Dr Tshegofatso Mabelane, director of About Allergy, highlights the common and not-so-common symptoms and signs of allergies with helpful tips to make living with allergies just a little bit easier.
A clear sign that indicates that we know someone has an immune system reaction is the breakout of chronic spontaneous urticaria (CSU), or what we know as hives. Over the past few years, we have seen an increase in CSU lasting at least six weeks or more. CSU, or chronic hives, are a very itchy, raised rash and appear in different parts of the body, but fortunately, they leave no scars. Chronic hives arise due to the release of histamine in the body. At least 40% of people affected with chronic hives may have associated swelling of the eye, lip or any other body part, lasting up to three days.
The body starts presenting hives when allergy cells, known as mast cells, release histamine. The good news is that chronic hives are not food allergy related, meaning you do not have to eliminate food or change skin products to treat them. Once your doctor has examined you and ruled out other medical conditions, chronic hives can be managed easily with antihistamines which counter the effects of the over-produced histamine in the body. As allergies have evolved, so too has medication. The second-generation antihistamines make having allergies significantly more manageable, without the side effects of feeling sleepy etc. However, please ensure that you consult your doctor, particularly if your child’s allergies have just been triggered.
While we don’t have the answers for the cause of massive outbursts of hives, we do know the triggers. Preservatives, especially in takeaway food, medication such as non-steroidal anti-inflammatory, oestrogen contraceptives and stress are significant hive triggers. About 40% of people with hay fever may develop chronic hives. Being female and middle age is also a predisposing factor.
Skin allergies are also present in various forms. Rashes or atopic eczema often develop as early as infancy; you will see them around your child’s elbows and knees. They are very irritating and itchy, and this is chronic inflammation. It may leave dark patches and thickened skin. There are simple ways to help your little one.
Treating your baby’s atopic eczema
Because of its dryness, you must moisturise the skin at least twice a day. Do not use soap to wash your baby or child with atopic eczema. Wash the skin with an emollient – such as Epimax cream – and apply it within three minutes. Taking care of the skin is critical. In addition, a topical steroid is a primary medication to use in atopic dermatitis. Apply it only in areas affected proactively, meaning two days per week to minimise acute flares. Side effects of the medication occur mainly when you apply topical steroids mixed in an emollient daily because you cannot control the dose used on the skin. To measure the amount of medication needed, use the fingertip method: your fingertip (of the medicine) is enough for an area equal to the palm of your hand (affected area with rash).
The atopic gene may manifest from infancy as atopic eczema, followed by food allergies during solid introduction around four to six months old. In early childhood, hay fever may occur and later childhood asthma. On that note, I’d like to introduce the term “allergic march.”
The “allergic march”
The allergic march refers to “the progression of allergies, from eczema to later developing food allergies, allergic rhinitis and asthma.” Many parents want to know if they can test their little ones for allergies, but you can’t guess them or test them. The allergy must manifest first. There must be a reaction which occurs consistently with every exposure.
For instance, when children have a viral infection, particularly Ebsten Barr and penicillin is administered, they will have a rash when the virus first interacts with the penicillin. This does not mean the child has a penicillin allergy. Also, you may want to just read up on significant allergy symptoms, like insect venom allergies.
Let’s touch on bee venom allergy briefly. – when someone is stung, and the protein is released into the blood system, the body starts releasing Immunoglobulin E (IgE) antibodies, resulting in allergy symptoms. If your little one starts developing hives or swelling and starts feeling nauseous and vomiting after being stung, this is particularly dangerous as this is part of anaphylaxis.
Anaphylaxis is a severe, life-threatening reaction due to an allergic reaction – often due to IgE antibodies resulting in shortness of breath, coughing, wheezing, heart palpitations, sweating, dizziness and other systemic symptoms. The psychosocial impact can be traumatic and severe, especially on children as they grow older. But let’s bring it closer to home this allergy season when we see an uptick in hay fever.
Getting into hay fever
Many of you reading will be familiar with the hay fever symptoms. It includes sneezing and an itchy or runny nose with clear mucus. Furthermore, there are the unseen effects of hay fever. Patients feel tired, and they lose concentration quickly. There are even what we call the “allergic faces.” These are long elongated faces with dark circles around the eyes and lines that appear under the eye. Those suffering from hay fever have been found to Rub their nose so frequently that they get a crease line over the lower third of the nose. If your child wakes up and is tired, with their turbinates enlarged (tiny structures in the nose), this is the inflammation because they are not breathing in enough oxygen. This little one is expected to be in a class, sitting still and concentrating when they physically aren’t able to.
They are expected to function like everyone else – you could have a child misdiagnosed with ADHD. It could be hay fever. Studies show that grades improve once a child with hay fever is adequately treated.
Constant clearing of the throat would be a symptom of hay fever; coughing when lying down, maybe post nasal drip. You will notice your child’s “mouth breathes” a lot and have dry, cracked lips. Seasonal allergies can be more debilitating than we realise.
Seasonal allergies are usually associated with hay fever and asthma. Often during springtime, especially in Gauteng, Limpopo and the Freestate, we see an increase in pollen allergies.
You can’t eliminate pollen; you can try to minimise the effects. For instance, exercise with a mask, use air conditioning instead of opening windows when driving and minimise the time your clothes hang outside in the wind.
When it comes to house dust mites (primarily seen in KZN and Western Cape) and pet control, minimise the carpets in your home where possible. Wash the linen in very high temperatures of more than 550C, or you can pop your linen in the freezer overnight. Dust mites die at very high and very low temperatures.
If you have no washing machine, soak your linen in boiling water. Invest in a HEPA filter vacuum, and you can vacuum your mattress or floor. Change your pillows every three years and invest in house dust must pillow encasing.
On the note of anaphylaxis, what do you do if you don’t have an EpiPen? – Have a supply of adrenalin from your local clinic, a syringe, and a needle. The nurse or doctor will teach you how to use it. They will draw the actual dosage of adrenalin into the syringe for you that you need; wrap it in a foil, and you can keep it safely for 3-6 months in a cool, dark spot. If you cannot afford an EpiPen, I would encourage you to always carry this adrenalin hack on hand if you or your child are at risk of anaphylaxis – it’s practical, cost-effective and lifesaving-keep in a dark place.
Learn how to use a nasal spray correctly. This is critical for those with hay fever in particular. Check out the video I created that teaches you how here. Using your nasal spray correctly.