Allergy in children_fd1e29b0179f990a3e7ca4088842acb2.pdf

University of Baghdad College of Medicine 2022-2023 Title: Allergy in children Grade: fifth Module: Pediatrics Speaker:Prof. Dr. Muhi Kadhem Al-Janabi Date: 2022-2023  University of Baghdad/...

University of Baghdad College of Medicine 2022-2023 Title: Allergy in children Grade: fifth Module: Pediatrics Speaker:Prof. Dr. Muhi Kadhem Al-Janabi Date: 2022-2023  University of Baghdad/ College of Medicine 2022-2023 Allergic disorders in children Up to 40% of children have one or more allergic disorders (eczema, allergic rhinitis, or asthma). Up to 6% have food allergy. allergic disorders increased in prevalence  University of Baghdad/ College of Medicine 2022-2023 Risk is lower in: children of large families. children raised on farms. Cause : altered microbial exposure associated with modern living University of Baghdad/ College of Medicine 2022-2023 Hygiene Hypothesis  University of Baghdad/ College of Medicine 2022-2023 Abnormal immune system may result in: allergic diseases autoimmune disorders organ-specific: type I diabetes mellitus systemic: systemic lupus erythematosus Immunodeficiency  University of Baghdad/ College of Medicine 2022-2023 Allergic reactions: 1. IgE mediated: The majority of severe life-threatening allergic reactions are IgE mediated early phase occurs within minutes of exposure caused by release of histamine and other mediators from mast cells. Causes urticaria, angioedema, sneezing, vomiting, bronchospasm and/or cardiovascular shock late phase occurs after 4–6 hours of exposure. causes nasal congestion, and cough and bronchospasm.  University of Baghdad/ College of Medicine 2022-2023 Allergic reactions: 2. non-IgE mediated delayed onset of symptoms more varied clinical course e.g. GIT symptoms  University of Baghdad/ College of Medicine 2022-2023 History and examination An allergy-focused history is the cornerstone to a correct diagnosis. mouth breathing , allergic salute, nasal ( allergic ) crease pale and swollen inferior nasal turbinates hyperinflated chest or Harrison sulci atopic eczema allergic conjunctivitis prominent creases (Dennie–Morgan folds) blue grey discoloration below the lower eyelids Growth faltering  University of Baghdad/ College of Medicine 2022-2023 Allergic face (a) habitually open mouth due to mouth breathing. (b) allergic salute, from rubbing an itchy nose. Allergic disorders at different ages: University of Baghdad/ College of Medicine 2022-2023 Eczema and food allergy in infancy. Allergic rhinitis, conjunctivitis and asthma in preschool and primary school. Allergic disorders often coexist  University of Baghdad/ College of Medicine 2022-2023 Investigations Skin prick testing For food and inhaled allergens, and drug or insect sting allergies. Negative tests suggest that allergy is unlikely. Raised total IgE, specific IgE. ( atopy)  Negative results make IgE-mediated allergy unlikely. Allergen challenge If history and investigations are not clear if the child is thought to have grown out of an allergy Spirometry and other lung function tests University of Baghdad/ College of Medicine 2022-2023 Skin prick test Multiple positive results are present. Weals of 4 mm or greater are positive.  University of Baghdad/ College of Medicine 2022-2023 Prevention of allergic diseases definite reduced risk immune tolerance by feeding common food allergens may reduce risk house dust avoidance for children with asthma. approaches tried without success : probiotics, nutritional supplements, medications.  University of Baghdad/ College of Medicine 2022-2023 Food allergy  University of Baghdad/ College of Medicine 2022-2023 Common causes of food allergy In infants cow’s milk, eggs, nut In older children peanut, fish, shellfish Fruits, legumes and seeds are also common causes of IgE mediated food allergies.  University of Baghdad/ College of Medicine 2022-2023 IgE-mediated food allergy occurs 10–15 minutes (up to 2 hours) after ingestion of a food urticaria facial swelling anaphylaxis atopic eczema  University of Baghdad/ College of Medicine 2022-2023 Non- IgE-mediated food allergy occurs hours after ingestion involves GIT : diarrhea, vomiting, abdominal pain blood in the stools in the first few weeks of life Eosinophilic esophagitis: vomiting and dysphagia faltering growth  University of Baghdad/ College of Medicine 2022-2023 Food intolerance A non-immunological reaction to a specific food is called food intolerance. ( lactose intolerance )  University of Baghdad/ College of Medicine 2022-2023 Diagnosis Clinical history typical symptoms occur following exposure to a particular food. confirmatory tests for IgE-mediated food allergy skin prick tests and specific IgE antibodies  University of Baghdad/ College of Medicine 2022-2023 Management Avoidance of the relevant food. heat degradation or other forms of processing for proteins manage an allergic reaction Written self-management plans  University of Baghdad/ College of Medicine 2022-2023 Management Mild reactions (rash, swelling of lips/face/eyes) treat with non-sedating antihistamines. Severe reactions (with cardiovascular, laryngeal or bronchial involvement) treat with adrenaline given intramuscularly by autoinjector (EpiPen), which the child or parent should carry with them at all times.  University of Baghdad/ College of Medicine 2022-2023 Management Immunotherapy giving minute amounts of the food, and building up that amount over time.  University of Baghdad/ College of Medicine 2022-2023 Prognosis Food allergy to cow's milk and egg often resolves in early childhood Food allergy to nuts and seafood usually persists through to adulthood. diagnosis should not be made lightly dietary restrictions and fear of accidental reactions make a major impact on family life.  University of Baghdad/ College of Medicine 2022-2023 Summary Food allergy: Affects up to 6% of children. most common causes are egg, milk, nuts, seafood, wheat, legumes, seeds and fruits. Diagnosis of IgE-mediated food allergy is based on history and by skin-prick tests or specific IgE antibodies. If at risk of a severe reaction, should carry an adrenaline autoinjector.  University of Baghdad/ College of Medicine 2022-2023 GOOD LUCK