Unfortunately, there can also be unpleasant milestones, such as allergic diseases occurring at a specific age range. These include eczema shortly after birth, gastrointestinal diseases as the child approaches age two, and asthma and other upper respiratory diseases starting at age three and lasting through young adulthood. This is the "Allergy March."
A physician from the Mayo Clinic is presenting an assessment of how proper intervention can derail this march from causing a wide range of uncomfortable illnesses for the pediatric population. He notes that early detection of allergies is key to management of the disease progression. This can entail linking allergic syndromes to a specific age, identifying the underlying genetic hypersensitivity to the disease (atopy), and developing an allergen avoidance and treatment plan to derail the Allergy March.
Henry A. Homburger, MD is from the Department of Clinical Biochemistry and Immunology at the Mayo Clinic in Rochester, MN. He will make his presentation on "The Allergy March" at the 55th Annual Meeting of the American Association for Clinical Chemistry (AACC) being held July 20-24, 2003 at the Pennsylvania Convention Center, Philadelphia, PA. More than 16,000 attendees are expected.
Background
The impact of childhood allergies can be considerable. More than two million lost school days are incurred each year. Continued absence can lead to behavioral and learning problems in school. Even when a child is able to attend school the allergies can be debilitating, causing a severe limitation of physical activity and subsequent loss of self-esteem, especially in social interaction with other children.
A disposition towards an allergic reaction is often pre-determined by one's genetic makeup. Childhood atopy is the genetically-determined state of hypersensitivity to environmental allergens. Type I allergic reactions are associated with the IgE antibody and a group of diseases, principally asthma, hay fever and atopic dermatitis. The condition is characterized by a noted increase in IgE levels. The good news is that the s-IgE test is available to identify the atopic child, enabling the development of a treatment plan.
Age and the Allergy March
As children develop, so to can the likelihood of common childhood diseases related to atopy. For example, eczema is most likely to occur between birth and three months of age; gastrointestinal distress is most prevalent during the second year; upper respiratory distress generally manifests itself between ages three and seven; and asthma's onset is most likely to occur when a youngster is between 7-15 years old.
Diseases in the Early Years
The most common diseases requiring treatment include:
Eczema: Eczema (atopic dermatitis) is a chronic itch that develops into a rash. Allergy commonly underlies itch, with 30 percent of all skin disorder cases in toddlers being allergy-induced eczema. Research has established a link between IgE and food allergen-induced atopic dermatitis with food allergy the root cause in one-third to one-half of all childhood cases. This is not surprising, given hidden ingredients in commercial foods, the presence of preservatives and stabilizers, as well as artificial colors and flavors and the early introduction of solid foods to infants.
The symptoms are intense itching and skin cutaneous reactivity, and a spreading of rash-like symptoms. This condition can also be caused by immunodeficiency, metabolic disease, neoplastic disease, infection and infestation, and dermatitis. However, at the first sign of these symptoms, the specific IgE blood test is appropriate, even with infants. Early testing will lead to appropriate diagnosis and treatment and modify the advance of atopic disease.
Failure to treat eczema can lead to gastrointestinal symptoms or atopic disease. Additionally, 40 percent of infants with atopic dermatitis develop asthma by age four. Besides the physical consequences, the child with eczema can incur a reduced image in the eyes of their peers.
Gastrointestinal (GI) Complaints: These can include colic, diarrhea, persistent vomiting or stomach aches, and may be due to food sensitivities. Researchers like Homburger believe that food allergy maybe the root cause in 10-15 percent of colicky infants. Scientific findings have identified a wide array of allergy-associated gastrointestinal inflammatory diseases and elimination of allergic trigger decreases of GI eosinophils and inflammation.
During the diagnosis, the patient history is discussed and a physical exam in performed. The clinician will test for infection or obstruction as well as conduct the specific IgE test. Treatment can involve mediation such as anti-histamines and corticosteroids or avoidance therapy, the elimination of a specific allergen.
Diagnosis and Treatment
Early diagnosis leads to early treatment and early treatment can prevent serious complications. Therefore, Dr. Homburger offers the following observations:
Diagnosis: Either food or the surrounding environment can trigger the allergic reaction. If food is the culprit, then keeping the child away from the item is the suggested course of action. Environmental triggers often cannot be avoided; hence, a systemic or topical treatment may be required. One suggested diagnostic test offers an accurate diagnosis for testing symptomatic people and determining which children have underlying atopy. Specific IgE blood testing dictates treatment and influences prognosis.
Both positive and negative test results aid in the diagnosis. Positive results highlight the need for medical intervention and elimination of allergens from the environment. Negative results rule out allergy as a clinical factor and support further medical examination to identify the underlying factor of disease. There are limitations to even the most proven tests, however: a false positive reading results in an improper diagnosis and possible overmedication and subsequent adverse reactions. But an accurate diagnosis – allergen identification – can contribute to altering the progression of the allergy march, improve quality of life and insure better outcomes.
Treatment: Allergies can be treated with topical anti-inflammatory, antiseptic and antifungal agents, as well as oral antihistamines and systemic antibiotics. The treatment required often must address the state of the Allergy March.
Conclusions
Just eight foods account for approximately 90 percent of allergies. The culprits include peanuts, tree nuts, fish, shellfish, eggs, milk, soy and wheat. The majority of food-allergic children are atopic to three or fewer food types. Regardless of the source of the allergy, however, early diagnosis with a reliable test will offer significant support to the child with an inherited disposition for allergies. This course of action will offer strategies to avoid diseases that can incur significant physiological and psychological damage on the growing child.
The American Association for Clinical Chemistry (AACC) is the world's most prestigious professional association for clinical laboratorians, clinical and molecular pathologists, and others in related fields. AACC's members are specialists trained in the areas of laboratory testing, including genetic disorders, infectious diseases, tumor markers and DNA. Their primary professional commitment is utilizing tests to detect, treat and monitor disease.
***Editor's Note: To schedule an interview with Dr. Homburger, please contact Donna Krupa at 703-527-7357 (direct dial), 703-967-2751 (cell) or djkrupa1@aol.com. Or contact the AACC Newsroom at: 215-418-2429 between 8:00 AM and 4:00 PM EST July 20-24, 2003.
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