Allergic disease in children: integrated approach

Overview & Definition

Picture the child who arrives in clinic with itchy, dry skin in infancy, a frightening reaction to egg at the high-chair, wheeze through the pre-school winters, and a constantly blocked nose at school. Each presentation looks like a separate problem to a separate organ, but they are expressions of one atopic tendency, and the integrated approach treats that tendency rather than chasing each flare in isolation.[10]

Allergic disease in childhood is an immune dysregulation in which a Th2-skewed response generates allergen-specific immunoglobulin E against otherwise harmless environmental proteins, producing reproducible inflammation across skin, gut and airway. The four diseases that dominate practice are atopic dermatitis, food allergy, asthma and allergic rhinitis, and they cluster so predictably in the same children that the older term "atopy" is still the most honest shorthand for what is going on.[9]

The unifying emergency that runs across all of them is anaphylaxis, a rapid, life-threatening reaction that demands intramuscular adrenaline before any test is drawn. A child may live for years with eczema and rhinitis and never see a hospital, yet die in minutes from a peanut, so the action plan that puts an adrenaline autoinjector in the bag is the single most important outcome of every allergy consultation.[11]

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