Sneezes, Rashes, and More: Understanding Childhood Allergies in India

As parents, we closely watch our children for any sign of discomfort. A sudden rash, persistent sniffles, an upset tummy after eating – these common childhood occurrences sometimes leave us wondering: could it be an allergy? Understanding Childhood Allergies is becoming increasingly important for families everywhere, including here in India.

I’m Dr. Santosh Madrewar. As a senior paediatrician and the founder of Borneo Hospital, with our dedicated centres for child and family health in Thane and Nashik, I frequently encounter parents seeking clarity about allergies. Identifying and managing allergies effectively is crucial for a child’s comfort, health, and safety. Our goal at Borneo is to provide not just treatment, but also clear information and support for families navigating these conditions.

This article aims to help you understand what Childhood Allergies are, how to recognise potential symptoms of common allergies seen in India, and outline the approaches to diagnosis and management. Please remember, this information provides general guidance; a proper diagnosis and personalised management plan must always come from your doctor or an allergy specialist.

What Are Allergies? How Do They Happen?

At its core, an allergy is an over-reaction by the body’s immune system. Normally, our immune system protects us from harmful invaders like bacteria and viruses. In someone with an allergy, however, the immune system mistakenly identifies a normally harmless substance – called an ‘allergen’ – as a dangerous threat.

When the child encounters this allergen again (by eating it, breathing it in, touching it, or being stung), their immune system launches a defence, releasing chemicals like histamine. It’s these chemicals that cause the typical allergy symptoms – the itching, swelling, sneezing, rashes, or breathing difficulties. The tendency to develop allergies (known as ‘atopy’) often run in families, meaning if parents have allergies, asthma, or eczema, their children have a higher chance of developing them too, though not necessarily the same specific allergies. Common allergens fall into categories like foods, airborne particles (pollen, dust mites), insect stings, medications, and things that touch the skin.

Common Types of Childhood Allergies in India & Their Symptoms

Allergies can manifest in many ways. Here are some common types we see:

1. Food Allergies:

• Common Triggers in India: While any food can cause an allergy, some are more common. These include cow’s milk protein (a frequent cause in infants), eggs, peanuts (moongaphalee), tree nuts (like cashews/kaju and almonds/badam, which are common in Indian diets), wheat, soy, fish, and shellfish.
• Key Symptoms: Reactions often happen quickly after eating the trigger food. Symptoms can range widely:
  • Skin: Hives (itchy, red raised welts, sometimes called ‘पित्ती’/’shit-pitta’), generalised itching, eczema flare-up, swelling (lips, tongue, face – angioedema).
  • Gut: Vomiting, diarrhoea, abdominal pain, cramping.
  • Respiratory: Coughing, wheezing, shortness of breath, tight throat, runny/stuffy nose.
  • Severe reactions (anaphylaxis) are a medical emergency (see below).

2. Allergic Rhinitis (Nasal Allergy / ‘Hay Fever’):

• Common Triggers in India: Inhaled allergens are widespread.
  • Pollen: From specific trees, grasses, and weeds, often causing seasonal symptoms that vary geographically.
  • Dust Mites: Tiny creatures living in bedding, carpets, upholstery – a major cause of year-round symptoms indoors. Very common in humid environments.
  • Mould Spores: Found in damp indoor or outdoor areas.
  • Pet Dander: Skin flakes, saliva from cats, dogs, or other furry pets.
  • Cockroach Allergens: Common indoor allergen in some areas.
• Key Symptoms: Often mimics a persistent cold but without fever. Look for: Frequent runny nose (typically clear, watery discharge), nasal congestion (stuffy nose), bouts of sneezing, itching (inside the nose, eyes, roof of mouth, throat), red and watery eyes, sometimes dark circles under the eyes (‘allergic shiners’).

3. Asthma (Often Allergy-Triggered):

• The Link: Many children diagnosed with asthma find their symptoms are triggered or worsened by allergies. Common triggers overlap with allergic rhinitis (dust mites, pollen, pets) but also include viral infections, smoke exposure (including passive smoking and air pollution), exercise, and changes in weather.
• Key Symptoms: A persistent cough (often worse at night, early morning, or with activity/laughter), wheezing (a high-pitched whistling sound when breathing out), shortness of breath, or a feeling of tightness in the chest. Proper diagnosis and an asthma action plan from a doctor are essential.

