Pediatric Allergy and Immunology

Boy in a field with cats in his lap

At RWJBarnabas Health, we take your child’s allergies very seriously and do our best to evaluate and help your family manage them. We educate parents about their child’s medical condition because preparation is key to preventing any complications or reactions. We also provide guidance on early food introduction, which is important to prevent food allergies.

Early detection of allergies is vital to improving a child’s quality of life, not to mention to reducing the number of days missed from school.

Allergies commonly begin in childhood, and if your child is struggling with allergies, they may benefit from seeing a pediatric allergist/immunologist.

Pediatric allergists/immunologists also care for patients with immune disorders.

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What Does a Pediatric Allergist/Immunologist Do?

Pediatric allergists are medical doctors who are experts in the detection, treatment and management of food, environmental and medication allergies as well as immunodeficiencies in children. They also manage eczema (atopic dermatitis) and asthma.

Allergies are very common, while immunodeficiency problems are less so. In the United States, food allergies affect about 5.6 million children and about 6 million American children have asthma, which is often caused by allergies. Other common allergens include pollen, dust mites, pet dander, medications and insect stings.

At RWJBarnabas Health, our allergists are also trained immunologists who treat immune disorders. They are here to help diagnose the cause of your child’s recurrent infections, and perform screenings and evaluations, including genetic testing when indicated for immunodeficiency (when the immune system is impaired and fails to respond adequately to infections).

What Is an Allergy?

Allergic reactions are caused by the body reacting to a specific foreign substance (allergen) that has been inhaled, touched or eaten.

While the purpose of the immune system is to defend itself against harmful substances such as viruses or bacteria, sometimes the immune system overreacts to usually harmless substances like dust, mold or pollen. It triggers an allergic reaction that may lead to itchy eyes, runny nose, sneezing, cough and possibly difficulty breathing if your child has asthma.

Food allergies occur when the body has an abnormal response to a specific food or ingredient. Eggs, milk, peanuts, wheat, soy, tree nuts, fish, shellfish and sesame are the most common food allergies in children, but there are many other types of food allergies.

Allergic reactions can begin within minutes to an hour after ingestion. If a child is highly allergic, it may only take a small amount of allergen to trigger a reaction. Allergic reactions to food include hives, vomiting, diarrhea, and wheezing, as well as a severe reaction called anaphylaxis.

Allergy Symptoms

Allergy symptoms can include one or more of the following:

  • Nasal congestion
  • Sneezing and coughing
  • Itchy or runny nose
  • Red, itchy, watery eyes
  • Breaking out in hives
  • Itchy rashes
  • Shortness of breath
  • Anaphylaxis (a severe allergic reaction that can be life-threatening without prompt treatment)

Common Allergies

Pediatric allergists/immunologists generally provide treatment for the following types of allergies:

  • Asthma
  • Allergic rhinitis or “hay fever”
  • Sinusitis
  • Eczema
  • Hives
  • Reactions to foods, insect stings and medications
  • Immune disorders that lead to:
    • Frequent sinusitis, pneumonia
    • Thrush and abscesses that keep coming back
    • Severe, unusual infections

Why Does My Child Have Allergies?

Allergies can affect patients of any age. While the human immune system is supposed to fight off infections, sometimes the immune system mistakenly reacts to things that are usually harmless.

Some common allergens can be found indoors, outdoors and in irritants or foods. Allergy triggers include pet dander, pollen, dust, mold, insect stings or venom, as well as specific foods and medications.

Diagnosing Allergies in Children

Pediatric allergists/immunologists use a variety of tests to diagnose allergies in their patients, including:

  • Skin prick tests. This common allergy test checks how the patient’s skin reacts to a small amount of diluted allergen placed on the skin. If the child is allergic to the substance, a small raised bump will appear at the site where the test was placed and result appears about 15 minutes afterwards.
  • Blood tests. This test measures antibodies to specific allergens found in the blood and is used when a skin test cannot be performed, such as if the patient has a certain skin condition that makes skin tests unadvisable or if the patient is taking oral antihistamines that interfere with skin testing. These tests take several days to get results back and must be interpreted by an allergist, as a positive blood test doesn’t always indicate a specific allergy.
  • Spirometry (pulmonary function test). Used to diagnose asthma and determine its severity, this test measures how quickly the patient can exhale air. This diagnostic tool is used to check lung function and study the air capacity of the patient’s lungs.
  • Food or drug challenge. While a skin or blood test only indicates the likelihood of having a reaction to an allergen, this test determines what the reaction will look like.Supervised by a doctor, this test is conducted by having the patient ingest small amounts of the allergen to figure out how severe the problem is, or if the patient is not truly allergic.

