Allergies & the Immune System

If your child has asthma, you probably understand triggers — those substances or activities that bring on breathing problems.

But what if the asthma trigger is in the air your child breathes? Ground-level ozone and other air pollutants can trigger worsening symptoms and asthma flare-ups. But you can help minimize your child’s exposure.

About Ozone

Ozone is a gas that’s found in both the Earth’s upper and lower atmospheres. The protective ozone in the upper atmosphere is very different from the harmful ozone in the lower atmosphere. Ozone that exists naturally 10 to 30 miles (16 to 48 kilometers) above the Earth protects us all from the sun’s ultraviolet (UV) rays.

But ground-level ozone is different. It’s found close to Earth’s surface and is a serious pollutant. It’s produced when sunlight combines and reacts with chemicals produced by cars, power plants, and factories. That’s why ground-level ozone, a main component of smog, tends to be higher in sunnier climates or during hot, still weather.

Ground ozone levels have declined somewhat since 2000, but according to the American Lung Association, 38% of the population of the United States live in areas with unhealthy ozone levels. This includes 2.5 million kids with asthma who live in towns or cities with very high levels of ozone.

Other Pollutants

Although ozone gets a great deal of press, it’s not the only pollutant that causes poor air quality. In 2004, for the first time, the American Lung Association included not only ozone but particle pollution levels in its annual “State of the Air” report for the United States.

Particle pollution refers to tiny particles of acids (such as nitrates and sulfates), dust, dirt, smoke, soot, and droplets from aerosols that are suspended in the air we breathe. The smaller the particles, the deeper they can get into the lungs, where they cause problems.

Particle pollution data are graded by both year-round and short-term levels:

• More than 44 million U.S. residents, including more than 125,000 kids with asthma, live in areas with levels of particle pollution that are unhealthy year-round.
• More than 47 million Americans live in areas that experience too many days with short-term spikes (from several hours to several days) in particle pollution, including more than 940,000 kids with asthma.

In addition to ozone and particle pollution, other pollutants include gases such as carbon monoxide, sulfur dioxide, and nitrogen dioxide. High levels of these gases can also affect lung function.

How Poor Air Quality Affects People With Asthma

Air pollution is a problem for everyone — not just people with asthma. Studies have shown that high levels of air pollution can be associated with decreased lung function and more frequent reports of respiratory symptoms. This is especially true for people who spend a lot of time outdoors.

Kids may be particularly affected by pollution levels because they:

• play outdoors
• have faster breathing rates
• have lungs that are still developing

But although high levels of pollution affect everyone, people with asthma are more sensitive and experience the effects more quickly and severely. Additional studies have shown that ozone, particle pollution, and other forms of air pollution worsen asthma and increase hospital visits for people with asthma. And again, it’s kids with asthma who are especially vulnerable to these effects.

Pollutants in the air have the same effect on people with asthma as other triggers. They reduce lung function by inflaming the lining of the lungs. Exposure to pollutants in the air can cause flare-ups and may increase the chance of upper respiratory infections, which can worsen asthma symptoms. If allergens in the air are an asthma trigger, pollutants can make the lungs even more sensitive to them.

What You Can Do

An important aspect of managing your child’s asthma is avoiding triggers. That means you should pay attention to pollution levels and plan accordingly when they’re going to be high.

The Air Quality Index (AQI) was created by the Environmental Protection Agency (EPA) to monitor outdoor air quality. In more than 900 counties across the United States, it measures levels of five major air pollutants regulated by the Clean Air Act:

1. ground-level ozone
2. particle pollution
3. carbon monoxide
4. sulfur dioxide
5. nitrogen dioxide

Using a color-coded system, the Air Quality Index indicates when air quality is dangerous. Green or yellow are acceptable colors; orange, purple, or maroon mean people with asthma should limit their time outdoors.

The Air Quality Index varies from season to season, from day to day, and even from morning to evening. In cities larger than 350,000 people, state and local agencies are required to report the index to the public daily. But many smaller communities also report the AQI. In many places, the next day’s index is reported, so you can make plans.

You can get Air Quality Index information:

• from weather reports
• in the newspaper
• at www.airnow.gov

On days when air quality is poor, run the air conditioning and limit your child’s time outside. Plan any outdoor activities for early in the day — when air quality tends to be better — and avoid spending time in areas with a lot of traffic.

If your child participates in a sport that practices outside during hot weather, talk to the coach about other arrangements, such as working out in an air-conditioned gym. Also, make sure your child always has rescue (fast-acting) medication on hand.

Improving the air quality in your home is also wise. You can do this by using an air cleaner, venting all gas appliances to the outside, and avoiding wood fires in your house.

Talk to your doctor about increasing medication during times when air pollution is high. This can be included as part of your child’s asthma action plan.

And although you can’t single-handedly solve air pollution, you can take these important steps to help improve it when the air quality is poor:

• Don’t drive — share a ride, take public transportation, ride a bike, or walk.
• Don’t put gas in your car until after 7 p.m.
• Avoid using outboard motors, off-road vehicles, or other gasoline-powered recreational vehicles.
• Avoid mowing your lawn or using other gasoline-powered gardening equipment until the late evening or until the air quality improves.
• Don’t use paints, solvents, or varnishes that produce fumes.
• If you’re barbecuing, use an electric starter instead of charcoal lighter fluid.

Leaves of three, let them be! You’ve probably heard that little rhyme about poison ivy. But did you know that poison ivy, poison oak, and poison sumac all contain the same rash-causing substance? It’s urushiol, a colorless, odorless oil (or resin) contained in the leaves of the plants.

Signs and Symptoms of Poison Ivy

Urushiol is considered an allergen because it causes an allergic reaction — which takes the form of a rash, itching, and sometimes swelling. About 60% to 80% of all people get a reaction to urushiol, which can appear within hours of contact or as much as 5 days later.

