When thinking about allergic reactions, one of the first things that may come to mind is the sneezing and itchy eyes typically associated with seasonal allergies. An allergic reaction is something that happens when the body’s immune system attacks a substance that is normally harmless. Many things can cause allergic reactions including foods, bug bites and stings, pollen, and even the family pet. Allergic reactions can also be caused by medications and other “helpful” items, such as latex (found in some rubber gloves and balloons), bandage adhesive soap and laundry detergent.
Seasonal and environmental allergies are fairly common. They should not be confused with more serious allergic reactions, including anaphylaxis, the most severe type. Knowing the difference is an important step in recognizing symptoms and getting your child the correct treatment.
Signs of an allergic reaction can vary from person to person and range from very mild to very severe. A mild reaction may be nothing more than annoying, while a severe reaction requires immediate medical attention.
Mild Allergic Reactions
A child having a mild allergic reaction may experience:
- minor swelling
- skin redness
- itching and/or red bumps (hives)
- stuffy/runny nose
- itchy, watery eyes
Your child will probably be uncomfortable for a little while, but generally there is no need to worry. Sneezing, runny nose and even hives are treatable with an antihistamine taken by mouth. These are easily found over-the-counter in your local pharmacy, but you should consult your child’s pediatrician first to make sure it is okay for them to take.
Severe Allergic Reactions
If something about an allergic reaction starts to concerns you, take that as a sign to seek medical attention.
Kids who have a severe allergy can be at risk for a potentially life-threatening reaction called anaphylaxis/anaphylactic shock. Although it isn’t common, it is important to recognize the signs and know what to do. These reactions are usually indicated by:
- swelling of the mouth or tongue
- difficulty swallowing/speaking
- wheezing or difficulty breathing
- stomach pain
- nausea, abdominal pain or vomiting
- fast heartbeat
- skin itching, redness or swelling
In general, swollen lips or tongue, wheezing and throat or chest tightness are the first signs that you should seek medical attention for your child. Dizziness and fainting, vomiting and paleness are also key signs of a serious reaction.
Severe reactions may need the use of an epinephrine injection. If your child has an allergy that requires epinephrine, their doctor will prescribe an auto injector that is easy for parents and older kids to carry. You might already know of this medication by the brand name EpiPen®. Your child’s doctor will show you and your child (if they are old enough) how to use the injector. Anyone else who takes care of your child should also know about the allergy what to do in case of an emergency—this includes other family members, teachers, coaches and babysitters.
These reactions can be a frightening experience for children, especially if they feel like their throat is closing up. It is important to stay calm and try to keep the child calm. Call 911 or seek care at a hospital emergency room right away. A quick response is very important. If your child has a known allergy and carries epinephrine, give the medication first and then call 911 or have another person call 911 while you administer the medicine.
Skin Reactions to Allergens
An outbreak of hives is a common skin reaction. It occurs when contact with a specific allergen (a substance that causes an allergic reaction) causes cells in the bloodstream to release a chemical that causes tiny blood vessels under the skin to leak. The fluid then pools within the skin to form the spots and large welts known as hives.
These raised red areas can be tiny bumps or large interconnected welts the size of dinner plates. They may itch, sting or cause a burning feeling. Hives can appear in clusters and can change shape and location during the span of a couple hours.
A mild case of hives often goes away on its own. Your child’s doctor may recommend an antihistamine to help with the itching.
A breakout that lasts for more than six weeks is called chronic hives. Your child’s pediatrician will be able diagnose chronic hives and provide treatment options that are right for your child based on severity and medical history. They may ask you to keep a daily record of what your child eats and drinks, and where the hives appear to help diagnose the cause. Sometimes a simple blood test or allergy test may be necessary.
In some people, a condition known as angioedema may also happen during an allergic reaction. While very similar to hives, this is swelling that occurs under the skin instead of as welts on the surface. Affected areas are typically the hands, feet, eyes, lips and/or throat. Swelling of the throat may cause breathing trouble or a loss of consciousness. You should call 911 or visit the emergency room right away if your child is experiencing breathing trouble.
There is one type of angioedema that is hereditary and may not respond to antihistamines.
Hives and angioedema can also be caused by non-allergic triggers, including temperature changes, pressure (such as a heavy backpack strap on the shoulder) and infections.
If your child has shown signs of a severe or chronic allergy, you may be referred to an allergist—a doctor that has had specialized training in treating allergies. The allergist will test your child to find what allergens are a problem and then work with you to develop a treatment plan.
Pamela F. Love, MD, MHS, FAAP is currently an attending physician in Pediatric Emergency Medicine at All Children’s Hospital Johns Hopkins Medicine. She has served as Associate Director of Emergency Medicine at Miami Children’s Hospital, as well as Medical Director of Pediatric Emergency Medicine at the Children’s Hospital of Palms West, Loxahatchee, FL. She holds a Masters of Health Science degree from The Johns Hopkins University School of Hygiene and Public Health. Certifications include the American Board of Pediatrics and the American College of Emergency Physicians. She has most recently served as Vice President on the executive board of the T. Leroy Jefferson Medical Society, and The Sickle Cell Foundation of Palm Beach County.