Allergy problems can start at a very young age and often will follow a predictable progression. Allergists define the progression of the initial stages of childhood allergic disease as the “Allergic March.” A dry skin condition, known as eczema or atopic dermatitis, is often the first manifestation of allergic disease and it can begin at a few months of age. The rash is very itchy and it usually starts on the face and will also occur on the trunk and extremities. Initial treatment may involve starting low dose antihistamine for itching and applying a very mild steroid cream or ointment on the affected skin. Unscented, mild soap, such as Dove, and an unscented moisturizer, such as CeraVe Healing Ointment, will help to moisturize the dry skin. If this problem persists, a referral to an allergy specialist may be needed to test for common food allergies. The most common food allergies at this age are milk and egg, with peanut, soy, and wheat also playing a major role. Older individuals will also commonly have food allergies to tree nuts, fish, and shellfish. Interestingly, food allergies may only cause eczema or food allergies may cause more severe allergic symptoms, such as hives, wheezing, or other symptoms of anaphylaxis. It is very important that the cause of these reactions be identified as early as possible and a plan of action be given to the parents in case of emergency. At around 1-2 years of age, the “Allergic March” can progress to include allergic rhinitis due to environmental allergies. Initially the indoor allergens, such as house dust mites and pet dander, are common to cause allergy symptoms.  Allergic rhinitis due to pollen will usually begin after age two since generally you need a few years of exposure to the pollens to develop symptoms. Common allergic rhinitis symptoms include chronic runny nose, itchy, watery eyes, and allergic shiners, which are dark circles under the eyes. Skin tests may or may not be positive or confirmative for allergy at this age. Testing may need to be repeated in the next 1-2 years if symptoms of allergies persist. Finally, allergic rhinitis can be a risk factor for developing asthma. Symptoms of asthma consist of recurrent cough and wheezing. It can be triggered initially by a viral illness. Some children require Albuterol for quick symptom relief and some need daily inhaled steroids to control recurrent cough and wheezing. Studies have been done to show the predictability of early childhood wheezing and the likelihood of when it may be outgrown. Some of the factors which can lead to long term wheezing include having confirmed allergies when tested and having a parent with asthma. As some children develop asthma, they will often start showing signs of improvement in other allergic problems, such as atopic dermatitis.  In summary, the “Allergic March” can start with atopic dermatitis, then progress to possibly more severe food allergy, allergic rhinitis, and asthma. If you see any of these symptoms in your child, please call our office at 501-673-3030 for an allergy evaluation. The allergy evaluation will help identify the cause of the allergic problem and give you, the parent, peace of mind!

 

Deanna N. Ruddell MD
Board Certified Pediatric and Adult Allergy, Asthma, & Immunology