Typically, the skin becomes red, itchy, and swollen and blisters will appear. After a few days, the blisters may become crusty and start to flake off. The rash from poison ivy takes 1 to 2 weeks to heal.

When to Call the Doctor

Consult your doctor if your child has any kind of rash, especially with a fever. If poison ivy or a similar plant caused the rash, the doctor might recommend cool showers and a soothing lotion, such as calamine lotion.

For more severe cases, doctors sometimes prescribe pills or creams that contain antihistamines or steroids (not the same type of steroids that bodybuilders use) to decrease itching and redness.

Prevention

Poison ivy can grow anywhere — from the woods to suburban backyards. And it’s hard to identify: Not only can the green leaves of poison plants blend right in with other plants and brush, but there are several types of poison ivy, and each one can look different depending on the time of year.

It’s also possible to get a rash from poison ivy without ever venturing into the woods or directly touching a plant. Urushiol can be transferred from one person to another. Plus, kids can pick it up from anything that’s come in contact with the oil, including pets. Urushiol can even travel through the air if someone burns some of the plants to clear brush.

The leaves of poison ivy plants release urushiol when they’re bumped, torn, or brushed against. (When the resin is released, the leaves may appear shiny or you may see black spots of resin on them.) Once released, urushiol can easily get on skin.

Here are some tips to help kids avoid getting a rash from poison ivy:

• Teach them how to identify poison ivy, oak, and sumac, so they can steer clear of them (they should be especially careful of plants if the leaves look shiny).
• Tell them to avoid areas where you know there’s poison ivy.
• Have them wear long sleeves and long pants when in areas where poison ivy might grow.
• If your dog has been out exploring the woods, give him a bath to wash off any urushiol oil that may be on his coat.

If your kids come into contact with urushiol oil, have them try to wash it off their skin right away by taking a shower and using lots of soap.

Psoriasis can be worrying, especially when you see your child struggle with itching or discomfort.

For most kids, psoriasis is limited to just a few patches that usually respond well to treatment. More serious cases might need more aggressive treatment. But the good news is that there are many options. If one treatment doesn’t work, another probably will.

About Psoriasis

Psoriasis (suh-RYE-uh-sus) is a non-contagious disease that causes skin cells to build up on the surface of the skin, forming itchy red raised areas (plaques) and thick scales. It can appear anywhere on the body but is most commonly found on the scalp, knees, elbows, and torso.

Psoriasis is a long-lasting (chronic) condition that can get better or worse, seemingly at random. It may go away completely before suddenly reappearing.

For many kids, psoriasis is just a minor inconvenience; for others, though, it can be quite serious. Psoriasis can lead kids to feel self-conscious about their appearance. Sometimes that affects their emotions, and some kids may develop low self-esteem and even depression as a result.

Right now, there’s no cure for psoriasis, but a number of good options are available to treat the symptoms. Lifestyle changes, such as maintaining a healthy diet and weight, also can help ease the symptoms.

Causes

Doctors aren’t sure why people get psoriasis, but they do know how the disease works. White blood cells known as T lymphocytes or T cells are part of the immune system. They travel through the bloodstream fighting off bacteria, viruses, and other things that cause illnesses. When someone has psoriasis, however, T cells attack healthy skin as if they were trying to fight an infection or heal a wound.

Skin cells, which are made deep in the skin, normally take about a month to rise to the surface, where they die and are sloughed off. When psoriasis triggers T cells to attack healthy skin, the immune system responds by sending more blood to the area and making more skin cells and more white blood cells. This forces skin cells to rise to the surface in a few days instead of a month. The dead skin and white blood cells can’t be shed quickly enough, and they build up on the surface of the skin as thick, red patches. As the skin cells die, they form silvery scales that eventually flake off.

Psoriasis isn’t contagious. Some people inherit the genes that make them susceptible to having it. Many with psoriasis have an immediate family member who also has the disease.

Risk factors that can increase the chances of psoriasis outbreaks include:

• Infections. Strep throat, colds, and other infectious diseases trigger the body’s immune system to respond, making a psoriasis outbreak more likely.
• Obesity. The plaques that are produced by many kinds of psoriasis often develop in folds of skin.
• Certain medicines. Lithium, beta-blockers for high blood pressure, and drugs used to prevent malaria have been shown to increase the risk of psoriasis.
• Stress. High stress levels can have an effect on the body’s immune system and can make psoriasis symptoms worse.
• Skin irritations. Cuts, scratches, sunburns, rashes, and other irritations that affect the skin can make a psoriasis outbreak more likely.
• Cold weather. In the winter, kids generally spend more time indoors and get less sun. A moderate amount of direct sunlight can help to improve psoriasis.

Symptoms

People with psoriasis will most likely have one or more of these symptoms:

• raised red patches of skin that can have silvery scales on them
• dry, cracked skin that may bleed at times
• itching, soreness, or a burning sensation in the affected area
• thick, pitted fingernails

There are many different types of psoriasis that all have their own symptoms. Common types include:

• Plaque psoriasis. By far the most common type of psoriasis, this causes dry red patches (plaques) and silvery scales. Plaques can appear anywhere on the skin but most often are on the knees, elbows, lower back, and scalp. They can be itchy and painful and may crack and bleed.
• Guttate psoriasis. This most often affects people younger than 30 and often shows up after an illness, especially strep throat. It causes small red spots, usually on the trunk, arms, and legs. Spots also can appear on the face, scalp, and ears or where someone had plaque psoriasis.
• Pustular psoriasis. This type of psoriasis causes the skin to become red, swollen, and covered with pus-filled bumps. Usually, this is on the soles of the feet or the palms and fingertips. Sometimes, though, it covers large areas of the body. This is known as generalized pustular psoriasis, and can sometimes be accompanied by fever, chills, severe itching, and fatigue.
• Inverse psoriasis. This causes smooth, raw-looking patches of red skin that feel sore. The patches develop in places where skin is touching skin, such as the armpits, buttocks, upper eyelids, groin and genitals, or under a woman’s breasts.
• Erythrodermic psoriasis. This type of psoriasis is rare. It can cause a bright red rash that covers the entire body, making the skin look as if it has been burned. It’s often accompanied by intense itching and pain, a fast heartbeat, and an inability to maintain a proper body temperature.

