Allergies in Children: Food, Anaphylaxis, Harmattan and Stings

Anaphylaxis: An Emergency

Anaphylaxis is a severe allergic reaction that affects breathing or circulation. It usually starts within minutes of eating a food, being stung or taking a medicine, and can get worse quickly. It can happen even when earlier reactions were mild. A rash is not always present.

What to Do in Anaphylaxis

1. Use the adrenaline auto-injector straight away, if your child has one. Press it firmly into the outer middle of the thigh; it can go through clothing. Hold it in place for the time given in its instructions. Note the time.
2. Lie your child down with their legs raised. If breathing is difficult, let them sit up with legs out in front. Do not let them stand or walk, even if they feel better. A baby can be held flat on your lap.
3. Come to Limi Children's Hospital now, day or night. If you cannot get here quickly, go to the nearest emergency department. Have someone else drive if you can, so you can watch your child, and call 0813 408 5400 on the way so the team can prepare.
4. If there is no improvement after 5 minutes and you have a second auto-injector, use it in the other thigh, as the plan says.
5. Give the asthma reliever through a spacer if your child has asthma and is wheezy, but only after the adrenaline.
6. If your child stops breathing, start CPR — see CPR for children.

Signs of a Food Allergy

In a food allergy, the immune system mistakes a food for a threat. Reactions usually start within minutes to 2 hours of eating:

• Skin: hives (raised, itchy welts, pale or red, which on darker skin may look like skin-coloured bumps), flushing, itching, and swelling of the lips, face or eyelids.
• Mouth: itchy or tingling mouth and throat.
• Gut: tummy pain, vomiting, diarrhoea.
• Breathing and circulation: sneezing, cough, wheeze, hoarseness, paleness or floppiness — these mean anaphylaxis.

Some babies have a slower type of food allergy, usually to cow's milk, with eczema, reflux, diarrhoea, blood in the stool or poor weight gain over days. This needs a doctor's assessment; do not switch milks on your own. Eczema and food allergy are linked — see our eczema guide.

Allergy or Intolerance?

Common Food Allergens, and Where They Hide

Almost any food can cause allergy, but a few cause most reactions in children. Some are hidden in everyday Nigerian food:

Many children outgrow milk and egg allergy. Groundnut, tree nut, fish and shellfish allergies are more likely to last, but can also improve; the team may re-test over time.

Introducing Allergy Foods to Babies

For many years parents were told to delay foods like groundnut. We now know that was wrong. A large trial (the LEAP study) found that babies at high risk who ate groundnut regularly from infancy were much less likely to develop groundnut allergy than babies who avoided it. Early introduction of well-cooked egg also appears to help.

• Start around 6 months, when your baby starts solid foods, and not before 4 months.
• Groundnut as a smooth paste only. Thin a little smooth groundnut paste with breast milk, water or pap. Never give whole or chopped nuts to children under 5 — they are a choking hazard.
• Egg well cooked, for example hard-boiled and mashed, or in a well-cooked moi moi.
• Introduce one new allergy food at a time, at home, in the morning or early afternoon when your baby is well, so you can watch for a reaction.
• Once it is tolerated, keep it going a few times each week. Stopping can allow an allergy to develop.
• Talk to your doctor first if your baby has severe eczema or has already reacted to a food. Do not delay for months; the team plans it with you, sometimes with a test first.

Our starting solids guide covers first foods and textures, and choking first aid is worth knowing for every carer.

Allergy Testing

Allergy tests are useful, but only when they are chosen and read by someone who knows the full story. Many children have a positive test to a food they eat without any problem. Testing without a clear reason can lead to foods being cut out for no benefit.

Skin prick test

A tiny drop of the food extract is placed on the forearm and the skin is pricked lightly. A raised bump after 15 minutes shows sensitisation. Quick and only mildly uncomfortable. Antihistamines must be stopped for a few days before, as the team advises.

Blood test (specific IgE)

Measures allergy antibodies to particular foods. Useful when skin testing is not possible.

Food challenge

The child eats small, increasing amounts of the food in hospital, with staff and emergency medicines ready. This is the clearest way to confirm whether an allergy is real or has been outgrown.

Avoid tests sold without a doctor, such as hair analysis, "IgG food intolerance" panels, and machines that claim to detect allergies through the skin. They are not reliable and often lead to unnecessary diets.

Harmattan, Sneezing and Catarrh

Allergic rhinitis (hay fever) is common in Nigerian children, and often worse in the harmattan, when dust, pollen and dry air irritate the nose. Signs include sneezing, a runny or blocked nose, itchy eyes and nose, rubbing the nose upwards, snoring, and dark circles under the eyes. It is not an infection, so antibiotics do not help.

• Rinse the nose with saline (salt-water drops or spray from a pharmacy) to clear dust.
• Reduce exposure: close windows on dusty days, damp-dust, wash faces and hands after outdoor play, and wash bedding often.
• Medicines as prescribed: a non-sleepy antihistamine or a steroid nasal spray can help a lot when used regularly through the season.
• Watch for asthma. Many children with allergic rhinitis also have asthma, and treating the nose helps the chest. See our asthma guide.

Insect Stings

Bee and wasp stings and fire ant bites usually cause pain, redness and swelling where the sting went in. A large swelling that spreads over a whole limb over a day or two is uncomfortable but not usually dangerous. Anaphylaxis after a sting is uncommon in children, but it is an emergency.

• Remove a bee sting quickly by scraping it out sideways with a fingernail or card.
• Wash the area and apply a cold compress. Pain relief from the pack, used as directed for your child's age, can help.
• Watch for signs of anaphylaxis for the next hour: swelling of the face or throat, breathing difficulty, paleness, vomiting, or hives spreading over the body. See first aid for bites and stings.

Medicine Allergies

Rashes during a course of antibiotics are common, especially with a viral illness, and many are not a true allergy. But children labelled "allergic to penicillin" may miss out on the most suitable medicines for years. If your child gets a rash, swelling or wheeze on a medicine:

• Stop the medicine and see a doctor, or come in now if there are any signs of anaphylaxis.
• Take a photo of the rash, and write down the medicine, the date and what happened.
• Blisters, peeling skin, sore mouth or eyes, or a fever with a widespread rash can be a rare but serious skin reaction. Come in now.
• Ask whether the allergy can be checked later, rather than carrying a label for life.

Living with Allergy

• Get a written allergy action plan from your doctor that lists the allergens, the signs of a reaction, and what to give.
• Read every label, every time. Recipes change. Look for the allergen in the ingredients and in "may contain" warnings. Be careful with street food, party food and unlabelled products, where you cannot check ingredients.
• If adrenaline is prescribed, carry two auto-injectors at all times, check the expiry dates, keep them out of heat, and make sure every carer knows how to use them. Ask the team about availability and supplies.
• Tell everyone who feeds your child: grandparents, nannies, drivers, teachers, friends' parents, and the kitchen at school or parties. Allergy is sometimes dismissed as fussiness; a printed plan helps.
• Plan for school: share the action plan and medicines, and agree who will act. See our starting school checklist.
• Teach your child, in words they understand, which foods to avoid, to ask before eating, and to tell an adult straight away if they feel unwell.
• Keep a varied diet. Avoiding several foods can affect growth; ask for a dietitian's help if you need it.

Our paediatric dermatology service and nutrition service help you build that plan, and the care team tells you where each allergy test is done.

Myths About Allergies

Questions Parents Ask