4. Atopic Dermatitis (Eczema):

• What it is: A common chronic skin condition causing itchy, inflamed skin. It often starts in infancy and frequently occurs in families with a history of allergies or asthma (the ‘atopic march’).
• Common Triggers: These can be complex and differ between children. Potential triggers include certain food allergens (especially milk, egg, peanut in infants), environmental allergens like dust mites, harsh soaps or detergents, rough fabrics (like wool), sweating, heat, stress, and even just dry skin itself.
• Key Symptoms: Patches of skin become intensely itchy, dry, red, and inflamed. In babies, it often appears on the cheeks, scalp, and outer surfaces of limbs. In older children, it commonly affects the creases behind the knees and inside the elbows, wrists, and ankles. Scratching worsens the rash and can lead to skin thickening or secondary infections.

5. Urticaria (Hives) & Angioedema:

• What they are: Hives are itchy, raised red or skin-coloured welts that appear suddenly, can vary in size, and often seem to move around the body. Angioedema is a similar reaction but involves deeper swelling, typically affecting the lips, eyelids, face, hands, feet, or throat.
• Common Triggers: Can be triggered by food allergies, medication reactions, insect stings, viral infections, or sometimes the cause remains unknown (idiopathic urticaria).

6. Insect Sting Allergies:

• Common Triggers: Stings from honeybees, wasps, hornets, and certain types of ants (like fire ants).
• Key Symptoms: Most stings cause only a local reaction (pain, swelling, redness at the site). However, a child with a severe allergy can develop a systemic reaction (anaphylaxis) with symptoms appearing rapidly across the body: widespread hives/itching, difficulty breathing/wheezing, swelling of the throat/tongue/face, dizziness, stomach cramps, vomiting, or collapse.

7. Medication Allergies:

• Common Triggers: While any drug can cause an allergy, antibiotics (especially penicillin and related drugs) and some non-steroidal anti-inflammatory drugs (NSAIDs) are common culprits.
• Key Symptoms: Can range from mild skin rashes (like hives) or itching to severe, life-threatening anaphylaxis. Always report any suspected reaction to a medicine immediately.

Recognising Anaphylaxis: A Life-Threatening Emergency

This is the most severe allergic reaction and requires immediate action.

• What it is: A rapid, potentially fatal allergic reaction impacting multiple body systems at once.
• Key Signs (Act FAST – symptoms often appear within minutes):
  1. Difficulty breathing (wheezing, gasping, persistent cough)
  2. Swelling of the throat, tongue, or lips; difficulty swallowing or speaking; hoarse voice
  3. Widespread hives or rash; flushing; itching
  4. Dizziness, feeling faint, sudden weakness, collapse, loss of consciousness
  5. Severe stomach pain, vomiting, or diarrhoea
  6. Feeling of intense anxiety or that something terrible is happening
• IMMEDIATE ACTION REQUIRED:
  1. Administer Adrenaline Auto-Injector: If the child has been prescribed an adrenaline auto-injector (like EpiPen®, Anapen®, Jext®), use it IMMEDIATELY according to instructions. This is the first-line life-saving treatment.
  2. Call for Emergency Help: Call for an ambulance or rush to the nearest hospital emergency department (like Borneo Hospital’s) straight away, even if adrenaline has been given and symptoms seem to improve. A second reaction can occur later.

Diagnosing Childhood Allergies: How We Find Out

Accurate diagnosis is key to effective management. This usually involves:

1. Detailed Medical History: This is the most important starting point. Your paediatrician at Borneo Hospital will ask lots of questions about the symptoms (what happens, when, how often, severity), potential triggers you’ve noticed (foods, environment, activities), timing relative to exposure, family history of allergies, asthma, or eczema. Keeping a detailed diary of symptoms and potential exposures can be very helpful for your doctor.
2. Physical Examination: A thorough examination checking the skin, nose, eyes, chest, and general health.
3. Allergy Testing (Often Requires Specialist Referral): If an allergy is strongly suspected, specific tests might be needed, often performed by an allergy specialist (allergist/immunologist), to whom our paediatricians can refer you. Common tests include:
   • Skin Prick Tests: Tiny amounts of purified allergen extracts (e.g., pollen, dust mite, food proteins) are placed on the skin, and the skin is gently pricked. A positive reaction (a small, itchy red bump called a wheal) usually appears within 15-20 minutes, suggesting possible sensitisation.
   • Blood Tests (Specific IgE): Measures the amount of IgE antibodies (the allergy antibody) to specific allergens in a blood sample. Useful when skin tests aren’t suitable (e.g., severe eczema, certain medications).
   • Patch Tests: Used mainly for diagnosing contact dermatitis (e.g., allergy to nickel, fragrances). Patches with suspected allergens are applied to the back for 48 hours and checked for delayed skin reactions.
   • Oral Food Challenge: Considered the definitive test for confirming or ruling out a food allergy. This involves carefully eating gradually increasing amounts of the suspected food under strict medical supervision in a hospital setting, prepared to manage any reaction. Never try this at home.

