Reunited in the summer vacation, Doudoujia welcomes a new member: my cousin brought a cute ragdoll cat. Doudou hugged the kitten and was reluctant to put it down, but after a while, his face was full of red rashes and itching, and the pain of allergies offset his first love for pets. His mother quickly took him to a specialist. The doctor diagnosed Doudou with an allergy to animal fur and reminded him not to keep pets for the time being. As a last resort, Doudou said goodbye to the fluffy puppet cat…
Research shows that allergic diseases in children are on the rise. Taking childhood asthma in my country as an example, the prevalence rate was 1.09% in 1990, and increased to 3.02% in 2010. How to prevent children’s allergies, what should children with allergies do at home? August 8 to 14, 2022 is the seventh China Allergy Prevention Week. Qin Xiaojian specially invited Hou Wei, Deputy Director of the Department of Pediatrics and Director of the Department of Respiratory and Asthma of the Children’s Hospital of the Second Affiliated Hospital of Xi’an Jiaotong University, to serve as the father of a child with allergies. Mom focuses on how to fight allergies.
1. Qin Xiaojian: Are children more prone to allergies than adults? What are the common symptoms of allergies in children?
Director Hou:Because children are in the stage of growth and development and the functions of various organs are immature, the incidence of allergic diseases in children is indeed higher than that in adults. With changes in the environment and lifestyle, allergic diseases in children are increasing. The prevalence of asthma in children is 3.02%, the prevalence of allergic rhinitis is 8.7%-24.1%, and the prevalence of food allergy is 3%-6%. The prevalence of atopic dermatitis was 2.9%. Allergic diseases are systemic diseases that follow the “allergy march” law and occur allergic symptoms. Food allergies, such as milk protein allergy, can also appear as eczema in infants and young children; allergic rhinitis and ( Or) allergic conjunctivitis, manifested as frequent sneezing, runny nose, nasal congestion, nasal itching and eye itching; bronchial asthma in school age, manifested as repeated wheezing and long-term coughing. Allergic diseases often occur at the same time, and most children with bronchial asthma suffer from allergic rhinitis-conjunctivitis, atopic dermatitis and food allergies.
2. Qin Xiaojian: What are the main factors that affect children’s allergies? What are the most common allergies in children?
Director Hou: The occurrence of allergic diseases in childrenIt is the result of genetic and environmental interactions, in which environmental exposure plays an important role in the pathogenesis of allergic diseases. Environmental factors include allergens, climatic factors, infections, exercise, and mood.
Among the environmental factors, dust mites are the most common allergens, in addition to milk, eggs, peanuts, fish and shrimp. Allergens in the environment can be the triggering factors of childhood asthma, of which respiratory tract infection is the most important cause. About 95.2% of asthma in children aged 1 to 3 years is related to respiratory tract infection, especially viral infection.
It is worth mentioning that,Irritant tobacco smoke, pollutants in the air, etc. can stimulate the sensory nerve endings in the bronchial mucosa, causing reflex cough and bronchial smooth muscle spasm, and can also cause the release of inflammatory mediators and cause respiratory inflammation, thereby inducing or aggravating asthma.
Common childhood allergic diseasesThere are food allergies (milk, eggs, nuts, seafood, etc.), skin allergies (eczema, atopic dermatitis, urticaria), allergic rhinitis, allergic conjunctivitis, allergic asthma and anaphylactic shock.
3. Qin Xiaojian: “eczema→allergic rhinitis→asthma” is called the trilogy of children’s allergies. Do allergy children go through this process?
Director Hou: Allergic diseases in children do not exist independently.One allergic symptom in infants or early childhood often predicts an increase in other allergic diseases in the future.Allergy symptoms in childrenFirst manifested as infant eczema(or atopic dermatitis) or food allergies, atopic dermatitis is often seen as the starting point of the atopic process,Followed by allergic rhinitis and asthma。
With the growth of children’s age, the manifestations of allergic diseases will change in stages, and different allergic symptoms will continue to appear in each system. For example, skin eczema, atopic dermatitis, and food allergy appear first in infants, and after 1 year of age, recurrent wheezing and asthma, allergic conjunctivitis, and allergic rhinitis gradually develop. Typically, most children with food allergies resolve spontaneously by age 2, respiratory symptoms mostly appear before age 5, and more than half of children with eczema will develop asthma and/or allergic conjunctivitis,Food allergy in infancy may increase the risk of allergic disease in later childhood.
4. Qin Xiaojian: How does allergic asthma affect the lung function of children? How to carry out standardized treatment?
Director Hou:Bronchial asthma is the most common chronic airway inflammatory disease in children.80% of childhood asthma is allergic asthma.It is an IgE-mediated immediate allergic reaction. Inhaled allergens transmit antigens through airway dendritic cells, act on B cells to produce IgE, cause basophils, mast cells, etc. to produce inflammatory mediators, or dendritic cells directly act on eosinophils to produce inflammatory mediators. mediators, leading to airway inflammation.
becauseAllergic asthma has airway inflammation and airway hyperresponsiveness, leading to impaired lung function,It is manifested as a decrease in the maximum expiratory flow in the first second (FEV1) and peak expiratory flow (PEF).The risk of chronic obstructive pulmonary disease (COPD) increases 10- to 32-fold in adulthood.
