases to full-blown life-threatening anaphylaxis. That is why it is a good idea to proceed with testing when allergies are suspected.
by Christopher C. Chang, M.D., Ph.D.
We all look forward to enjoying summer’s bounty of fresh fruits and vegetables at the peak of the season. However, for some of us, fruits and veggies can cause allergic reactions ranging from hives and swelling of the skin to irritation of the mouth and throat. Some of the most common fruit allergies include melons, apples, strawberries and bananas.
What parents can do: Once you know a child is allergic to these foods, avoidance is the only reliable treatment. But if you’re not sure there has been a reaction, skin-prick test or a blood test may be helpful. After all, we want kids to enjoy these healthy foodsif they can indeed tolerate them.
by Christopher C. Chang, M.D.
In the summertime, our region is abundant with stinging insects including apis (e.g. honeybees), vespids (e.g. yellow jackets, wasps and hornets) and formicids (e.g. fire ants). Stings from all of these species can cause a variety of reactions, ranging from local reactions such as pain, swelling and redness at the site of the sting, to full-blown anaphylaxis–life-threatening swelling of tissue in the mouth and throat that can block airways.
For the majority of kids and adults, a bee or wasp sting is just a nuisance. But for others, a more serious reaction can occur due to the toxin in the venom or an allergic reaction to the sting. Here’s how to avoid stings – and how to react if a child (or adult) with you has a troubling reaction.
Pollen season came early this year, bringing with it an early start to the sneezing, sniffling, itchy-eyes season for many kids. If your child’s discomfort lasts for weeks or months on end or is so severe that it interferes with school, other activities or sleep, you may wonder if allergy shots are the answer.
At Nemours, only a small proportion of our allergy patients receive allergy shots. In fact, allergy shots were more common 30-40 years ago than they are today for a variety of reasons. Now medication does the trick for most kids.
There are basically three treatments for allergies:
- Avoid the allergen. Environmental controls such as keeping windows shut on high-pollen days and keeping pets out of a child’s bedroom; if he or she is allergic to pet dander.
- Medication to relieve symptoms. These include antihistamines and decongestants (ask your doctor about the best types and dosage for your child) and prescription drugs such as inhaled nasal steroids and leukotriene antagonists.
- Allergy shots. To treat allergies that are not effectively relieved by medications, allergy shots are a viable option for children. For some kids, allergy shots may temporarily alter their immune systems and allow them to develop tolerance to allergens. Shots don’t work for everyone or every allergen; for example they haven’t been effectively studied in the treatment of mold and certain animal allergies (horses, rabbits, etc). However, they do work well for dust mite, some common household pet allergies (dog and cat), grass and other pollen allergies.
When it comes to alternative remedies for children’s allergies, my mantra is “buyer beware.” At best, some herbals are viewed as “promising,” but the scientific research into their therapeutic benefit has just begun.
If your child has respiratory allergies – to springtime tree pollen or to grass or ragweed pollen later in the summer or fall – you may have considered alternative remedies due to worries and fears about over-the-counter and prescription allergy medications or the desire to provide more ‘natural’ relief for your child. Here’s what you should know:
Do alternative therapies for allergies work? The jury’s still out. We have to approach alternative therapies for allergies the same way we approach pharmaceutical drugs – by starting in the lab to see what the agent does to the cells, then moving to animal models and finally conducting clinical trials in humans. There is simply not enough good evidence out there for me to recommend herbal remedies, acupuncture, or manipulative therapies, such as massage, for the treatment of allergies. If families are reading Web sites that promote certain alternative remedies, I remind them that the jury is still out and they should proceed with caution. These treatments are not necessarily harmless, and they may have no clinical effect, either.