Managing Childhood Allergies: The Cornerstones

While allergies often cannot be ‘cured’, effective management allows children to live healthy, active lives. Management typically involves these key strategies:

1. Allergen Avoidance (Where Possible):

• Once allergens are identified, avoiding exposure is crucial.
  • Food Allergies: Requires strict avoidance of the trigger food(s). This means diligently reading all food ingredient labels every time (formulations change!), preventing cross-contamination during cooking, and clear communication about the allergy when eating outside the home, at school, parties, or family gatherings (this needs careful planning, especially in India).
  • Airborne Allergies: For dust mites: Use allergen-proof covers on mattresses and pillows, wash bedding weekly in hot water, reduce humidity, minimise carpets/heavy curtains/soft toys in the bedroom, damp dust regularly. For pollen: Keep windows closed during high pollen season, use air conditioning if possible, shower/change clothes after being outdoors. For mould: Address dampness issues, clean visible mould. For pets: Ideally, avoid keeping pets the child is allergic to; if present, keep them out of the child’s bedroom, use HEPA air filters, wash hands after touching.
  • Insect Stings: Teach children to avoid walking barefoot outside, be cautious near bins/flowers/fallen fruit, check drinks for insects before sipping outdoors.

2. Medications (For Symptom Control & Emergencies):

• Medications help manage symptoms or treat acute reactions. Always use them as prescribed by your doctor at Borneo Hospital.
  • Antihistamines: Oral liquids or tablets help relieve hay fever symptoms (sneezing, itching, runny nose) and hives. Non-drowsy options are usually preferred for daytime use.
  • Nasal Steroid Sprays: Highly effective for controlling allergic rhinitis symptoms when used daily as prescribed. They reduce nasal inflammation.
  • Asthma Inhalers: Essential for children with asthma. ‘Reliever’ inhalers (e.g., Salbutamol) provide quick relief during an attack. ‘Preventer’ inhalers (usually inhaled corticosteroids) are taken daily to reduce inflammation and prevent attacks. Following a personalised Asthma Action Plan is vital.
  • Eczema Treatments: The cornerstone is frequent application of thick moisturisers (emollients) to combat dry skin. Topical steroid creams or ointments are used to settle flare-ups (use the correct strength for the prescribed duration). Other non-steroidal creams may also be used.
  • Adrenaline Auto-Injector (AAI): If your child is diagnosed at risk of anaphylaxis, they must have an AAI (like EpiPen®, Anapen®, Jext®) prescribed. It is life-saving. Parents, caregivers, and school staff must be trained on precisely when and how to use it. It must be carried by or with the child at all times. An Anaphylaxis Action Plan, developed with your doctor, is essential. Borneo Hospital paediatricians will guide you on this.

3. Allergy Immunotherapy (Specific Cases):

• For certain severe environmental allergies (like dust mite, grass pollen) or insect sting allergies that are difficult to manage, an allergy specialist might discuss immunotherapy. This involves gradually exposing the body to tiny amounts of the allergen over several years (via injections or under-the-tongue drops/tablets) to help the immune system become less reactive.

4. Education & Personalised Action Plans:

• It’s crucial that parents, the child (age-appropriately), school staff, and close family understand the child’s specific allergies, triggers, symptoms to watch for, and exactly what to do in an emergency (especially for anaphylaxis). Your paediatrician at Borneo Hospital will help create these clear, written action plans.

Living with Childhood Allergies in India

Managing Childhood Allergies in India can present unique challenges: reading diverse food labels, ensuring safety when eating out or at social functions where food sharing is common, managing exposure to high levels of dust or pollution triggering respiratory allergies, and ensuring consistent understanding and preparedness in schools. Clear communication, vigilance, always carrying necessary medications (especially AAIs), and teaching children self-advocacy skills (as they get older) are key.

Childhood Allergies are common and can range from mild nuisances to potentially life-threatening conditions. While they can’t always be prevented or cured, understanding the triggers, recognising symptoms early, and implementing an effective management plan makes a huge difference. The cornerstones are accurate diagnosis (often involving allergy testing), diligent allergen avoidance where possible, appropriate use of medications to control symptoms, and crucially, having a clear emergency action plan for severe reactions like anaphylaxis.

Working closely with your paediatrician at Borneo Hospital, and potentially an allergy specialist, is essential for developing a personalised management strategy. With careful planning and support, most children with allergies can enjoy full, active, and healthy lives.