Allergic rash in a child

An allergic rash in a child is one of the most common types of reaction to an allergen from the immune system and skin. In clinical practice, such a rash is called allergic urticaria or urticaria (from the Latin urtica - nettle). A characteristic clinical symptom of an allergic rash is papules localized in certain areas or spread over the body. The rash looks like painless but itchy erythematous blisters, which in children are most often provoked by food allergens.

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Causes of allergic rash in a child

Factors that provoke allergies, causes of allergic rashes in children are combined into the following groups:

• Drug allergens.
• Food allergens.
• Physical factors (sun, overheating, cold).
• Chemical factors (household chemicals, washing powders, etc.).

Infants are most often susceptible to food allergies, which are characterized by skin manifestations, while older children may suffer from drug allergies, hay fever, or rashes caused by ultraviolet radiation (sun).

Among food products, the most allergenic are all types of citrus fruits, seafood, chocolate, cocoa, strawberries, and an allergic rash can also be caused by intolerance to milk protein.

Causes of allergic rash in a child

Type of allergy	Allergens
Food	Milk protein, dairy products, mixtures Fruits, especially citrus fruits Vegetables (red, yellow, orange skin and pulp) Sea fish, seafood Eggs Wheat products porridge Honey Poultry meat (chicken) Nuts Products containing preservatives, colorants, flavorings
Medicinal	Penicillin group drugs Sulfanilamide group drugs B vitamins NSAIDs – non-steroidal anti-inflammatory drugs Anticonvulsants Preparations for X-ray diagnostics (contrast agents)
Aeroallergy	Household dust Household chemicals in aerosol form Animal hair Pollen

It should be noted that urticaria in a child can be caused by viral, bacterial infections, as well as parasitic invasions, but such rashes do not fall into the category of allergic, despite the similarity of clinical manifestations.

According to pediatric allergists, the list of "provocateurs" of allergic rash in children is led by food allergens, especially dairy products, sea fish, and eggs, i.e. those that contain protein. These factors cause an indirect reaction in which antibodies of the immunoglobulin class IgE participate. Allergens of orange and red fruits and vegetables cause a direct release of histamine, without the involvement of IgE.

Allergic urticaria in acute form, provoked by airborne factors (household chemicals, pollen), most often occurs in children over 3 years of age and is a symptom of cross-polyvalent allergy.

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Symptoms of allergic rash in a child

The main signs of allergic rashes in children are the following:

• Erythema (redness) of certain areas of the skin.
• There may be slight swelling at the site of the rash.
• Small papules - vesicles.
• Itching, sometimes very severe.
• Irritability, tearfulness.
• If the papules burst, erosive wounds filled with exudate may appear.
• In case of food allergies, localization is on the skin of the face (cheeks), buttocks, calves, and less often on the forearms.

Symptoms of an allergic rash in a child depend on the form of the underlying disease – allergy, which can be chronic or acute.

1. Acute allergy most often develops as a reaction to a food allergen or a drug factor. Allergic rash looks like papules, less often large blisters, localized on the skin of the face, forearms. The vesicular formations are colored pink, dull, cause characteristic itching and irritation. Acute allergy manifests itself mainly on the upper half of the child's body, and the rash can also be located in large folds (inguinal). The child is capricious, begins to scratch the itchy skin, loses appetite, sleeps poorly. Vomiting and dyspeptic manifestations are possible against the background of general irritability.
2. If the allergy shows symptoms for a long time, and the rash does not go away after 4-6 weeks, such rashes are diagnosed as chronic allergic rash. Its symptoms are similar to acute manifestations of allergy, however, they cause more aggravated manifestations from the nervous system - insomnia, nervousness, irritability, weight loss due to refusal to eat.

Symptoms of an allergic rash can also manifest in the form of angioedema (Quincke's edema), which is considered the most dangerous and is characterized by the rapid development of the following symptoms:

• A tingling sensation in the tongue, lips, or roof of the mouth.
• Pain, colic or cramps in the abdominal area.
• Erythematous rash, most often on the face.
• The rash on the face spreads quickly and is accompanied by developing swelling.
• The eyelids and mucous membrane of the mouth swell literally before your eyes.
• Conjunctivitis is possible.
• The swelling may spread (migrate) to the nasopharynx and cause difficulty breathing.
• The skin of the face takes on a characteristic bluish tint (cyanosis).
• Angioedema is a serious life-threatening symptom and requires immediate medical attention to avoid serious complications.