Diagnosis

Usually, diagnosis of psoriasis is fairly straightforward. The doctor will physically examine your child’s skin, scalp, and nails and ask you and your child some questions. The doctor may ask if anyone in your family has psoriasis and if your child recently had an illness or started a new medication.

On rare occasions, the doctor may remove a skin sample (do a biopsy) to examine it more closely. A biopsy can tell the doctor whether it’s psoriasis or another condition with similar symptoms.

Treatment

There are lots of ways to treat psoriasis, and different things work for different people. Be sure to talk with a doctor to figure out what treatments work best for your child.

Psoriasis treatments fall into three categories:

1. Topical treatments are creams, lotions, and ointments applied directly to the skin. These include moisturizers, prescription corticosteroids and vitamin D creams, and shampoos made with salicylic acid or coal tar. Topical treatments can effectively treat many types of mild to moderate psoriasis, but can be a little messy.
2. Light therapy (phototherapy) involves using natural or artificial ultraviolet (UV) light to treat the psoriasis symptoms. A doctor may recommend brief daily exposure to the sun, but too much sunlight can make psoriasis worse. More aggressive forms of light therapy include using controlled doses of UV light on the affected skin, laser therapy, and therapies that combine UV light with medicines and topical treatments.
3. Oral or injected medications are used to treat severe psoriasis or psoriasis that resists other treatments. They include pills, shots, and medicines given intravenously (through an IV into a vein). Some of these can have serious side effects and might be prescribed for short periods of time only.

A doctor might try one therapy and then switch to another, or recommend a combination of therapies. It’s not always easy to find a therapy that works, and sometimes what works for a time will stop being effective. It’s important to work closely with the doctor to stay on top of your child’s treatment.

Things You Can Do at Home

Besides following your doctor’s advice, you can help your child by making healthy lifestyle choices:

• Serve healthy foods. Eating a lot of fruits and vegetables can help fend off diseases that might trigger psoriasis.
• Help your child stay at a healthy weight. This decreases the risk of inverse psoriasis.
• Remind your child to keep skin clean and well moisturized. Bathing daily with bath salts or oils and then applying moisturizer can help ease the symptoms of psoriasis.
• Spend time outdoors. Limited amounts of natural light can help with psoriasis.
• Give your child emotional support. Many kids who have emotional problems due to their psoriasis can benefit from talking with a therapist or joining a support group of people who understand the challenges of dealing with psoriasis.

Most psoriasis will respond well to treatment, but it’s important to stay on top of it. If your child should apply an ointment twice a day, remind him or her to do so; if a little more sun is recommended, join your child for a daily walk. Your efforts, and your child’s, will help control psoriasis symptoms.

About Seasonal Allergies

“Achoo!” It’s your son’s third sneezing fit of the morning, and as you hand him another tissue you wonder if these cold-like symptoms — the sneezing, congestion, and runny nose — have something to do with the recent weather change. If he gets similar symptoms at the same time every year, you’re likely right: seasonal allergies are at work.

Seasonal allergies, sometimes called “hay fever” or seasonal allergic rhinitis, are allergy symptoms that happen during certain times of the year, usually when outdoor molds release their spores, and trees, grasses, and weeds release tiny pollen particles into the air to fertilize other plants.

The immune systems of people who are allergic to mold spores or pollen treat these particles (called allergens) as invaders and release chemicals, including histamine, into the bloodstream to defend against them. It’s the release of these chemicals that causes allergy symptoms.

People can be allergic to one or more types of pollen or mold. The type someone is allergic to determines when symptoms happen. For example, in the mid-Atlantic states, tree pollination is February through May, grass pollen runs from May through June, and weed pollen is from August through October — so kids with these allergies are likely to have increased symptoms at those times. Mold spores tend to peak midsummer through the fall, depending on location.

Even kids who have never had seasonal allergies in years past can develop them. Seasonal allergies can start at almost any age, though they usually develop by the time someone is 10 years old and reach their peak in the early twenties, with symptoms often disappearing later in adulthood.

Signs and Symptoms

If your child develops a “cold” at the same time every year, seasonal allergies might be to blame. Allergy symptoms, which usually come on suddenly and last as long as a person is exposed to the allergen, can include:

• sneezing
• itchy nose and/or throat
• nasal congestion
• clear, runny nose
• coughing

These symptoms often come with itchy, watery, and/or red eyes, which is called allergic conjunctivitis. Kids who have wheezing and shortness of breath in addition to these symptoms might have allergies that trigger asthma.

Diagnosis

Seasonal allergies are fairly easy to identify because the pattern of symptoms returns from year to year following exposure to an allergen.

Talk with your doctor if you think your child might have allergies. The doctor will ask about symptoms and when they appear and, based on the answers and a physical exam, should be able to make a diagnosis. If not, the doctor may refer you to an allergist for blood tests or allergy skin tests.

To find an allergy’s cause, allergists usually do skin tests in one of two ways:

1. A drop of a purified liquid form of the allergen is dropped onto the skin and the area is pricked with a small pricking device. If a child reacts to the allergen, the skin will swell a little in that area.
2. A small amount of allergen is injected just under the skin. This test stings a little but isn’t extremely painful. After about 15 minutes, if a lump surrounded by a reddish area appears (like a mosquito bite) at the injection site, the test is positive.

