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Allergic illnesses have a significant impact that allergic diseases have on children's health and quality of life. Allergic diseases, including asthma, are among the major causes of chronic illnesses in the United States, affecting approximately 50 million patients or as many as one in
General Features of Allergic Diseases
Allergic diseases are immunoglobulin E (IgE)-mediated immunologic illnesses that can affect any of the body's major organ systems either individually or collectively. Typically, children are not born having allergies because maternal IgE normally does not cross the placenta. In rare instances, neonates and young infants who
Epidemiologic surveys indicate that the familial trait for allergy is inherited as autosomal recessive. Whereas the frequency of positive allergy skin tests is similar in boys and girls, asthma is twice as common in males as in females prior to
Allergens sensitize by several potential routes and are categorized as inhalants, ingestants, injectants, and contactants (Table 1). It is important for the
Inhalant Allergy
Microscopic inhaled airborne allergens are responsible for most respiratory allergy (Table 2). In temperate climates, seasonal allergic rhinitis is induced by tree pollens in the early spring, grass pollens in the late spring and early summer, and ragweed in the late summer and early fall. Because of geographic differences in the US, clinicians must become familiar with the pollination patterns in their individual regions. Hay fever is an inappropriate term for allergic rhinitis because these
In addition to allergens, viral infections, aerosolized cosmetics, cigarette smoke, industrial fumes, and changes in temperature, humidity, and barometric pressure contribute to exacerbation of both upper and lower respiratory tract symptoms in
DIAGNOSTIC TESTS
Nonspecific Allergy Tests
Many pediatricians believe in the need for a screening test for allergy. Blood eosinophilia and total serum IgE levels have been proposed as screening tests, but they have relatively low sensitivity and should be used selectively (Table 3).
Ingestant (Food) Allergy
The evaluation of the child who is suspected of having a food allergy can be fraught with unnecessary confusion because of misuse of terms. It is important to define the clinical syndrome to enhance understanding of the medical problem. An adverse food reaction is a generic term used to describe any untoward reaction following the ingestion of a food or food additive. Adverse food reactions can be categorized into food allergy (food hypersensitivity) or food intolerance. A food allergy is an abnormal immunologic response. A food intolerance is due to a nonimmunologic mechanism, such as
DIAGNOSTIC TESTS FOR FOOD HYPERSENSITIVITY
The evaluation for adverse food reactions begins by attempting to define whether the patient is suffering from a nonimmunologic intolerance or from an immune reaction, which can be IgE- or nonIgE-mediated. The following must be established if possible: 1) the identity and quantity of the food allergen suspected of provoking the reaction, 2) the time elapsed between the ingestion of the suspected food and the onset of symptoms, 3) a complete description of the symptoms elicited and the duration of the
An elimination diet can be used as a diagnostic and therapeutic test when the history suggests that certain foods may be provoking the specific symptoms. Foods and all "hidden" sources of those foods suspected of inducing symptoms are
The role of breastfeeding and food allergen avoidance in the