Treatment of allergic diseases in childhood presents unique challenges, as both the beneficial effects and the detrimental effects of intervention(s) may last for decades and even for a lifetime. Most allergic diseases are managed in a community setting by primary care physicians, rather than in a hospital setting by allergy specialists. Here, we describe outpatient treatment, which is focused on prevention and relief of morbidity from allergic diseases and on the identification of children at high risk of fatality from asthma or anaphylaxis, who require regular, frequent monitoring.
The quantity and quality of evidence for the efficacy and safety of therapeutic approaches for allergic disease in the pediatric population varies greatly with: the age of the patients, the disease, and the treatment modality studied. The evidence base consisting of adequately powered, randomized, placebo-controlled, double-blind trials is largest for adolescents receiving pharmacologic interventions for asthma or allergic rhinoconjunctivitis.
It is considerably smaller for young children and infants; for allergic diseases such as allergic urticaria, atopic dermatitis/eczema, and anaphylaxis; and for non-pharmacologic interventions such as education, avoidance of environmental asthma allergens, and allergen-specific immunotherapy. At this time, evidence-based international and national guidelines are available only for asthma treatment in the pediatric population.
Children often have allergic co-morbidities, that is, concomitant allergic diseases such as asthma, allergic rhinitis, atopic dermatitis/eczema, and food allergies & intolerance in children. For such children and their families, it is therefore important to provide a comprehensive approach to protect kids from allergy and management including: education about the long-term nature of allergic inflammation and the intermittent exacerbations that characterize allergic diseases, and the need to avoid triggers for symptoms where possible and to consider the potential benefits of allergen-specific immunotherapy.
It is also important to have a systematic, stepwise approach to pharmacologic treatment and to keep the overall number of prescribed allergies medications to a minimum, in order to facilitate adherence to treatment regimens. Healthcare professionals should recognize that the most common reason for apparent lack of response to treatment is lack of adherence. This is particularly true for glucocorticoid treatment, due to caregivers’ concerns about potential adverse effects.
Although many physicians respond to a child’s apparent failure to improve on a medication by prescribing an increased dose, this is of little value if the medication is not being given or taken in the first place. Intensified efforts with regard to education, allergen avoidance, non-specific, non-medicinal approaches to treatment and, in some children with allergies, allergen specific immunotherapy, may be more helpful.