Allergic rash in a baby

The most common symptom of food allergy in formula-fed newborns is urticaria, which is often called diathesis. In fact, there is no diagnosis of "diathesis", this word means predisposition, inclination to any disease. Allergic rash in a baby is a type of transient, non-pathological dermatitis, when the baby's skin reacts to the invasion of an antigen substance. There are three ways in which an allergen is introduced into an unprepared, unadapted child's body:

• During feeding, that is, a food allergen.
• During contact with skin - contact allergen.
• During breathing - aeroallergen (inhalation allergen) or respiratory tract.

Allergies in babies under one year are most often provoked by a food factor. If the child is breastfed, he may have similar problems in cases where the mother does not follow a hypoallergenic diet. A child receiving artificial mixtures reacts to cow's milk protein, too early or ill-considered from a dietetics point of view complementary feeding.

Allergic rash in infants is currently an extremely common phenomenon, according to statistics, up to 45% of babies under the age of one and a half years suffer from it. In the etiology of food allergies in newborns, the hereditary factor plays an important role:

• If mom and dad are allergic, the probability of their child having allergies is up to 65%.
• If one of the parents is allergic, the risk of developing an allergic reaction reaches 40%.

In addition, the cause of an allergic rash can also be an intrauterine congenital pathology (hypoxia), diseases suffered by the mother during pregnancy.

Physiologically, an allergic reaction can be explained by the insufficient development of the baby's digestive tract and the low activity of the production of protective antibodies - Ig A. Thus, local protection of the mucous membranes of the gastrointestinal tract with the help of immune antibodies is practically absent, and allergic substances quite easily penetrate the bloodstream, overcoming the intestinal barrier.

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How does an allergic rash manifest itself in a baby?

The first to react to the allergen is the child’s skin:

• Redness of the cheeks, less often the forehead or neck.
• Diffuse or localized rash, usually starting on the face. The rash may migrate to the forearms, buttocks, and calves.
• Roughness and flaking of the facial skin.
• Constant diaper rash not associated with objective hygienic reasons.

The most serious and threatening manifestation of allergy in a baby is angioedema or Quincke's edema, which develops very quickly and requires immediate action to stop it. Signs of Quincke's edema in newborns are very specific:

• The child suddenly starts to act up and cry.
• Small papules (rash) appear on the skin of the face.
• The baby's voice becomes hoarse and intermittent.
• Shortness of breath appears, and breathing may stop.
• The child quickly develops swelling of the larynx.
• The face takes on a characteristic bluish tint (cyanosis), then turns sharply pale.

At the slightest alarming symptoms that a caring mother notices in her baby, it is necessary to consult a doctor. The choice of diagnostic method and therapeutic actions is the prerogative of the attending pediatrician or allergist, parents are required to strictly follow the doctor's recommendations.

What can I do to make sure that an allergic rash in a baby goes away and doesn’t recur?

• The introduction of complementary foods must be agreed upon with a pediatrician and nutritionist, especially if there is a risk of developing an allergy due to a hereditary factor.
• The first complementary food should be hypoallergenic even for those babies who have not previously shown allergy symptoms.
• Whole cow's milk, eggs and dishes containing them, wheat porridge, citrus fruits, nuts - these are the products that are best not given to a child under one and a half years old.
• A breastfeeding mother must follow a special hypoallergenic diet.
• A baby who has periodic constipation may react to the delay in stool with an allergic rash. Therefore, it is necessary to regulate the timely emptying of the digestive tract in the child.
• For hygienic purposes, to care for your baby's skin, you should use only hypoallergenic, special cosmetics that do not contain perfumes, fragrances, or dyes.
• Allergic contact rash can be caused by chlorinated bathing water, so it is better to bathe your baby in dechlorinated or boiled water of the right temperature.
• Allergies can be caused by clothing and bedding made of synthetic materials; this factor should be excluded.
• Heat allergy can be triggered by overheating and too warm clothing. The baby should not be over-bundled, as the body temperature of newborns is higher than the normal temperature of an adult, and the heat exchange mechanisms are arranged differently.
• It is necessary to exclude or minimize the child’s contact with pets, whose fur may cause an allergy in the form of a rash.

Allergic rash in a baby is usually a temporary phenomenon. The baby is growing, and all the metabolic and protective functions of the digestive tract, liver, and immune system are also developing and improving. With age, almost all symptoms of food allergies disappear if anti-allergic measures were taken in a timely manner and in full. According to statistics, only 1-1.5% of children remain allergic in adulthood, most of them have a hereditary predisposition to allergies.

Diagnosis of allergic rash in a child

The main clinical sign that allows differentiating allergic rash from infectious rashes is the relatively normal general condition of the baby. With all the nervous manifestations - whims, irritability associated with itchy skin, the child's appetite remains at the same level, the body temperature, as a rule, does not increase.

