Allergies in Childhood
Hypersensitivity
● Condition in which an exaggerated or augmented immune response occurs that
is harmful to the host.
○ Requires a presensitized state
● 4 types:
○ Type I: Immediate Hypersensitivity
■ Systemic or localized; food/medication allergies
■ Ex: Anaphylaxis, Allergic Dermatitis, Hives, and Erythema
Reactions
○ Type II: Cytotoxic
■ Antibody-dependent
■ Autoimmune Hemolytic Anemia, Goodpasture, Graves, Rheumatic
Fever, ITP
○ Type III: Immune Complex
■ Inflammatory reaction
■ Ex: Serum Sickness; Polyarteritis Nodosa; post streptococcal
glomerulonephritis
○ Type IV: Delayed (Cell-Mediated)
■ Ex: SJS, Contact Dermatitis, Transplant Rejection
Allergic Rhinitis
● Most common allergic disease
○ Often co-exists with asthma and atopic dermatitis
● Type I IgE mediated allergic response
● Inflammation of nasal epithelium
○ Sneezing, rhinorrhea, congestion
● Typically seasonal, perennial and episodic
● Clinical Manifestations
○ Congestion, pale or light blue turbinate, conjunctival injection and watery
drainage, ocular pruritus, nasal pruritus (allergic salute)
○ Postnasal drip, pharyngitis, cough
○ Infraorbital cyanosis (allergic shiners)
● Labs and/or Imaging
○ Allergy testing
○ Blood work (IgE)
○ Skin testing - BEST
● Classification
○ Intermittent
■ Symptoms present < 4 days a week or for < 4 weeks
, ○ Persistent
■ Symptoms present > 4 days a week and for > 4 weeks
○ Mild
■ Without impairment or disturbance of sleep, daily activities, leisure,
sport, school, or work, or without troublesome symptom
○ Moderate-severe
■ Disturbance of sleep, daily activities, leisure, sport, school, or work
● Tx:
○ Allergen avoidance
○ Antihistamines
■ DiphenhydrAMINE (Benadryl)
■ Cetirizine (Zyrtec)
○ Mast Cell Stabilizer
■ Ipratropium (Atrovent)
○ Intranasal decongestant
○ Intranasal corticosteroids
■ Fluticasone (Flovent)
○ Other:
■ Nasal Saline
■ Montelukast (Singulair)
■ Immunotherapy
Atopic Dermatitis
→ eczema
● Typically begins before age 5
● Clinical Manifestations
○ Pruritic, erythematous papules with excoriations
○ Dry, itchy skin
○ Red-brown patches
○ Patches thicken with chronic scratching – lichenification
○ Face, scalp and extensor surfaces in infancy
● Associated conditions:
○ Dennie-Morgan Folds
■ Infraorbital fold
■ Fold in skin below lower eyelid
● Genetic
● Occurs in 25% of patients with atopic dermatitis
○ Keratosis Pilaris
■ Benign
■ Dry, rough patches and tiny bumps
● No pain or pruritis
Hypersensitivity
● Condition in which an exaggerated or augmented immune response occurs that
is harmful to the host.
○ Requires a presensitized state
● 4 types:
○ Type I: Immediate Hypersensitivity
■ Systemic or localized; food/medication allergies
■ Ex: Anaphylaxis, Allergic Dermatitis, Hives, and Erythema
Reactions
○ Type II: Cytotoxic
■ Antibody-dependent
■ Autoimmune Hemolytic Anemia, Goodpasture, Graves, Rheumatic
Fever, ITP
○ Type III: Immune Complex
■ Inflammatory reaction
■ Ex: Serum Sickness; Polyarteritis Nodosa; post streptococcal
glomerulonephritis
○ Type IV: Delayed (Cell-Mediated)
■ Ex: SJS, Contact Dermatitis, Transplant Rejection
Allergic Rhinitis
● Most common allergic disease
○ Often co-exists with asthma and atopic dermatitis
● Type I IgE mediated allergic response
● Inflammation of nasal epithelium
○ Sneezing, rhinorrhea, congestion
● Typically seasonal, perennial and episodic
● Clinical Manifestations
○ Congestion, pale or light blue turbinate, conjunctival injection and watery
drainage, ocular pruritus, nasal pruritus (allergic salute)
○ Postnasal drip, pharyngitis, cough
○ Infraorbital cyanosis (allergic shiners)
● Labs and/or Imaging
○ Allergy testing
○ Blood work (IgE)
○ Skin testing - BEST
● Classification
○ Intermittent
■ Symptoms present < 4 days a week or for < 4 weeks
, ○ Persistent
■ Symptoms present > 4 days a week and for > 4 weeks
○ Mild
■ Without impairment or disturbance of sleep, daily activities, leisure,
sport, school, or work, or without troublesome symptom
○ Moderate-severe
■ Disturbance of sleep, daily activities, leisure, sport, school, or work
● Tx:
○ Allergen avoidance
○ Antihistamines
■ DiphenhydrAMINE (Benadryl)
■ Cetirizine (Zyrtec)
○ Mast Cell Stabilizer
■ Ipratropium (Atrovent)
○ Intranasal decongestant
○ Intranasal corticosteroids
■ Fluticasone (Flovent)
○ Other:
■ Nasal Saline
■ Montelukast (Singulair)
■ Immunotherapy
Atopic Dermatitis
→ eczema
● Typically begins before age 5
● Clinical Manifestations
○ Pruritic, erythematous papules with excoriations
○ Dry, itchy skin
○ Red-brown patches
○ Patches thicken with chronic scratching – lichenification
○ Face, scalp and extensor surfaces in infancy
● Associated conditions:
○ Dennie-Morgan Folds
■ Infraorbital fold
■ Fold in skin below lower eyelid
● Genetic
● Occurs in 25% of patients with atopic dermatitis
○ Keratosis Pilaris
■ Benign
■ Dry, rough patches and tiny bumps
● No pain or pruritis
