Allergies in children are very common and can exhibit a range of symptoms. Holly Shaw goes through the most common allergic conditions in children and how pharmacists can help manage them
KEY LEARNING POINTS
• Allergies are very common in the UK, with one in five people affected by at least one allergic condition
• Allergies are even more common in children
• Children whose tongues have swollen up due to allergy should be referred directly to A&E
The UK has some of the highest prevalence rates of allergic conditions in the world, with more than 20% of the population affected by one or more allergic disorder. Allergies are more common in children with up to 50% of them diagnosed with an allergic condition. Allergy symptoms can affect all aspects of a child’s day-to-day life, including their health and wellbeing, education and social activities.
But this doesn’t have to be the case. Community pharmacists can play a valuable role in helping customers manage or treat their child’s symptoms. They are well placed to support parents of allergic children with advice and appropriate treatments.
These can include:
• Supplying prescription-only medicines and advising on appropriate OTC medicines. The choice of anti-allergy products is vast and potentially bewildering for parents and carers: pharmacists can help them recognise symptoms suggestive of allergy, identify possible allergy triggers and select appropriate OTC products.
• By providing expert advice on how to take prescribed medicines for allergic conditions.
• By providing specialist medicines management services for allergic conditions.
• By prescribing and supplying prescription-only medicines for allergic conditions. This only applies to pharmacists who have successfully completed accredited training courses to become supplementary or independent prescribers.
• Reviewing adherence and compliance with medications
• Patient education on device technique for allergy related devices eg, nasal sprays, adrenaline auto-injectors, inhalers and spacers.
The most common children’s allergies are:
Atopic eczema affects 15-30% of children and is more common in children than adults. Children often develop eczema before their first birthday. Children’s eczema can improve as they grow older but it can be a long-term chronic condition.
The exact cause of eczema is unknown but it is clear there are several factors, including genetics and environmental factors. It often develops alongside other conditions such as asthma and hay fever.
One in every 11 children in the UK are currently receiving treatment for asthma. Asthma is a long-term lung condition that causes sensitivity to the airways, which can become inflamed and narrow on exposure to certain triggers, leading to difficulty in breathing.
Symptoms commonly start in childhood. Asthma in children is commonly triggered by environmental allergens such as house dust mite, pet dander, pollen and moulds. Among school-age children who experience asthmatic attacks, 7-10% may suffer from allergies that trigger their asthma.
Allergic rhinitis or, as it is more commonly known, hay fever can affect 40% of children. Allergic rhinitis is an inflammatory condition affecting the nasal lining.
Allergic rhinitis can be seasonal or perennial (all year round) depending on the triggers. Seasonal allergic rhinitis is caused by pollen from grass, trees and weeds depending on pollination and the time of year. The most common cause of hay fever is grass pollen, which affects the majority of those with the condition.
Perennial rhinitis can be triggered by environmental allergens often found in indoor environments, including house dust mite, animal dander and moulds.
Almost one in 12 children suffer from a food allergy and these allergies are on the rise. A food allergy is caused when the body’s immune system mistakenly identifies a food as a threat and produces antibodies to fight it.
When the food is next eaten (or sometimes only comes into contact with the skin) it triggers an immune system response that releases chemicals, including histamine, causing the symptoms of an allergic reaction. Allergic reactions can be mild, moderate or severe. The most severe form is anaphylaxis, which is a life threatening medical emergency.
Food intolerances are more common than food allergies and are commonly confused — however, food intolerances do not involve the immune system and do not pose the risk of anaphylaxis.
Almost any food can cause an allergic reaction but the most common food allergens affecting children are:
• Tree nuts (such as almonds, cashews, walnuts).
Managing children’s allergies
Once the child’s allergy has been diagnosed by their GP, the community pharmacist can support the child and parents with advice on managing their condition. The pharmacist can discuss with parents and, if age appropriate, the child about any changes that need to be made to their diet or lifestyle. This will include advice on avoiding exposure to the allergen in food or the environment.
If the child is at risk of anaphylaxis, they must carry an Epi-pen at all times and know how to use it. For less severe allergic reactions the child should have anti-histamines readily available.
The child’s nursery or school needs to be informed and there needs to be regular communication so that staff know how to effectively manage the child’s allergies and medication needs.
The whole community pharmacy team needs to be able to give advice to families on where they can get more information on their child’s allergies and what services the pharmacy can offer, such as a designated testing service.
Spotting the symptoms
Symptoms of allergy are broad and varied and can be seen in other common childhood conditions. It is important that parents are signposted to their GP for further a definitive diagnosis of their symptoms if allergy is suspected.
An allergy focused medical history should be taken and may involve onward referral to secondary care for allergy testing depending on the availability of resources locally.
Holly Shaw is Allergy UK’s nurse adviser