Advice on Children’s Allergies with Dr David Cremonesini

How to Manage Allergies in Children

Dr David CremonesiniDr David Cremonesini is a consultant paediatrician specialising in allergies and respiration. His private children’s clinics located in Huntington, Milton Keynes and Oxford offer allergy testing, immunotherapy and general paediatrics.

He also takes part in regular Q and A sessions on Netmums, where parents can post their questions for him to answer.

Here he offers his expert advice on effective allergy management.

Primarily based at Hinchingbrooke Hospital, Huntington, David developed an interest in allergies seven years ago while working with the respiratory team at John Radcliffe Children’s Hospital in Oxford.

“While dealing with respiratory, obviously there’s a lot of overlap with allergies. Often children who have asthma will also get a food allergy or eczema as well, so they’re quite closely linked.

“While training as a middle−grade doctor I worked under an allergy consultant and gained a strong interest in it. About six or seven years ago, allergies weren’t very well presented and there was a clear need for consultants to come out,” says David.

As a consultant of four years, David first created a children’s allergy service in Walsall, which is still going strong today. Now he runs several clinics, providing much−needed services for families who are worried about allergies.

“A lot of parents will take their child to their local doctor because they are worried their child may have an allergy. If the GP doesn’t refer them to hospital, then there is no alternative but to go to the private sector because they understandably want answers.

“Allergy is one of those things that a lot of people are worried about. There is a real need for allergy clinics and hopefully I’m providing a helpful service for families.”

Allergy and Asthma are Closely Linked

David says that many children who develop a food allergy at a young age are at a higher risk of developing asthma.

“If you go into the actual science of what causes asthma, they are very linked with allergies in terms of cell level and how they react to the airwaves. We can see a strong connection because a lot of children who have asthma also will have hayfever, eczema, or a food allergy.”

Spotting the Signs of a Food Allergy

When it comes to food, there are two types of allergies to be aware of.

“The first is the intolerance, which is related to symptoms in the gut. The most common substance for this is dairy. An intolerance can often occur in babies when they are weaned, as problems arise when they go from breast milk to formula milk,” says David.

“The second is called IgE mediated allergy. Children with this type of allergy have symptoms every time they eat something. If you’re allergic to milk you will have problems every time you drink milk, it doesn’t come and go.”

Symptoms with this type of allergy include −

    • Swelling in the mouth
    • Itchy rash
    • Lip swelling
    • Itchy mouth
    • Vomiting

“This will happen within an hour of eating the food, it comes on very quickly. That sort of allergy is one that we have testing for, either in the form of a skin prick or blood testing, ” he adds.

Allergies are on the Increase

David says that cases of allergies, asthma and eczema are rising globally.

“Studies across the globe suggest that asthma, eczema and food allergies are all on the increase. There are many possible theories as to why. At this stage we don’t really know for sure. ”

He says that diet may play a part in why more children are being diagnosed with food allergies.

“There is definitely evidence to suggest that diet may be a factor. There’s currently a study going on in London, where babies are being weaned at three months or six months. It’s called the EAT Study.

“It’s possible that when we introduce food to babies, there may be a window where food introduced at that time may reduce your risk of allergy. At the moment we don’t know exactly when that window is, ” says David.

Most Children will Outgrow the Allergy

Although there is no evidence as to why, studies suggest that most children outgrow allergies by the time they reach adulthood.

“With milk and egg allergies, 80 percent of children will no longer be allergic by the age of five. Some allergies like nut and fish often persist to adulthood, but with a lot of food allergies many children outgrow them.

“The key thing at the moment is to detect the allergy and when this has been determined, manage it, treat it properly and get the right advice.”

Managing an Allergy in Your Child

Getting the right advice is a crucial step in managing allergies effectively.

“The key thing is to get correct, accurate advice regarding what your child is allergic to. There are lots of parents I see who are avoiding things which they don’t actually need to because they were given the wrong advice.

“Once you’ve got advice on how to avoid the substance, then it’s really about informing the school, family, friends and childminders. Check all food labelling carefully, try and stick to home cooking and be wary when you go to restaurants.”

He also says that with allergies to more common substances it’s advisable to seek advice from a dietician.

“With something like dairy, lots of foods contain it, so we often advise parents to see a dietician and also read about it − so going on the appropriate websites like AllergyUK and downloading information. ”

Ensuring your child understands their condition is also important, but you mustn’t push children into managing their condition themselves.

“You need to make sure children understand their allergy from a very young age, but it’s all about getting that balance right. Parents often rush to let children manage their condition, when in some cases they do still need help. There’s no written rule about when a child is ready, it’s all about the individual,” says David.

Being Prepared for Anaphylaxis

Anaphylaxis is a severe allergic reaction which can affect anyone with an allergy, particularly those who also suffer from asthma, so it’s important that both conditions are treated effectively.

“Children who have both asthma and a food allergy are at the highest risk of getting a severe reaction. If they are exposed to the food on a day they are having an asthma attack, the reaction can be a lot worse, ” says David.

“Over 90 percent of people who die from anaphylaxis have also got asthma, so yes, it’s about managing the allergy effectively, but all other conditions need to be addressed and treated properly as well.”

He says that carrying an adrenaline pen, which can be administered in the event of an anaphylactic emergency, is crucial.

Make sure your child always carries their EpiPen because there will be situations where they may come into contact with the substance by mistake. It’s out of your control, so you must ensure your child carries their pen at all times.

“If your child is having an allergic reaction, adrenaline is potentially a life−saving treatment and it must be given as soon as possible.

“We do advise parents to consider medical ID jewellery. If a child is having a problem and people aren’t aware of their allergy, then something like that is useful, ” says David.

“With slightly older, more independent children medical ID is a good idea.

“We know that teenagers in particular are very bad at carrying their EpiPens. They’re not good at telling other people about it because they’re embarrassed or anxious about their condition. Having something like an ID Band, which people can see in an emergency is potentially life−saving.”

Medical Disclaimer

If you have any concerns for your child regarding allergies or asthma please consult your GP.