FAQ’s Allergy and Intolerance
What should I do if my child has an allergic reaction?
Anaphylaxis is rare however, if you think your child has had an anaphylactic reaction especially with collapse, loss or decreased level of consciousness, breathing difficulties (including wheezing), tongue swelling or spreading lip facial swelling, do call an ambulance without delay. Do NOT put your child in a car and drive as moving them in a car seat without oxygen may be very dangerous. It is important to try and stay as calm as possible in order to keep your child calm as any narrowing of their airway may worsen if distressed. A child who is finding breathing difficult will usually want to sit up, leaning forwards slightly with their chin slightly sticking out. This is instinctive and is the position that will keep their airway open. If your child is doing this do NOT try and lie them down. If they have any food left in their mouths encourage them to spit it out.
If your child is seen in hospital having had a serious allergic reaction, they are likely to receive antihistamine medicine, steroid medicine and possibly adrenaline. Trained paramedic ambulance crews are also able to give adrenaline if needed- another reason to call an ambulance if you are worried. They will then need a period of observation in hospital until the signs of the reaction die down. Follow up in a paediatric allergy clinic is usually arranged and depending on the severity of the reaction, you may be given an adrenaline “pen” to take home. If you are given one, you will be trained how to use it and all people who care for your child will need to receive this training. Spare pens will need to be provided in due course for school or nursery. They must be replaced when out of date. Having said that, the vast majority of allergic reactions do not need adrenaline. It is a medicine that carries its own risks so must not be given lightly and anyone who receives adrenaline must be taken immediately to hospital.
If you think your child has had an allergic reaction but not as severe as the above, then you can either see your GP or go to your local Emergency Department depending on how urgently you feel they should be seen. If your child has had a rash or mild facial swelling not involving the lips or tongue but seems well in themselves, with no breathing difficulties, then it is probably appropriate to see your GP. If the rash is itchy or troublesome a dose of antihistamine such as Piriton may be helpful if you have it at home. Your GP may refer you to a paediatric allergy clinic for severe or especially troublesome allergies.
It is difficult if there have been several possible causes of the reaction but often with severe reactions, it is clear what the offending food has been. Obviously, you must avoid giving this food again or anything containing it until you have seen your GP for further advice. Do make sure that all people who care for your child are aware of all possible allergy causing foods.
Can my child be tested for allergy?
Only if your child has had a fairly clear allergic reaction. The results of the tests can be impossible to interpret without a detailed history of an allergic event so your child cannot be currently tested “just in case they may be allergic to something”.
In considering tests it is important for your doctor to try and identify what sort of hypersensitivity reaction your child has had so they should ask detailed questions about the symptoms of the reaction. This is so that they can decide whether your child has had an allergic reaction involving IgE in the immune system (“IgE mediated”), an allergic reaction that does not involve IgE (“Non IgE mediated”) or a Non Allergic Food Hypersensitivity (Intolerance), as discussed above under “How can I tell if my child is allergic to something”. Different tests are needed for each type of reaction. If the wrong test is used the results can be meaningless.
For IgE Mediated Allergies:
Skin Prick Tests: These are the most commonly used and are simple and quick. A tiny amount of the protein thought to be the cause of the allergic reaction is placed on the childs skin and a tiny puncture is made in the skin. The size of the weal (reaction- skin redness/ swelling) is measured. This test does have some false positives which means that a positive test does not always mean that your child is actually allergic to the substance.
For this test to work, children cannot be on antihistamine medicines so it cannot be used for children in whom it is unsafe/ too unpleasant to stop antihistamines.
Blood Tests: Such as RAST tests measure the amount of IgE in the individuals blood to specific allergens (causes of allergies). This is a very expensive test and only a few different foods/ allergens can be tested for.
It is a useful test for children who cannot stop their antihistamines or have conditions like eczema which make skin prick tests difficult.
It is a less accurate test than skin prick testing with false positives (a positive result does not always mean that the child is actually allergic to the substance) and false negatives (a negative result does not always mean the child is not allergic to the substance).