Even if a skin test or a blood test shows an allergy, a child must also have symptoms to be definitively diagnosed with an allergy. For example, a child who has a positive test for grass pollen and sneezes a lot while playing in the grass would be considered allergic to grass pollen.

Treatment

There are many ways to treat seasonal allergies, depending on how severe the symptoms are. The most important part of treatment is knowing what allergens are at work. Some kids can get relief by reducing or eliminating exposure to allergens that bother them.

If certain seasons cause symptoms, keep the windows closed, use air conditioning if possible, and stay indoors when pollen/mold/weed counts are high. It’s also a good idea for kids with seasonal allergies to wash their hands or shower and change clothing after playing outside.

If reducing exposure isn’t possible or is ineffective, medicines can help ease allergy symptoms. These may include decongestants, antihistamines, and nasal spray steroids. If symptoms can’t be managed with medicines, the doctor may recommend taking your child to an allergist or immunologist for evaluation for allergy shots (immunotherapy), which can help desensitize kids to specific allergens.

Kids with severe allergies can be at risk for a sudden, potentially life-threatening allergic reaction called anaphylaxis. This reaction can be frightening — a child may feel like his or her throat is closing or might faint, for example.

But the good news is that when treated properly, anaphylaxis can be managed.

Anaphylaxis isn’t common, but some kids with allergies are more at risk for it. So if your child has allergies, it’s important to know about it and be prepared.

Signs of Anaphylaxis

As with other allergies, anaphylaxis can trigger symptoms in any of these four body systems:

1. skin
2. digestive system
3. respiratory system
4. cardiovascular system

An allergic reaction might be a medical emergency if it happens in two or more of these systems — for example, hives on the skin together with stomach pain.

The most common signs that someone might have anaphylaxis after exposure to an allergen are:

• difficulty breathing
• tightness in the throat or feeling like the throat or airways are closing
• hoarseness or trouble speaking
• wheezing
• nasal stuffiness or coughing
• nausea, abdominal pain, or vomiting
• fast heartbeat or pulse
• skin itching, tingling, redness, or swelling

Fast Treatment Needed

Anaphylaxis requires immediate treatment. It can get worse very quickly. This is why doctors usually want people with life-threatening allergies to carry a medication called epinephrine. Epinephrine enters the bloodstream and works quickly against serious allergy symptoms; for example, it decreases swelling and raises blood pressure.

Epinephrine is given as an injection. This isn’t as scary as it sounds, though — there’s no big needle and plunger involved. Instead, doctors will prescribe an auto injector about the size of a large pen that’s easy for parents — and older kids — to carry and use. If your child is prescribed epinephrine, your doctor will show you how to use it.

Your doctor also might instruct you to give your child over-the-counter (OTC) antihistamines, too — but they won’t work alone. OTC antihistamines are never a replacement for epinephrine in life-threatening reactions.

If Your Child Has a Serious Reaction

If your child shows signs of a serious allergic reaction:

Step 1: Give the epinephrine auto-injector right away. Seconds count during an episode of anaphylaxis. If you are alone with your child, give this medication first, then call 911. If you are not alone with your child, have someone else call 911 while you give the medicine.

Step 2: At the emergency room, additional treatment can be given, if needed. Also, your child needs to be under medical supervision for at least 4 hours because even if the worst seems to have passed, a second wave of serious symptoms (called a biphasic reaction) often happens.

Serious allergies can be alarming. But they’re a lot easier to recognize and treat now than in the past, thanks to greater awareness and the availability of epinephrine. Also, make sure that any caregivers, teachers, or coaches know about the allergy and what to do in an emergency.

Right after they’re born, babies are partially protected from infections by antibodies transmitted to them by their mothers. (Antibodies are special chemicals made by the body to fight infections.) Within the next few months, though, their immune systems develop and begin to assume responsibility for fighting off infections. But sometimes, babies have immune deficiencies and they don’t have the ability to fight off routine infections on their own.

The immune system has many parts. The symptoms of immune deficiency depend on what part of the immune system is affected. Immune deficiencies can range from mild to life-threatening. One example of a life-threatening immune deficiency is severe combined immunodeficiency (SCID). “Combined” means that multiple parts of the immune system are affected.

SCID , an uncommon disease, can be successfully treated if it’s identified early; otherwise, it is almost always fatal within the first year of life.

What Is SCID?

SCID is actually a group of inherited disorders that cause severe abnormalities of the immune system. These disorders lead to reduced or malfunctioning T- and B-lymphocytes, the specialized white blood cells made in the bone marrow and the thymus gland to fight infection. When the immune system doesn’t function properly, it can be difficult or impossible for it to battle viruses, bacteria, and fungi that cause infections.

SCID is called “combined” immunodeficiency because it affects the function of two kinds of infection-fighting cells. There are 14 forms of SCID. The most common type is caused by a problem in a gene found on the X chromosome and affects only males. Females may be carriers of the condition, but because they also inherit a normal X chromosome, their immune systems can fight infections normally. Males, on the other hand, only have one X chromosome, so if the gene is abnormal the disease appears.

Another form of SCID is caused by a deficiency of an enzyme (adenosine deaminase or ADA), which is necessary for lymphocytes to develop. Other cases of SCID are caused by a variety of other genetic defects.

Diagnosing SCID

Classic signs of SCID include an increased susceptibility to infection and failure to thrive as a result of infections. A baby with SCID will have recurrent bacterial, viral, or fungal infections that are much more serious and less responsive to treatment than would normally be expected. These can include ear infections (acute otitis media), sinus infections (sinusitis), oral thrush (a type of yeast infection in the mouth), skin infections, meningitis, and pneumonia. Infants with SCID also have chronic diarrhea. If a child has these symptoms, a doctor will test for SCID or other types of immune deficiency.

