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Allergy: to whom to go for treatment?

Allergy: to whom to go for treatment?

The first to experience allergies is a pediatrician observing a child. He knows the patient, the characteristics of his development and nutrition, and can make the necessary appointments.

If his efforts (correcting the diet of the nursing mother or changing the baby’s mixture, selecting the means to care for his skin, prescribing mild antiallergic agents such as Fenistil, Novartis; Zyrtek, UCB Farchim) will not solve the problem, the painful manifestations will continue or increase, he will send a little for consultation with narrower specialists: allergist, gastroenterologist, nutritionist.

How does the specialist see the problem?

Allergy is a manifestation of the impaired functioning of the immune mechanisms, due to which the baby has an increased sensitivity to certain components of the food. It must be said that the imperfection of the immune system, peculiar to all small children — the easily permeable walls of the intestine, which pass allergens and toxins into the blood — becomes fertile ground for the development of allergic reactions.

In babies up to 2 years, in 80% of cases, allergy is manifested by skin rashes (large red itchy scaly spots on the face, buttocks, legs, hands) caused by cow’s milk protein. Following this, the intestines can react with disorder, constipation, bloating, colic.

The development of allergies in children from 3 years of age leads to respiratory problems: runny nose, conjunctivitis, asthma attacks. They are no longer caused by food components, but by pollen of plants, house dust, wool and animal saliva.

Closer to 3 years old babies are often disturbed by a variety of allergic rashes (small itchy spots arising from contact with synthetic clothing or “response” to the appearance in the diet of vegetables and fruits of red and yellow color, nuts), urticaria (rashes, like a nettle burn) .

First of all – to find the allergen, having appointed the baby a course of examination. The next step is to determine the severity of the allegic reaction (using a blood test for immunoglobulins E (IgE) and select the appropriate treatment and nutrition regimen (if the allergen has been calculated). In most cases, the situation does not require prescription of medications and is decided by a dietitian who selects for baby safe diet (diet).

But if the allergen is unknown, before making an appointment, the doctor performs a dietary diagnosis. Milk, gluten-containing cereals (“oat-flakes”, rye, wheat) and other products with a high allergenic index are excluded from the child’s diet for a time.

Difficult cases of early food allergy, when the digestive process is disturbed, the pancreas and the intestinal microflora composition (dysbiosis occurs – the so-called experts now dysbacteriosis), the allergist observes and treats in conjunction with the gastroenterologist.

First of all, a general blood test – it shows the state of the body, whether there is inflammation in it, because the allergic children have weakened immunity. This is followed by a urine test, which will help establish how the metabolic processes go, since their violation often accompanies allergies, and there are no problems with the kidneys.

Coprology (fecal analysis) will determine how food is digested and absorbed, whether the digestive system works well, whether there are parasites in the body. The blood test for immunoglobulins E (IgE) shows the extent of the allergic reaction, and a study on the presence of antibodies to certain products (doctors will say on food allergens), such as cow’s milk proteins, helps establish its provocateur.

In the case of serious manifestations of the disease, these studies make babies from the first months of life. By the way, it is desirable to examine infants together with the mother: she will have to undergo the above-mentioned blood test for antibodies and pass on her milk for analysis.

From the age of 3, babies are subjected to skin tests (a solution containing allergens from household dust, pollen, animal dander and foodstuffs) is dripped into the skin scratch.

If it turns out that the baby is really allergic, it will be necessary to rid his body of contact with allergens, especially with food. An allergist will list the desired and unwanted products.

And since any form of allergy in infants often manifests as a violation of the intestine and its microflora, or, conversely, causes them, a gastroenterologist will help evaluate and improve the activity of the gastrointestinal tract.

How does the specialist see the problem?

If a baby has an allergy in the form of a rash on the skin, first of all you need to examine its gastrointestinal tract. The skin is a mirror of the intestines, almost 90% of the problems with it are caused by disturbances in its work, because the gastrointestinal tract is responsible for the processes of adaptation – the body’s adaptation to any new product. And increased sensitivity to food, normally safe, is a manifestation of these disorders.

