Ex­pert Voice:

A pae­di­a­tri­cian on com­mon al­ler­gies in kids

Expat Living (Singapore) - - Contents -


Ac­cord­ing to DR LIEW WOEI KANG, who spe­cialises in al­ler­gies, im­munol­ogy and rheuma­tol­ogy, this in­flam­ma­tory skin dis­ease, which is of­ten char­ac­terised by itchy skin and rash, af­fects 10 to 20 per­cent of chil­dren, es­pe­cially in­fants. Sub­types in­clude se­b­or­rheic eczema (cradle­cap), ir­ri­tant eczema and atopic eczema. Gen­eral man­age­ment in­cludes avoid­ance of trig­gers, fre­quent mois­tur­is­ing and top­i­cal anti-in­flam­ma­tory med­i­ca­tions, he says.


Food al­ler­gies af­fect five to eight per­cent of chil­dren, says Dr Liew. “The most com­mon food al­ler­gens in­clude eggs, cow’s milk, peanuts, soy, wheat, fish and shell­fish in young chil­dren. Most of these al­ler­gies are out­grown with time, but some per­sist into later child­hood. Food al­ler­gens that par­tic­u­larly af­fect older chil­dren and adults in­clude peanuts, tree nuts and shell­fish.” Treat­ment for food al­ler­gies is typ­i­cally strict avoid­ance, while oral im­munother­apy in the form of reg­u­lar baked or cooked food may be suit­able in some in­stances, he ex­plains.


A chronic res­pi­ra­tory con­di­tion in which the air­way to the lungs spasms, asthma af­fects up to 20 per­cent of chil­dren, and usu­ally causes cough­ing, wheez­ing, short­ness of breath and chest tight­ness. “The most com­mon type is vi­ral-in­duced asthma, or ‘child­hood asthma’, where wheez­ing is trig­gered by res­pi­ra­tory tract vi­ral in­fec­tions. This tends to be out­grown with time as im­mu­nity im­proves,” says Dr Liew. “In these cases, the wheez­ing is se­condary to re­cur­rent res­pi­ra­tory tract in­fec­tions; so, when the im­mu­nity ma­tures with time, the re­duced fre­quency of res­pi­ra­tory tract in­fec­tions leads to less ir­ri­ta­tion to the res­pi­ra­tory tract, al­low­ing for com­plete re­cov­ery of bronchial hy­per­ac­tiv­ity.”

There’s also al­ler­gic asthma, which is associated with en­vi­ron­men­tal al­ler­gens, es­pe­cially house dust mites, pets, cock­roaches, mould or pollen. “The res­pi­ra­tory al­ler­gies are treated with al­ler­gen avoid­ance, and the use of bron­chodila­tors like Ven­tolin, and pre­ven­ters like mon­telukast and in­haled cor­ti­cos­teroids. Sublin­gual im­munother­apy, where the pa­tient is given small doses of an al­ler­gen un­der the tongue, can also be con­sid­ered for per­sis­tent cases,” says Dr Liew.


This type of in­flam­ma­tion in the nose oc­curs when the im­mune sys­tem re­acts to al­ler­gens, re­sult­ing in a stuffy or runny nose, sneez­ing, itchy and wa­tery eyes. Ac­cord­ing to Dr Liew, al­ler­gic rhini­tis af­fects 20 to 30 per­cent of chil­dren, and is of­ten associated with al­ler­gic con­junc­tivi­tis (eye in­flam­ma­tion). He says the causes and treat­ment are sim­i­lar to those of al­ler­gic asthma. Dr Liew also notes that hay fever, which is a type of al­ler­gic rhini­tis, is usu­ally a sea­sonal al­lergy to grass pollen, while peren­nial al­ler­gic rhini­tis here in Sin­ga­pore is usu­ally due to house mite al­ler­gies. Dr Liew adds, “Al­ler­gic rhini­tis can im­prove with age, as many ex­ac­er­ba­tions in young chil­dren are se­condary to re­cur­rent in­fec­tions. The more op­ti­mal the con­trol of the res­pi­ra­tory al­ler­gies, the more likely the child will have a good out­come, in­clud­ing hav­ing op­ti­mal lung func­tion in adult­hood.”

Preva­lence and pro­gres­sion

While the com­mon­ness of asthma and al­ler­gic rhini­tis has re­mained stable, the per­va­sive­ness of food al­ler­gies and atopic eczema has in­creased in re­cent years.

“We don’t know why the preva­lence of atopic eczema and food al­ler­gies is in­creas­ing, but rea­sons could in­clude en­vi­ron­men­tal pol­lu­tion, mod­i­fi­ca­tions of food sources and the en­vi­ron­ment be­ing too hy­gienic, mak­ing the im­mune sys­tem more skewed to­wards al­ler­gies,” says Dr Liew.

And, while some al­ler­gies can be out­grown, if there’s a fam­ily his­tory of al­lergy then there’s a pos­si­bil­ity that a child may de­velop other al­ler­gies. The most im­por­tant thing, Dr Liew says, is to get the right di­ag­no­sis in or­der to man­age things cor­rectly.

“Pa­tients with asthma re­quire a spe­cial high­light, as food al­ler­gies are more dan­ger­ous if the un­der­ly­ing asthma is not di­ag­nosed or op­ti­mally con­trolled. This is one of the main rea­sons why food ana­phy­laxis can lead to fa­tal­i­ties, some­thing we see re­ported around the world.”

Gle­nea­gles Hos­pi­tal is at 6A Napier Road. To sched­ule an ap­point­ment, text 8799 7767 (What­sapp). gle­nea­gles.com.sg

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