Parents who have a child with SCID or a family history of immunodeficiency might want to consider genetic counseling and early blood testing, since early diagnosis can lead to prompt treatment and ensure a good outcome. It may also be possible to test a high-risk baby for the disease before birth if the genetic mutation causing SCID in a family is known. Technology has made it possible to test newborn babies for SCID using the blood spot that is collected at birth. And, many states in the United States have SCID screening for newborns.

Children without a known family history of the disease are often not diagnosed until 6 months of age or older.

Treating SCID

SCID is a pediatric emergency. When a child is diagnosed with SCID, a referral typically is made to a doctor who specializes in treating immune deficiencies — usually a pediatric immunologist or pediatric infectious disease expert.

It’s important to prevent infections in babies with SCID, so doctors may prescribe antibiotics to prevent infection and admit the child to an isolation room in the hospital.

Children with SCID cannot be immunized with live viruses — like the chickenpox (varicella) or measles, mumps, and rubella (MMR) vaccines. Because they lack the normal defense of antibodies to the viruses, introducing a virus to a child with SCID, even a weakened vaccine virus, can be dangerous. Children with SCID can only receive blood transfusions with blood that has been irradiated to kill white blood cells, because live white cells might attack the body.

Doctors may also administer an infusion of intravenous immune globulin (IVIG) to help the body fight infection.

The curative treatment for SCID is a stem cell transplant. This is when stem cells — cells found primarily in the bone marrow from which all types of blood cells develop — are introduced into the body in the hopes that the new cells will inhabit and rebuild the immune system of the child with SCID.

To provide the best chances for success, a transplant is usually done using the bone marrow of a sibling. However, a parent’s marrow is also acceptable. Some children do not have family members who are suitable donors — in such cases, doctors may use stem cells from an unrelated donor. The likelihood of a good outcome also is greater if the transplant is done early, within the first few three months of life, if possible.

Some SCID patients require chemotherapy before their transplant. Chemotherapy will destroy cells in the bone marrow to make room for the donated cells and help prevent the child’s immune cells from attacking the donated cells. Other kids with SCID may not need such treatment, especially if they have very few immune cells to start with. The use of pre-transplant chemotherapy depends on the severity of the immune deficiency, the type of SCID, the donor used, and the transplant center.

In cases of SCID caused by a missing enzyme, the enzyme can be replaced via a weekly injection. This is not a cure and these children must receive the injections for the rest of their lives.

Another treatment approach currently being studied is gene therapy. This involves removing cells from a child with SCID and inserting healthy genes into them, then transplanting them back into the child. When they find their way to the bone marrow, they can start to produce healthy immune cells. Gene therapy has been successful for some patients with certain types of SCID, but a few children treated with it developed complications, so it has not yet become routine treatment. New trials of gene therapy are ongoing.

Caring for Your Child with SCID

Babies who have had bone marrow transplants may need additional treatment with antibiotics or immunoglobulins. The immunologist will advise you about these.

Until a child’s immune system develops adequate protection after a bone marrow transplant, you can help reduce the risk of infection by having the child wear a mask. A mask can also serve as a signal to others that your child is trying to avoid infection.

Understand that infants with SCID may have to endure many painful procedures and repeated hospital stays. And that can be stressful and difficult for the entire family. Luckily, this doesn’t have to be handled alone: support groups, social workers, and family friends often can lend a helping hand. It’s important to reach out for support during this time.

When to Call the Doctor

If you’re concerned that your child has more frequent infections than usual, discuss the possibility of immune deficiency with your doctor. If your child has a serious infection, contact your doctor immediately.

Early treatment is essential, and only early intervention can improve a healthy immune system.

About Shellfish Allergy

A shellfish allergy is not exactly the same as a seafood allergy. Seafood includes fish (like tuna or cod) and shellfish (like lobster or clams). Even though they both fall into the category of “seafood,” fish and shellfish are biologically different. So fish will not cause an allergic reaction in someone with a shellfish allergy, unless that person also has a fish allergy.

Shellfish fall into two different groups: crustaceans (like shrimp, crab, or lobster) and mollusks (like clams, mussels, oysters, scallops, octopus, or squid). Some people with shellfish allergies are allergic to both groups, but some might be allergic only to one.

Most allergic reactions to shellfish happen when someone eats shellfish, but sometimes a person can react to touching shellfish or breathing in vapors from cooking shellfish.

Shellfish allergy can develop at any age. Even people who have eaten shellfish in the past can develop an allergy. Some people outgrow certain food allergies over time, but those with shellfish allergies usually have the allergy for the rest of their lives.

A shellfish allergy can cause a very serious reaction, known as anaphylaxis, even if a previous reaction was mild. So anyone with a shellfish allergy should completely avoid shellfish.

If your child has been diagnosed with a shellfish allergy, keep injectable epinephrine on hand in case of a severe reaction. This is a medicine that your doctor can prescribe. Discuss emergency plans with anyone who will be taking care of your child, including relatives and school officials. Also consider having your child wear a medical alert bracelet.

What Happens in a Shellfish Allergy

When someone is allergic to shellfish, the body’s immune system, which normally fights infections, overreacts to proteins in the shellfish. Every time the person eats (or, in some cases, handles or breathes in) shellfish, the body thinks these proteins are harmful invaders.