This remark applies to the reaction to cow’s milk protein: congenital allergy to it is quite rare, and the so-called sensitization (or intolerance) – excessive sensitivity due to disorders of the gastrointestinal tract – very often.

First of all, you need to improve the work of the child’s digestive system, since, continuing the conversation about the reaction to milk protein, the exclusion of dairy products from its diet will not help. Why?

Recall that the beneficial bacteria in the intestine act as a filter that retains harmful substances, including allergens.

Violation of the microflora (dysbacteriosis) leads to insufficient “cleaning” of food from harmful impurities, which causes intolerance. Example: untreated water is not suitable for ingestion, but this does not mean that you need to completely stop drinking water.

Refusal of cow’s milk protein will lead to a deep imbalance of the whole organism: calcium deficiency and animal protein deficiency, weakening of the immune system, delaying the formation of various organs and systems.

In this case, treatment of intestinal dysbiosis and related problems in its work will save the child from the intolerance of a particular product. Moreover, the course of therapy must necessarily be complex and, in addition to the points mentioned above, also include a correction of the local immunity condition of the intestinal mucosa, because the gastrointestinal tract is one of the organs of the immune system, and failures in its area necessarily affect the work of the entire system.

In order for a gastroenterologist to prescribe the right treatment, some tests are required.

The necessary information about the condition of the baby will be given to the doctor by an analysis of feces for dysbacteriosis and coprology (this study shows whether the food is well digested), an ultrasound scan of the abdominal cavity. Sometimes the baby is prescribed tests to detect an infection that can cause allergies: chlamydia, mycoplasma, Giardia, worms (helminths). The reason for this step will be the lack of results of treatment (correction of intestinal dysbiosis and pancreas work) or the doctor’s reasonable suspicions that foreign agents are present in the baby’s body (for example, if a child has many animals at home or an infection is found in someone’s family).

The necessary therapy in these cases is prescribed to the child by an infectious disease doctor, although pediatricians can also treat helminthiasis and giardiasis.

How does the specialist see the problem?

Since the main type of allergens for the smallest are food, possible dietary restrictions should not affect their development. But to begin with, an allergist and a nutritionist will help to establish the correct diagnosis, not all the problems caused by food (we have already said that they most often cause a painful reaction in babies of the first years of life) are manifestations of allergy. The basis of pseudo-allergic reactions are most often problems with the gastrointestinal tract of the child.

In this case, his diet also needs adjustment. For example, it may be necessary to remove products from it that cause fermentation in the intestines.

The nutritionist will help to make the diet of the small safe without losing the nutritional properties, because the food must ensure the growth and development of his body. He will select specialized products for the child (hypoallergenic mixture, juices, mashed potatoes, cereals), will tell in what sequence and in what quantity they should be given to the baby.

The doctor will evaluate the diet of the small, determine whether he provides it with everything necessary. If you need to exclude certain foods from his diet, the doctor will select the optimal replacement for them. For example, the reaction to cow’s milk protein requires the exclusion of cottage cheese, kefir from the diet of the baby at a time when the body’s need for calcium is very high.

Then multivitamin preparations will help to compensate for this lack, and the deficit of protein will compensate for the increase in the portion of meat.

If the baby eats breast milk, nutritional correction will also be necessary for his mother. She has to give up products that cause a painful reaction in a child.

A dietitian will help balance these changes so that they do not affect the composition of breast milk and the health status of the woman.

If the baby has been examined by an allergist and a gastroenterologist, additional studies may not be necessary. The dietician will be sure to ask the mother to keep a food diary, where to write down what the baby eats and in what quantity and how it reacts to different food groups.

Using these records, the doctor will evaluate the child’s diet, identify “provocateurs” of painful reactions, check if there are any errors with the size of the portions.

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