Allergies in Children

Every child care centre usually has at least one child who suffers from allergies. As a result, it is important for caregivers to be aware of children's allergies, know how to avoid substances that trigger allergies and be prepared to manage reactions.

Substances found in our everyday lives are not normally harmful (e.g. pollen, peanuts, feathers and animal dander). These substances (called allergens) enter our bodies through breathing, eating, touching or being stung. Once an allergen has entered our bodies, the immune system responds by producing antibodies that attack the allergen. These antibodies remain in the body to protect the person the next time he/she is exposed to the allergen. This is the same way people usually develop life-long protection (i.e. immunity) from chickenpox once they have had the illness.

However, for people with allergies, repeated exposure to an allergen causes their immune systems to become overly-sensitive, rather than immune, to a particular allergen. An allergic reaction occurs when a person is exposed to an allergen and the body produces chemicals (such as histamine) that injure body tissues and cause allergic symptoms to develop. Allergies can be mildly annoying or they can cause severe reactions. Fortunately, most allergies are not life-threatening. The following table lists the allergens that are responsible for allergic reactions.

Common Allergic Substances	Typical Reactions
Environmental
dust, mould, pollen, grass and trees	itchy eyes and nose, nasal discharge, blocked nasal passages, sinus headache, sneezing, wheezing, coughing and shortness of breath
Animals and Birds
fur and feathers	itchy eyes and nose, nasal discharge, etc.
Insects
stings from bees and wasps	wheezing, hives, swelling of upper airway with difficulty breathing, swelling of face and anaphylactic shock in extreme cases
Foods
eggs, peanuts, nuts, shellfish, milk and wheat (the latter two are common in infants)	vomiting, diarrhea and bloody stools, plus symptoms as for insect venom* (such as hives, pallor, weakness, difficulties breathing and collapse).
Medications and Chemicals
medical (e.g. antibiotics) and non-medical (e.g. fabric softener)	any of the above reactions

Reprinted from the Canadian Paediatric Society, Well Beings: A Guide to Promote the Physical Health, Safety and Emotional Well-Beings of Children in Child Care Centres and Family Day Care Homes. 1992, p. 252 and *p 232.

Allergic reactions usually occur within four of the body's systems: the upper and lower respiratory tract, skin, eyes and gastrointestinal tract. The more body systems that are affected by an allergen, the more severe the allergic reaction. Anaphylactic shock, a potentially life-threatening allergic reaction, affects the entire body. This reaction can happen very quickly. Within seconds, the child's eyes, lips and face will begin to swell; a headache will develop; hives may appear all over the body; the throat may swell, thereby cutting off breathing; and vomiting and diarrhea may occur. Within ten minutes, the child can become unconscious. Caregivers must identify these symptoms immediately, administer the child's adrenalin (to counteract the attack) and call an ambulance. Anaphylactic shock is most commonly caused by peanuts, nuts, eggs, shellfish, bee and wasp stings, penicillin and aspirin. Even if caregivers are not sure about the child's symptoms, they should always administer the child's adrenalin and call an ambulance. Parents who have children with severe allergies should be encouraged to obtain medical alert bracelets for them and ensure that they are worn at all times.

There is no cure for allergies. Instead, caregivers must do their best to prevent reactions by eliminating or minimizing children's exposure to allergens. Treatment consists of alleviating or reducing the effects of the symptoms (e.g. runny noses, itchy red eyes, nasal and sinus congestion), usually with medications such as antihistamines and decongestants.

Effective communication between caregivers and parents is essential if allergic reactions are to be avoided. When enroling a child, caregivers should ask parents about allergies, including the names of any allergens, a list of specific symptoms, ways of preventing exposure to allergens, actions that should be taken if a reaction occurs and any drugs that have been prescribed or recommended by the child's physician. Caregivers can then use all of this information to develop an allergy care plan that meets the child's specific needs. The "Allergies History Form" in Well Beings is recommended for use in child care centres.

Every centre should have a policy and list of preventative practices for managing children with allergies. The following suggestions can be implemented in any child care centre:

• Caregivers should provide parents with a medical form, to be completed by the child's physician, requesting information about the management of allergies, including medications, preventative strategies and the handling of emergency situations. For an example of the form, see Well Beings, p. 863.

• A plan should be developed for sharing allergy information with all staff members. For example, a list of children's names and their allergies should be posted in the kitchen and eating areas. It's also a good idea to add photos of the children to the list, especially if the centre has substitute/volunteer caregivers or ECE students. Pertinent allergy information should also be added to each set of emergency information cards kept in first aid kits. As an added reminder, caregivers may find it useful to attach an allergy list to the top of the first aid kit that is used outdoors (i.e. on the playground, during field trips and walks), highlighting the children who are allergic to things found outside, such as bees, wasps, animal hair and feathers. Caregivers can quickly look at this list if they are have any concerns about a child and a possible allergic reaction. Before leaving the centre, caregivers can also refer to this list to ensure that they take the child's adrenalin kit (containing a needle or inhaler of medication) outside with them. Caregivers must ensure that the adrenalin kit is always in the same place as the child. A caregiver does not have time to run back into the centre to retrieve the kit, return to the playground and adminster the adrenalin. There is not even enough time to take the child into the centre for the adrenalin. Remember, anaphylactic shock happens quickly -- precious seconds cannot afford to be lost.

• Cooks and caregivers should also be vigilant about how food is purchased, prepared and served. Individuals who are responsible for snacks and meals must read all food labels and know which children have food allergies. Extreme caution is required for children who are allergic to peanuts and peanut products. Caregivers must take parents' concerns very seriously since even the smell of peanuts or trace amounts of grated nuts in a cookie can cause anaphylactic shock in children who have severe allergies to peanuts.

• Menus should be posted so that parents can suggest substitutions for foods or ingredients that cause allergic reactions in their children. When making substitutions, try to provide foods that look similar to what the other children are eating. This can help normalize eating for the children with food allergies.

• Centres should also promote an early awareness of allergies by gradually introducing new foods to children, especially infants and toddlers.

• If a child develops an allergic reaction, contact the child's parents and record all information in the child's file.

• All parents should give their children prescribed and over-the-counter medications for 24 hours before it is administered in the centre. This time period allows the parents to observe their children for any side effects or allergic reactions that might occur.

Allergic reactions can cause feelings of fear, discomfort and anxiety in children and their parents. It is important to provide these children with as normal a lifestyle as possible. By making children aware of their allergies and how to manage reactions, anxiety can be greatly reduced and excessive limits on activities can be avoided.

Developed by Deborah Kernested, RN, Toronto, Ontario.

Klich, B. (1994). "Be healthy back at school". The Toronto Star. Sunday, August 21:F1.

This article first appeared in Interaction published by the Canadian Child Care Federation, Winter, 1995.

Posted by: the Canadian Child Care Federation, September 1996.

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