The immune system responds by working very hard to fight off the invader. This causes an allergic reaction, in which chemicals like histamine are released in the body. The release of these chemicals can cause someone to have these symptoms:

• wheezing
• trouble breathing
• coughing
• hoarseness
• throat tightness
• stomachache
• vomiting
• diarrhea
• itchy, watery, or swollen eyes
• hives
• red spots
• swelling
• a drop in blood pressure causing lightheadedness or loss of consciousness

Your child could have different reactions to different types of shellfish or react differently at different times. Some reactions can be very mild and involve only one system of the body, like hives on the skin. Other reactions can be more severe and involve more than one part of the body.

Anaphylaxis Is a Life-Threatening Reaction

Shellfish allergies can cause a severe reaction called anaphylaxis. Anaphylaxis can begin with some of the same symptoms as a less severe reaction, but then can quickly worsen, leading someone to have trouble breathing or to pass out. If it is not treated, anaphylaxis can be life-threatening.

If your child starts having serious allergic symptoms, like swelling of the mouth or throat or difficulty breathing, give the epinephrine auto-injector right away. Every second counts in an allergic reaction. Then call 911 or take your child to the emergency room. Your child needs to be under medical supervision because even if the worst seems to have passed, a second wave of serious symptoms may follow.

An epinephrine auto-injector is a prescription medicine that comes in an easy-to-carry container about the size of a large marker. It’s simple to use. If your child needs to have it on hand, your doctor will show you how to use it. Kids who are old enough can be taught how to give themselves the injection.

Staff at your child’s school should know that your son or daughter has a serious food allergy. You should agree upon a plan in case of a serious reaction and be sure that the injectable epinephrine is available at all times. If your child is old enough to carry the epinephrine, it should not be in a locker, but in a purse or backpack that’s with your child at all times.

Your child’s allergy plan also might include giving an over-the-counter antihistamine for milder allergy symptoms. But the antihistamine should be given after the epinephrine in the case of a serious, life-threatening reaction.

Shellfish Allergy Safety Tips

To prevent allergic reactions, your child must not eat shellfish. He or she also must not eat any foods that might contain shellfish as ingredients. For detailed information, visit food allergy websites, such as the Food Allergy Research and Education (FARE), or others that your doctor recommends.

Also, read food labels to see if a food is free of shellfish. Makers of foods sold in the United States must state in understandable language whether foods contain any of the top eight most common allergens, including crustacean shellfish. The label should list “shellfish” in the ingredient list or say “Contains shellfish” after the list.

Also look for advisory statements such as “May contain shellfish,” “Processed in a facility that also processes shellfish,” or “Manufactured on equipment also used for shellfish.” These are cross-contamination warnings, but manufacturers are not required to list them.

Because products without precautionary statements also might be cross-contaminated and the company simply chose not to label for it, it is always best to contact the company to see if the product could contain shellfish. You might find this information on the company’s website or you can email a company representative.

Manufacturers also do not have to list mollusk shellfish ingredients because mollusk shellfish (clams, mussels, oysters, or scallops) are not considered a major food allergen. When labels say a food contains shellfish, they refer to crustacean shellfish. Contact the company to see about cross-contamination risk with mollusks.

Even if a food did not cause a reaction in the past, it still could be a problem. Manufacturers may change processes or ingredients at any time.

Shellfish ingredients also might be used in some non-food products, like nutritional supplements, lip gloss, pet foods, and plant fertilizer. Talk to your doctor if you have questions about what is safe.

Cross-Contamination

Cross-contamination is common in restaurants, which is where many people often mistakenly eat shellfish. This happens in kitchens when shellfish gets into a food product because the staff use the same surfaces, utensils (like knives, cutting boards, or pans), or oil to prepare both shellfish and other foods.

This is particularly common in seafood restaurants, so some people find it safer to simply avoid these restaurants altogether. Since shellfish is also used in a lot of Asian cooking, there’s a risk of cross-contamination in Chinese, Vietnamese, Thai, or Japanese restaurants. It’s a good idea to avoid a restaurant’s fried foods, like French fries and fried chicken, because the restaurant may use the same oil to fry shrimp.

Eating Away From Home

When your child eats in a restaurant or at a friend’s house, find out how foods are cooked and exactly what’s in them. It can be hard to ask a lot of questions about cooking methods, and to trust the information you get. If you can’t be certain that a food is shellfish-free, it’s best to bring safe food from home.

Also talk to the staff at school about cross-contamination risks for foods in the cafeteria. It may be best to pack lunches at home so you can control what’s in them.

If your child will be eating at a restaurant, take these precautions:

• Stay away from steam tables or stovetops when shellfish is cooked (especially places where food is cooked on a communal grill, like hibachi restaurants).
• Tell the restaurant waitstaff that your child has as serious shellfish allergy.
• Carry a personalized “chef card” for your child, which can be given to the kitchen staff. The card details your child’s allergies for food preparers. Food allergy websites provide printable chef card forms in many different languages.
• Don’t eat at a restaurant if the manager or owner seems uncomfortable about your requests for a safe meal.

About Soy Allergy

Soy has become a common ingredient in foods. It’s also a common cause of food allergy.

Soy comes from soybeans, which are in the legume family (along with beans, lentils, peas, and peanuts). Some people are allergic to just one type of legume; others are allergic to more than one. Allergy to soy is more common in infants and kids than teens and adults, but can develop at any age.

When someone is allergic to soy, the body’s immune system, which normally fights infections, overreacts to proteins in soy. If the person eats something made with soy, the body thinks these proteins are harmful invaders.

The immune system responds by working very hard to fight off the invader. This causes an allergic reaction, in which chemicals like histamine are released in the body. The release of these chemicals can cause someone to have these symptoms:

• wheezing
• trouble breathing
• coughing
• hoarseness
• throat tightness
• stomachache
• vomiting
• diarrhea
• itchy, watery, or swollen eyes
• hives
• red spots
• swelling
• a drop in blood pressure, causing lightheadedness or loss of consciousness

Allergic reactions to soy can differ. Sometimes the same person can react differently at different times. Most reactions to soy are mild and involve only one system of the body, like hives on the skin. Other times the reaction can be more severe and involve more than one part of the body.