Food Allergy Management and Treatment

The most effective strategy is complete avoidance of the offending allergen. For example, children with egg allergy should avoid eating eggs. Treatment also includes education to read labels on food packages, and understanding how to use epinephrine, a life-saving injectable medication, during anaphylaxis. Some childhood food allergies, such as milk or egg, can be outgrown. Food challenges can help determine that an allergy has been outgrown.

Environmental Allergy, Allergic Rhinitis, Allergic Asthma Treatments

Allergy Immunotherapy (Allergy Shots and Tablets)

Allergen immunotherapy includes allergy shots (subcutaneous immunotherapy) or dissolvable allergy tabs (sublingual immunotherapy – available for only grass and ragweed in the pediatric population). This type of allergy treatment is proven effective for children with allergic rhinoconjunctivitis and asthma. Allergy shots require routine injections over a period of about 3 to 5 years. Allergy tabs are taken daily and the length of treatment varies. Medical management (with medications) is also an option, with oral and topical medications to reduce symptoms.

Biologic Therapy

Biologic therapy includes medications such as omalizumab, dupilumab, mepolizumab, tezepelumab and benralizumab. These medications are usually very effective. They are injectables given every 2 to 4 weeks. Treatments can be done in the doctor’s office or at home.

Biologics are approved for different conditions and different ages but include:

  • Moderate to severe asthma
  • Moderate to severe atopic dermatitis
  • Chronic urticaria
  • Eosinophilic esophagitis
  • Nasal polyps

Drug Allergies

Some children are allergic to medications. To identify drug allergies, a pediatric allergist/immunologist may conduct:

  • Skin testing
  • Drug challenges
  • Medication desensitizations (done in a hospital setting)

Immune Diseases

To understand what immune diseases are, it helps to know more about the human immune system and how it works. The immune system includes blood cells and other body mechanisms intended to fend off diseases such as bacteria and viral infections. An immune deficiency, also called immunodeficiency, means the immune system has partly or completely lost its ability to fight infectious disease.

A child who has an immunodeficiency, which can be inherited (present at birth) or acquired, is called “immunocompromised” because of their disease.

An autoimmune disease is a kind of immune disorder characterized by an overactiveimmune system in which the body attacks its own healthy tissues, organs and cells. Examples of autoimmune disorders include lupus, rheumatoid arthritis, inflammatory bowel disease (IBD), Type 1 diabetes, psoriasis and celiac disease. Pediatric allergists/immunologists will refer patients to specialists for specific autoimmune disorders.

It is important to diagnose and treat pediatric immune diseases early because untreated disease can lead to recurrent serious infections and complications.

Immune Disorder Symptoms

Symptoms vary from one child to another, but the hallmark of childhood immunodeficiencies is long-lasting, frequent, hard-to-treat infections such as:

  • Pneumonia
  • Sinusitis
  • Ear infections
  • Skin infections

They may also have blood disorders such as anemia, digestive problems, delayed growth and development, or autoimmune disorders such as Type 1 diabetes or lupus.

Immune Disease Diagnosis

To diagnose immune disorders, a doctor may order testing to screen the immune system for antibodies, immune cells, immunoglobulins, blood counts and vaccine titers. Results of these tests will be interpreted by an immunologist.

Additional testing may be necessary to determine the best course of treatment, especially because treatment for inherited immunodeficiencies, which are also called primary immunodeficiencies, vary from treatment for acquired immunodeficiencies, or “secondary” types.

Common Immune Diseases We Treat

Some of the most common immune diseases allergists/immunologists treat are called:

  • 22q11 deletion syndrome (DiGeorge syndrome, also known as velocardiofacial syndrome)
  • X-linked agammaglobulinemia
  • Common variable immunodeficiency
  • Hyper IgE syndrome
  • Chronic granulomatous disease
  • Severe combined immunodeficiency (SCID), which is detected in newborn screenings
  • Specific antibody deficiency

Treatment for Immune Disorders

Therapy for childhood immune disorders aims to remove the cause of the disorder, manage the patient’s symptoms, and treat infections as they arise.

Treatments for pediatric immune disorders include:

  • Immunoglobulin (antibody) infusions or injection therapy to boost the immune system
  • Long-term antibiotics
  • Stem cell transplantation
  • Gene therapy
  • Preventing infections and treating existing infections

Multidisciplinary Care

Immune and autoimmune diseases can affect the whole body and symptoms may vary. Several doctors and specialists may be involved in your child’s care, from diagnosis to treatment to support, including hematologists, gastrointestinal specialists and rheumatologists.

If you have questions about your child’s allergies or immune system, make an appointment with an RWJBarnabas Health pediatric allergist/immunologist today to discuss your concerns.

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