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Worried about a rash? Suspicious of that sniffy nose? Curious about that cough? Concerned your child has a food allergy? Dr. David Cremonesini is a Consultant Pediatrician at Mediclinic Parkview Hospital with a special interest in Allergy. In this article, he outlines his approach and some useful tips if you believe your child has a possible allergy.
If you are a parent worried that your child might be allergic to something, then you are not alone. Every day I see parents who have been told their child has an allergy and it’s a common belief from doctors they do. Sometimes they have had a test but this doesn’t always mean they are allergic. Let’s breakdown the common problems where allergy is diagnosed, often wrongly, and share some clues that tells us it may not be allergy.
1. Runny nose and itchy eyes
Now that children are back at school, we are seeing this a lot, and in many cases, this will be due to viruses. A big clue is how the child was feeling before school, during the extended lockdown period. During this time, the child wouldn’t have been exposed to many viruses, but exposure to allergies won’t have changed much, especially ones in the home like dust mite, molds or pets. Therefore, if your child was well before, then it is unlikely allergies causing symptoms back at school. A fever, thick nose secretions or absence of itch makes allergy unlikely but if you are in any doubt, doing an allergy test can help. Confirming an allergy helps make things better as we then know what treatment to give. You can also try changes at home to reduce exposure to the allergic cause e.g. bed and pillow covers for dust mite allergy.
2. Stubborn cough
All children cough, many cough a great deal and most coughs are caused by viruses. Typically, sudden onset with fever or runny nose is likely to be a virus and it can take up to 4 weeks before it passes. In early childhood, its normal for children to get 10-12 viruses in a year so if they are unlucky, a persistent cough for months might be one virus after another. Typically, we see children get better for short periods in between coughs, and even if it’s just a week or two, periods of being normal are reassuring.
Allergy cough will normally either be accompanied with an itchy nose and persist for long time, or be associated with wheezing or difficulty with breathing. Asthma is a possibility, but the cough must be associated with a breathing problem (often during exercise) and its very rare to just be a cough. At the clinic we often see a “habit” cough where a child is coughing all day, breathing normally but at night no cough at all. In asthma, a child would be coughing at night too.
3. Itchy dry skin or eczema
Eczema is a skin problem and many things aggravate the skin that parents can’t avoid. Sweat, viruses, clothing, chlorine and soaps all irritate the skin, but often parents in my clinic worry about an allergy, especially related to food. It is possible food might be one trigger, but less likely in children older than 2 years. In my clinic, my main priority is treating the eczema properly, using moisturizers 3-4 times a day and steroid creams when the child is itchy and suffering. Steroids are safe and the best initial option to alleviate itching, which can make the skin bleed thereby causing more damage than steroids. Allergy tests especially those related to food are not always helpful in eczema cases and can lead to unnecessary food avoidance. So it is important that if you are avoiding foods to bring them back in the diet when the eczema is better to challenge the skin and see what happens.
4. Food allergy
Let me explain how one should diagnose food allergy. Firstly, the parents come to me with a story, one where the child had an itchy rash, swelling in the face, vomit and (rare) breathing problem less then 2 hours after eating a certain food. Such a reaction always happens when the child eats that food. I hear the story and if I suspect allergy, I do a skin prick or blood test and a positive test supports the story and CONFIRMS the allergy. In fact, allergy is defined not by a test but by a positive story. This is why I am against food panel tests where many foods are tested as it leads to OVER DIAGNOSIS of food allergy since you can’t rely on a test. This leads to two big problems.
Firstly, a child is avoiding foods, potentially unnecessarily, and this impacts their growth/nutrition status. Furthermore, it impacts a parent’s mental health, worrying about possible reactions at school or in restaurant. Secondly, avoiding foods as a child when they are not allergic to it, over time leads to increased risk of food allergy. In my allergy clinic, I would say I spend as much time undiagnosing food allergy as I do diagnosing it and to reassure parents, I do food challenges at the clinic so parents can feel safe trying different foods.
5. Antibiotic allergy
Ok. I see many children with suspected allergy after getting a rash or other problems while taking oral antibiotics. However, studies tell us that over 90% of children (and adults) who believe they are allergic to antibiotics (commonly penicillin) are not. It’s important to rule this out and in my clinic, we do this by doing a test first and then by giving some antibiotics at the clinic. Avoiding antibiotics unnecessarily leads to problems in adulthood when as an adult you get unwell and often a penicillin might be the best antibiotic to give but doctors won’t do it, worried about allergy. It is therefore important to try and check when you are a child, and we can do that safely in my clinic.
So, parents, my advice is to be careful when making a diagnosis of allergy too easily. When in doubt, you can do a test to check but first we check there is a story that suggests an allergy.
At Mediclinic Parkview Hospital, Dr. David is offering free skin prick tests to food or airborne allergies - the only charge is the consultation. By doing tests and discussing your child with him, you can get a clearer picture of what’s going on and a more accurate way to treat your child and make them better.
If you want to see how a skin prick test works, you can check out this video by Royal College of Paediatrics UK.
Reach out to Dr. David here if you want to book a consultation or call 800 1999
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