Anaphylaxis Is a Life-Threatening Reaction

Rarely, soy allergy can cause a severe reaction called anaphylaxis. Anaphylaxis can begin with some of the same symptoms as a less severe reaction, but then can quickly worsen, leading someone to have trouble breathing or to pass out. If it is not treated, anaphylaxis can be life-threatening.

Managing Serious Reactions

If your child has been diagnosed with a life-threatening soy allergy (or any kind of life-threatening food allergy), the doctor will want him or her to carry an epinephrine auto-injector in case of an emergency.

An epinephrine auto-injector is a prescription medicine that comes in an easy-to-carry container about the size of a large marker. It’s simple to use. If your child needs to have it on hand, your doctor will show you how to use it.

Kids who are old enough can be taught how to give themselves the injection. If they are responsible for carrying the epinephrine, it should be nearby, not locked in a locker or in the nurse’s office.

Wherever your child is, adult caregivers should always know where the epinephrine is, have easy access to it, and know how to give the shot. Staff at your child’s school should know about the allergy and have an action plan in place. Your child’s rescue medications (such as epinephrine) should be accessible at all times.

If your child starts having serious allergic symptoms, like swelling of the mouth or throat or difficulty breathing, give the epinephrine auto-injector right away. Seconds count during an episode of anaphylaxis. Then call 911 or take your child to the emergency room so additional treatment can be given, if needed. Also, your child needs to be under medical supervision for at least 4 hours because even if the worst seems to have passed, a second wave of serious symptoms (called a biphasic reaction) often happens.

It’s also a good idea to carry an over-the-counter (OTC) antihistamine for your child, as this can help treat mild allergy symptoms. Use antihistamines after — not as a replacement for — the epinephrine shot during life-threatening reactions.

Living With Soy Allergy

If allergy testing shows that your child has a soy allergy, the doctor will provide guidelines on how to stay safe. Your child may need to completely avoid products made with soy. This can be tough as soy has become part of many processed foods.

Asian foods, infant formulas, and baked goods are just a few of the foods that often contain soy. For more information on foods to avoid, check sites your doctor recommends, such as the Food Allergy Research and Education network (FARE).

You should always read labels to see if a packaged food contains soy. Manufacturers of foods sold in the United States must state in understandable language whether foods contain any of the top eight most common allergens, including soy. The label should list “soy” in the ingredient list or say “Contains soy” after the list.

This label requirement makes things a little easier. But you still may want to learn the names of some common ingredients that mean soy. It’s also important to remember that “safe” foods could become unsafe if food companies change ingredients, processes, or production locations.

Cross-Contamination

Cross-contamination means that the allergen is not one of the ingredients in a product, but might have contaminated it during production or packaging. Companies are not required to label for cross-contamination risk, though some voluntarily do so. You may see advisory statements such as “May contain soy,” “Processed in a facility that also processes soy,” or “Manufactured on equipment also used for soy.”

Since products without precautionary statements also might be cross-contaminated and the company simply chose not to label for it, it is always best to contact the company to see if the product could contain soy. You might find this information on the company’s website or you can contact a company representative via email.

Eating Away From Home

When your child eats in a restaurant or at a friend’s house, find out how foods are cooked and exactly what’s in them. It can be hard to ask a lot of questions about cooking methods, and to trust the information you get. If you can’t be certain that a food is soy-free, it’s best to bring safe food from home.

Watch for cross-contamination, as soy can get into a food product because it is made or served in a place that uses soy in other foods. This can happen on kitchen surfaces and utensils — everything from knives and cutting boards to a toaster. This is common in Asian restaurants, where soy is often used as an ingredient, and anyplace with communal grills (like hibachi restaurants). Buffets also can be risky since utensils may be moved from one food to another.

Also talk to the staff at school about cross-contamination risks for foods in the cafeteria. It may be best to pack lunches at home so you can control what’s in them.

Here are some other precautions to take:

• Don’t feed your child cooked foods you didn’t make yourself — or anything else with unknown ingredients.
• Tell everyone who handles the food — from relatives to restaurant waitstaff — that your child has a soy allergy.
• Make school lunches and snacks at home where you can control the preparation.
• Don’t eat at a restaurant if the manager or owner seems uncomfortable about your requests for a safe meal.

Stem cells are cells in the body that have the potential to turn into anything, such as a skin cell, a liver cell, a brain cell, or a blood cell. Stem cells that turn into blood cells are called hematopoietic (heh-mat-uh-poy-EH-tik) stem cells. These cells are capable of developing into the three types of blood cells:

1. red blood cells that carry oxygen
2. white blood cells that fight infection
3. platelets that help blood to clot

Hematopoietic stem cells can be found in bone marrow (the spongy tissue inside bones), the bloodstream, and the umbilical cord blood of newborn babies.

A stem cell transplant (sometimes called a bone marrow transplant) can replenish a child’s supply of healthy hematopoietic stem cells after they have been depleted. It’s used to treat a wide range of diseases, including cancers like leukemia, lymphoma, neuroblastoma, Wilms tumor, and certain testicular or ovarian cancers; blood disorders; immune system diseases; and bone marrow syndromes.

Transplanted hematopoietic stem cells are put into the bloodstream through an intravenous (IV) line, much like a blood transfusion. Once in the body, they can produce healthy new blood and immune system cells.

Types of Transplants

The two main types of stem cell transplants are autologous (aw-TAHL-uh-gus) and allogeneic (al-uh-juh-NEE-ik). The type of transplant needed will depend on the child’s specific medical condition and the availability of a matching donor.

