When an allergy can affect your life

BarcelonaFourteen-year-old Fiona Olivé lives with a constant cough and runny nose. It's as if she's always sick. During the cold season, her family is always on high alert to prevent her from getting seriously ill, as any respiratory infection can easily become complicated and develop into pneumonia. The young girl is allergic to various types of dust mites, grasses, and cats, and for a time, there was also a suspicion that she was allergic to eggplants, which was recently ruled out after controlled food exposure at the Sant Pau Hospital's day hospital. However, for the two years she lived with this suspicion, she had to act like a person with allergies. de facto to this vegetable. During this period, explains Karla Islas, her mother, the hardest thing for her was having to constantly be aware of the allergy "and, before eating anything, having to ask or be alert in case it contained eggplant." The young woman "also found it difficult at school," she adds.

Islas recalls how, from a young age, Fiona had atopic dermatitis. "Around the age of five, she began to suffer from recurrent bronchitis until, following a spirometry test, she was diagnosed with asthma. To keep her dust mite allergy under control, Fiona is currently undergoing immunotherapy treatment. This is known as vaccine It consists of an injection every seven weeks. "In addition," her mother adds, "she has a daily maintenance inhaler and a rescue inhaler, and she always carries an antihistamine with her just in case." The young woman also has annual checkups with an allergist, but because she is prone to pneumonia—she had three bouts last year—her pediatrician also monitors her closely. As her mother points out, "within hours, she begins to experience severe respiratory distress, and we have to rush to the emergency room to get her oxygen."

The most common allergies in childhood are food allergies—especially in very young children—and respiratory allergies, whether to dust mites, pollen, spores, or animals. Allergies caused by medications and insects, says Pilar Llobet, head of the pediatrics department at Granollers General Hospital, "are less frequent in pediatrics compared to adults." When describing how each type of allergy manifests, Llobet, who is also a consultant in Clinical Immunology and Pediatric Allergy at the hospital, points out that food allergies can produce a wide variety of symptoms. The most common, she notes, are rashes, vomiting, and sudden stomach pain without any other apparent cause, but they can also present with coughing, stridor, difficulty breathing, and even anaphylaxis (the combination of two or more of these symptoms), and in some cases, shock. "In fact," Llobet emphasizes, "the most frequent cause of anaphylaxis in childhood is food." "Currently, pediatric allergists don't recommend the gradual introduction of foods, but rather early introduction once children begin complementary feeding," Llobet stresses. The goal is simply to reduce food allergies. Furthermore, once a new food is introduced into the diet, it's important to offer it frequently, not occasionally. The reason, she explains, "is that during this period, there's a greater chance of developing immunological tolerance, and if the food is introduced regularly, the tolerance will also be maintained." She points out that it's important to remember that when children are young, certain foods, such as nuts, "should always be very finely crushed to avoid the risk of choking." Llobet notes that many factors influence this tolerance, "from genetic predisposition to environmental factors such as infections, exposure to tobacco, medications, etc." And therefore, he acknowledges, "further research is needed to make progress in preventing food allergies."

Respiratory allergies and medications

Pollen or dust mite allergies, in turn, present with respiratory symptoms such as coughing, wheezing, rhinitis, or conjunctivitis. "Sometimes," Llobet clarifies, "these symptoms can be confused with a food allergy, which is why it's important to have them evaluated by a pediatric allergist." Finally, allergies caused by certain medications present similarly to those in adulthood, primarily with skin symptoms such as rashes, swelling of the eyelids, legs, or limbs—manifestations which, as the head of pediatrics points out, "during childhood, can also be related to viral infections from the medication the child is currently taking."

In any case, if an allergy is suspected, it will be necessary to act according to the symptoms each child presents. Most, Llobet points out, "will resolve with an antihistamine and by avoiding the allergen, but in others we will need inhalers and even intramuscular adrenaline." In any case, the consultant in Clinical Immunology and Pediatric Allergy recommends a visit to the child's primary pediatrician, except in cases where the child presents with difficulty breathing, general malaise, or severe symptoms. "In these more serious cases, you must go to the Emergency Department, and if shock is suspected, call 112," she emphasizes.

The role of the environment

Given her condition, it's essential that Fiona always carries her medication with her, wherever she goes. "When she goes on outings or sleeps away from home, she tries to find the dustiest spot, but that's not always possible, which can lead to conflicts," her mother points out, adding that "sometimes, someone might think it's an excuse to choose a bed or to avoid sleeping on the floor." The role of the community, therefore, and its awareness, is crucial to ensuring that the lives of these children and young people with various allergies are not stigmatized by their condition. Karla Islas notes that, in general, she and Fiona have encountered considerable awareness from schools and institutes, as well as from school cafeterias, restaurants, and recreational facilities like children's party venues. However, she recalls a time when she received a call from the primary school saying that her daughter refused to eat pizza because she claimed to be allergic to eggplant. “I couldn’t believe it,” she exclaims. “It wasn’t just Fiona saying it, the school had a medical certificate from the pediatrician that I myself had given them a few months ago, where it specified it!” In contrast, at the high school she attends now, the experience has been very positive. “They are very careful and even organize a special open house for families with children with allergies and intolerances, so we can learn about the procedures and protocols, see how the cafeteria works on a typical day, and try the same food the students eat,” Islas says happily. Pilar Llobet, head of the Pediatrics Department at the Granollers General Hospital, is more critical of this issue, emphasizing that “in general, allergies are confused with intolerances, and the risk is often minimized.” Llobet also states that "the impact of social restrictions and the suffering of families is underestimated, as is the possibility of children having a severe reaction to accidental ingestion of a hidden allergen, whether due to its composition or contamination with another ingredient." In recent years, she notes, several information campaigns have been carried out, and many restaurants have menus with information on major allergens, though not all of them. Some schools have requested information from both the Pediatric Allergy Unit and their primary pediatricians, especially when a child has a severe reaction. "Information is essential to improving awareness, and above all, it's crucial to differentiate between allergies, intolerances, and other digestive disorders," Llobet insists.

Transition to adulthood

"With the onset of adolescence, we encounter several factors that make these patients, who suffer from a chronic illness such as allergies, especially susceptible," notes Patricia Martínez, acting head of the Allergy Department at Granollers General Hospital. Martínez cites factors such as a lack of awareness of the illness, the absence of a support network, and the beginning of independent decision-making, "which sometimes hinder disease control or lead to severe reactions." Society, Martínez points out, is not entirely prepared to welcome these adolescents as they transition to adulthood, since, for example, lactose intolerance is still confused with cow's milk protein allergy, which can lead to fatal outcomes, as has happened. In this regard, Dr. Martínez mentions allergy patient associations like AEPNAA, a community she considers "very active, helping and supporting parents of children, especially those with food allergies, and always providing alerts about correct food labeling." One of the objectives of the 2024 transition program is precisely to accompany and empower young people, fostering their autonomy and confidence in managing their condition. To this end, the committee members—comprised of doctors and nurses from the hospital's Pediatrics and Allergy departments—meet every two months. "During these sessions, we discuss each patient's case (their current situation, whether they have any other illnesses, and their individual circumstances). This way, when they arrive at the adult clinic, we already know their medical history and their specific situation," Martínez points out. More complex patients are scheduled for a joint evaluation by the specialist and the nurse. Their illness and treatment are explained to them, and efforts are made to raise their awareness of the disease while also helping them normalize it. "We also provide them with tools so they can manage their symptoms independently, and we explain to parents that they should continue to provide support, but with reassurance," Martínez continues. Since its inception, the service has evaluated a total of 80 patients who have transitioned from the pediatric allergy unit to the adult unit.