Standardized treatment of childhood asthma includes:Allergen avoidance, anti-asthma drug therapy, specific immunotherapy, health education and management. Among them, inhaled surface corticosteroids (ICS) are the “cornerstone” of asthma treatment. Once asthma is diagnosed, long-term inhaled ICS should be treated. Inhaled ICS has no obvious side effects at therapeutic doses.
Children’s asthma has a good prognosis after standardized treatment, and the vast majority of children can be completely controlled without affecting growth and exercise ability.The long-term treatment compliance and control levels of childhood asthma in my country are still low, and the number of pediatric asthma specialists and the establishment of specialized disease clinics are insufficient.The level of standardized diagnosis, treatment and management of childhood asthma still needs to be improved.
5. Qin Xiaojian: The temperature changes in the spring and autumn, and infants and young children are prone to runny nose, sneezing, and coughing. The symptoms are similar to those of a cold. How can parents tell whether it is a cold or an allergy?
Director Hou:Allergic rhinitis and upper respiratory tract infection will have symptoms of sneezing, runny nose, nasal congestion and nasal itching, which are easy to confuse.
Allergic rhinitis is usually characterized by runny nose and obvious nasal itching. The symptoms last for 2 weeks or longer and recur repeatedly without fever and pharyngeal congestion.
The symptoms of allergic rhinitis in children are as follows: ① Nasal itching: Most children will appear. ② Paroxysmal sneezing: There can be several paroxysmal seizures every day, which are obvious at night and in the morning, especially the most serious in the morning. ③ Water-like nasal discharge: It is the manifestation of increased vascular permeability of nasal mucosa and hypersecretion of goblet cell glands. ④ Nasal congestion: the severity varies, can be unilateral or bilateral, can be intermittent or continuous, often on both sides.
6. Qin Xiaojian: How is the treatment of children’s allergy different from that of adults? Does anti-allergy medicine contain hormones and does it affect children’s development?
Director Hou:Different types of allergic diseases in children have different treatment options.Food allergies are mainly to identify allergic foods and avoid diets.Children’s food allergies are not static. As children grow older, food allergies can be changed. For example, milk allergies in infants, most of them are no longer allergic after the age of 2, and can be eaten normally. Allergic skin diseases, allergic rhinitis-conjunctivitis and allergic asthma can be treated with oral antiallergic drugs when symptoms occur, and at the same time, specialist drug treatment is given.
Anti-allergic drugs do not contain hormones, long-term use without dependence, does not affect the growth and development of children.Second-generation antihistamines are commonly used in children, such as cetirizine, which can be used in children over 6 months old, and loratadine can be used in children over 2 years old. Since antihistamines are symptomatic drugs, symptoms are relieved You can then stop the medication.
7. Qin Xiaojian: Parents who have children with frequent allergies are very anxious. How to correctly understand allergies? Could you give these parents a focus?
Director Hou:Since childhood allergic diseases are repetitive and require long-term treatment, the disease itself and treatment will have a certain impact on children and their parents.Children with allergic asthma often suffer from psycho-behavioral diseases such as tics and neurosis.Moreover, the incidence of depression, anxiety, and social disorder in children with asthma is also much higher than that in normal children. Because allergic diseases require long-term treatment, sometimes there will be disease attacks, parents need to accompany their children to seek medical treatment, affecting work and causing parents anxiety and depression.
Here I remind everyone that allergic diseases are preventable and treatable diseases. Parents do not have to worry and worry too much. They should seek treatment under the guidance of a specialist in a timely manner when they find that their children have initial allergic symptoms (such as allergic eczema).
First, identify the allergen and avoid it.Children with pollen allergies should pay attention to closing windows in seasons with high pollen concentrations and minimize outdoor activity time; take appropriate precautions during outdoor activities, including wearing masks or applying microparticle blockers to the nasal cavity; Pollen contamination; indoor air conditioners and high-efficiency air filters.
Secondly, children with dust mite allergies should keep the room clean, air circulation, and reduce humidity.Regularly clean the air conditioner filter, use well-sealed bed boards and pillows, dust-mite sheets, keep away from plush toys, and do not use carpets and tapestries.
Thirdly, children with allergic asthma should see a doctor in the pediatric asthma outpatient clinic to formulate a long-term treatment plan.In recent years, the immune targeted therapy drugs anti-IgE antibody (omalizumab) and anti-IL-4-Ra (duprilumab) have been used in clinical practice, which have the characteristics of good curative effect and convenient use. Use 1 time in 4 weeks.
Editor: Qin Xiaojian Shuyun Mao Ziyu Junhui