• Autologous hematopoietic stem cell transplant. With this type of transplant, patients act as their own donor. For instance, a child who is about to undergo cancer treatment will have his or her own stem cells removed (harvested) and frozen for later use. After the child receives chemotherapy and/or radiation, the stem cells are thawed and put back into the child’s body.

  This procedure may be done once or many times, depending on the need. Sometimes doctors will use extra-high doses of chemotherapy during treatment (to kill as many cancer cells as possible) if they know a patient will be getting a stem cell transplant soon after.

• Allogeneic hematopoietic stem cell transplant. With an allogeneic transplant, the stem cells come from a donor — often a sibling but sometimes another volunteer — whose cells are considered a “match” for the patient. The process of finding a match is called tissue typing (or HLA [human leukocyte antigen] typing). HLA is a protein on the surface of blood cells. Basically, the more “HLA markers” a child and the potential donor have in common, the greater the chance that the transplant will be successful.

  Unlike with an autologous transplant, there is a risk of a child’s body rejecting the donated cells. This means that the body’s own immune cells destroy the transplanted stem cells because they sense they are foreign. Sometimes, despite the donor being a good match, the transplant simply may not take. Other times, the donor cells can begin to make immune cells that attack the recipient’s body. This condition is called graft-versus-host disease, and can be quite serious. Fortunately, most cases are successfully treated with steroids and other medicines.

  Sometimes, an upside of graft-versus-host disease is that the newly transplanted cells recognize the body’s cancer cells as different or foreign, and actually work to fight them.

Transplantation

Stem cell transplantation is a very complex process that may span several months. A team of doctors is usually involved in determining if a child is a candidate and, if so, whether the transplant will be autologous or allogeneic.

For an allogeneic transplant, a compatible donor will be sought among family members or through a national registry of volunteers. Once a match is found, the donor’s stem cells will be harvested. Three different types of hematopoietic stem cells can be collected or harvested:

1. Peripheral blood stem cells are harvested from donated blood. The stem cells are separated and collected and the rest of the blood is returned to the donor.
2. Bone marrow stem cells are collected from the donor’s hip bone through a surgical procedure.
3. Cord blood stem cells are collected from the umbilical cord (the part of the placenta that delivers nutrients to a fetus) immediately after a baby is born and the umbilical cord is clamped and cut.

While all three types can replenish a patient’s blood and bone marrow cells, there are advantages and disadvantages to each. The doctor will suggest the best type of stem cell for your child’s illness.

The next step in the transplantation process is conditioning therapy, which kills unhealthy cells (like cancer cells) to make room for stem cells to grow and/or weakens the immune system so that there’s less chance of the body rejecting the new cells.

One type of conditioning therapy delivers high doses of chemotherapy and/or radiation to kill cells, destroy the bone marrow, and weaken the immune system. Most kids will get this type of therapy. Another type of conditioning therapy delivers lower doses of chemotherapy, radiation, or another treatment to weaken the immune system. The doctor will decide which type of conditioning therapy is best.

Soon after the conditioning phase, the transplant itself will be done through intravenous (IV) infusion, and healthy stem cells will be introduced to the child’s body. After the infusion, the child will be watched very closely to make sure the new stem cells are settling into the marrow and beginning to make new blood cells (called engrafting). Doctors will watch for any signs of rejection as well as graft-verses-host disease in kids with allogeneic transplants.

Engrafting takes an average of 2 weeks, but can be as quick as 1 week or as long as 6 weeks. Your child will receive medicines to promote engrafting and prevent rejection and graft-versus-host disease.

Recovery

Kids who receive stem cell transplants have a high risk of infection. During conditioning therapy and while the transplant is engrafting, their immune systems are weakened and unable to fight bacteria and other germs that enter the body. Children who receive an allogeneic transplant have an even greater risk of infection because they require medicines to further suppress their immune systems to reduce the chance of rejection.

Because of these risks, a child who’s had a stem cell transplant will not be released from the hospital until doctors are sure the transplant has successfully engrafted and the child is otherwise doing well.

Once released, a child needs very close monitoring and follow-up care. School and other public indoor areas may be off limits for 3 months to a year, and other places might be restricted as well. This is because for kids with a compromised immune system, even a simple infection like a common cold can be serious and even life-threatening if untreated.

Coping

The stress of having a child who is being treated for cancer or another serious condition can be overwhelming for a family. That stress can grow when treatment requires a long “isolation period,” as is necessary with a stem cell transplant.

To find out what support is available to you and your child, talk to your doctor, a hospital social worker, or child life specialist. Many resources are available that can help you get through this difficult time.

What is oral allergy syndrome?
– Diane

Oral allergy syndrome, or OAS, is an allergic reaction that usually happens only in the mouth and throat. People with OAS can react to specific foods, such as certain fruits and vegetables. When they eat food they’re allergic to, they may notice itching, tingling, swelling, and redness of the lips, mouth, or throat — often within minutes.People who are allergic to pollen are more likely to have OAS. In fact, OAS is also called pollen-food allergy syndrome. The immune system gets confused and thinks that the foods being eaten are similar to pollen that the person is allergic to. Many people with OAS can eat these same foods without any problems if they are cooked, not raw. That’s because cooking changes the food enough that the immune system no longer thinks it is a threat.

OAS usually only involves mild symptoms in the mouth and throat. But, rarely, the reaction also can affect other parts of the body or cause more serious symptoms, like difficulty breathing. If there’s a concern that your child is at risk of a more serious reaction, your doctor might prescribe emergency medicine to always have available.

If the doctor thinks your child has OAS, he or she may give you a list of foods to avoid or to be careful with. The doctor also can give you other tips to make a reaction less likely, such as peeling or cooking the food before offering it to your child.