|Year : 2021 | Volume
| Issue : 4 | Page : 287-288
Uncommon causes of allergies in children
Department of Pediatrics, Hamdard Institute of Medical Sciences and Research, Delhi, India
|Date of Submission||16-Nov-2021|
|Date of Decision||16-Nov-2021|
|Date of Acceptance||16-Nov-2021|
|Date of Web Publication||29-Nov-2021|
Department of Pediatrics, Hamdard Institute of Medical Sciences and Research, Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bedi N. Uncommon causes of allergies in children. Indian Pediatr Case Rep 2021;1:287-8
The incidence of allergies has been increasing globally, especially those pertaining to food and environmental allergens. This has been attributed to reasons like the cross-reactivity of allergens, increased travel, and rising levels of pollution, among many others. In this section, we shall discuss three interesting, but uncommon allergic manifestations in children.
Irahara M, Nomura I, Takeuchi I, et al. Pediatric patient with eosinophilic esophagitis and pollen-food allergy syndrome. Asia Pac Allergy 2020;10:e28.
This case describes an 8-year-old Japanese boy with a history of intermittent episodes of vomiting since the age of 2 years. The child had undergone tonsillectomy when he was 4 years following the suspicion that tonsillar hypertrophy was the cause of his vomiting, but the symptoms persisted. Episodic rhinorrhea and nasal congestion that were more in the winter and spring began after he turned 5 years old. At the age of 7 years, the child developed episodes of a feeling of 'itchiness' of the lips and throat, following the vomiting. It was noted that this occurred immediately after eating certain fruit such as kiwi, cherry, and apple. A positive family history of allergies in his parents was elicited and he was referred for evaluation and elimination of allergens when he was 8 years old.
The boy was 125.7 cm tall (–0.1 standard deviation [SD]), and weighed 25.6 kg (–0.2 SD). The remaining examination was unremarkable. There was a significant elevation of total immunoglobulin E (IgE) levels (215 IU/mL), particularly for antibodies specific for birch, apple, kiwifruit, peaches, and walnuts (>0.35UA/mL). The skin prick test (SPT) for fruits and nuts (raw kiwifruit, raw and heated peach, raw cherry, walnut, and hazelnut) revealed a positive wheal (≥3 mm in diameter). A diagnosis of Pollen food Allergy Syndrome for apple, kiwifruit, and cherries was made. Since raw and heated antigens caused positive results only for peach, it suggested the possibility of different sensitization routes for apple, kiwifruit, and cherry, vis-à -vis peach. The SPT was not be followed by an oral food challenge with nuts and peach as per usual protocol, as the parents did not give consent. However, the aforementioned items were completely eliminated from his diet. The vomiting did not resolve.
An esophagogastroduodenoscopy was performed after 11 months. This showed longitudinal furrows and esophageal rings in the mid to lower esophagus, eosinophilic infiltration in the stratified squamous epithelium of the mid esophagus and marked lymphoid follicles in the lower esophagus. The diagnosis was changed to Eosinophilic Esophagitis. The child was started on oral esomeprazole (20 mg/day), following which his symptoms improved significantly, as did the repeat endoscopy findings.
Ballardini N, Nopp A, Hamsten C, et al. Anaphylactic reactions to novel foods: Case report of a child with severe crocodile meat allergy. Pediatrics 2017;139:e20161404.
A 13-year-old boy presented to the pediatric emergency following an anaphylactic reaction after ingesting crocodile meat (brought by his father, a professional chef, to prepare an exotic meal). After taking the first bite, the child developed itchiness in the mouth and throat, facial urticaria, conjunctivitis, angioedema, chest tightness, and breathing difficulties. The child had been diagnosed with chicken meat allergy since he was 5 years of age and followed a poultry-free diet. When he was 7 years old, he had an anaphylactic reaction after accidental intake of turkey, and an adrenaline autoinjector was prescribed.
The parents had immediately administered intramuscular adrenaline and β-2 agonist inhalation at before bringing him to the hospital. On hospitalization, salient examination findings were facial urticaria, periorbital angioedema, bilateral redness of the sclera, laborious breathing but no bronchospasm. The child became stable within 4 h and was discharged. As there were no previous reports of allergic reactions to crocodile meat in literature, the authors hypothesized that α-parvalbumin, a specific chicken meat allergen, may also be expressed in crocodile tail meat and/or the presence of IgE cross-reactivity between the two.
Das L, Ward MG. Case 1: A 12-year-old girl with food allergies and an acute asthma exacerbation. Paediatr Child Health 2014;19:69-70.
A 12-year-old girl, who was a known case of bronchial asthma, presented to the emergency department in the winter, with a sudden feeling of suffocation associated with bluish discoloration of the lips. She had been having an acute exacerbation (increased work of breathing, cough, and wheezing) for 3 days. The episode was preceded by symptoms suggestive of a mild upper respiratory tract infection. The patient reported increased requirement of inhalation with her prescribed short-acting bronchodilator, and incomplete response, compared to previous episodes. She had been compliant with her medication and had not had an exacerbation for the previous 6 months. At presentation, she had an oxygen saturation of 85% in room air, respiratory rate of 40 breaths/min, increased work of breathing and decreased air entry, bilaterally. She received salbutamol, ipratropium, intravenous steroids, and magnesium sulfate immediately, after which the child improved. The chest radiograph revealed hyperinflation.
Causes for the sudden worsening were probed for. History of symptoms of hypersensitivity (wheezing, dyspnea, and pruritis) was elicited on ingestion of certain food items (peanuts, chickpeas, and lentils) and seasonal exposure to grass and pollens. The parents reported that she had been demonstrating a depressed mood associated with reluctance and anxiety related to going to school for some time. There was no history indicative of substance abuse. Further probing revealed that she was being bullied at school for several months, primarily due to her food allergies. Three days earlier, her classmates had smeared peanut butter on her schoolbook and her symptoms had got triggered after she handled it.
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