Diagnosis of an allergic rash in a child involves the following steps:

• Collection of a thorough anamnesis, including allergic and family history to exclude possible hereditary factors.
• To confirm allergic urticaria, it is necessary to exclude other allergic, infectious, inflammatory diseases that are also associated with immunoglobulin IgE.
• A detailed analysis of the route of penetration of the allergen is carried out, all possible causes are identified, among which may be household and contact factors.
• Elimination of the suspected allergic factor is carried out as a diagnostic and simultaneously therapeutic measure. If there is information about provocative food, all dishes containing the allergen are excluded; if a contact route of allergy development is suspected, dust, wool, synthetic detergents, cosmetics, and linen are eliminated.
• If the disease is acute, diagnosis of allergic rash in a child involves laboratory blood tests to determine IgE in the blood serum.
• After the symptoms subside, usually after 1.5-2 months, it is possible to conduct skin tests (scarification, prick tests, application tests) in order to more accurately determine the nature of sensitization and identify the allergen.
• In a diagnostic sense, signs of an allergic rash or urticaria are an increased level of T-lymphocytes, CIC (circulating immune complexes), a decrease in IgA titers, and an increase in interleukin.

Diagnosis of allergic skin rashes in children is carried out taking into account all the features of the health condition, the collected anamnesis and clinical symptoms of the disease.

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Treatment of allergic rash in a child

Therapeutic actions against allergic rashes are a standard treatment regimen for allergies, including food, contact or drug allergies.

1. Immediate elimination of the suspected provoking factor. Food liberators (provocateurs) of histamine can be dairy products, eggs, fruits or vegetables, as well as food containing vasoactive amines - sausages and other sausage products, liver (pork), herring, tomatoes, hard cheese, smoked and fermented foods.
2. Antihistamines for the treatment of rash should be recommended and prescribed by a pediatrician. As a rule, H1 blockers are prescribed in a dosage and form corresponding to the child's age. If the symptoms develop quickly and become threatening (Quincke's edema), the doctor may use glucocorticosteroids.
3. As an emergency aid for a baby that does not require a prescription, Fenistil gel (used from 2 months), Bepanten, which will soften the skin and relieve itching, or a simple baby cream will do. Infusions and decoctions of medicinal herbs should be used only on the advice of a pediatrician, since many herbal remedies are allergens.
4. A mandatory step in the treatment of allergic rash is a diet that excludes provocative products. A hypoallergenic diet should be followed for 3 months even when symptoms subside. Then, risk products are included in the menu with maximum caution in microdoses so as not to provoke a relapse of the allergic rash.

In the room where the child is located, certain sanitary and hygienic conditions must be observed:

• multiple wet cleaning,
• ventilation,
• daily change of linen, clothes,
• It is necessary to exclude all provoking agents from the category of household chemicals.

Treatment of allergic rash in a child requires long-term observation by the attending physician or allergist. Outpatient registration is not necessary, but monitoring of the child's condition is carried out for six months after the first allergic manifestations have been stopped.

Prevention of allergic rash in children

Preventive measures to prevent allergies in babies, as pediatricians aptly put it, should begin a year, or better yet, two, before the baby is born. This means that the expectant mother, as well as the father, should monitor their health so that their baby is born healthy and does not suffer from allergies.

A pregnant woman should be aware of the need to follow a hypoallergenic diet and the possible risks associated with taking various medications.

• A nursing mother is the first potential source of food allergies in a baby, even a minimal dose of a food liberator (allergy trigger) eaten by a mother will cause a reaction in a breastfed baby. Nuts, chocolate, sea fish, citrus fruits, eggs, smoked meats and canned foods may be attractive in terms of taste, but they are also the main culprits of food allergies and rashes in a breastfed baby.
• Children who show milk protein intolerance should receive hypoallergenic formulas and follow a diet until they are 2 or sometimes 3 years old.
• Children with a burdened hereditary allergic history should receive complementary foods according to a special, individual scheme that takes into account all possible risks.
• If an allergic rash has appeared and it was stopped in time, to prevent relapses, parents should keep a special food diary. These records note the slightest alarming reactions to food products or new complementary foods. Thus, a diary is an opportunity to prevent or stop the development of allergies in time.
• A child prone to allergic rashes should not come into contact with animal hair, inhaled allergens - pollen, aerosols, household dust.
• The vaccination schedule for a child with allergies differs from the vaccination schedule for a healthy child. Vaccinations should be carried out taking into account the allergic anamnesis.
• The child's clothes and underwear should be made of natural materials. Also, toys made of latex, plastic without the "hypoallergenic" label, etc. should be excluded from the child's environment.

Prevention of allergic rash in a child is following doctor's recommendations and using only pharmacy drugs, both internal and external. Self-medication, experiments with the treatment of allergic rash in a baby can lead to serious complications.