1.How do I know my child is suffering from allergic diseases?
If you wake up every morning and have unexplained nasal congestion, nasal itching, continuous sneezing and clear nasal discharge, and usually like to rub your eyes and pick your nose, you should be alert to whether your child has allergic rhinitis; if you often have unexplained cough and shortness of breath in the morning or in the middle of the night, and if shortness of breath, chest tightness and dyspnea appear or worsen after the change of season, cold or exercise, you should be alert to whether your child has allergic asthma.
At this point, you should take the affected child to the doctor for a clear diagnosis.
It is important to note that when both parents are allergic, their children have a 70% chance of being allergic; when the mother alone is allergic, her children have a 50% chance of inheritance; when the father alone is allergic, his children have a 30% chance of inheritance.
2.What are the common allergens?
Common inhalant allergens include dust mites, mold, pollen, pets, cockroaches, and common food allergens include milk, eggs, nuts, seafood, soybeans, and wheat. Among them, dust mites are the most important inhalant allergens. About 70% to 80% of allergic asthma, especially in children, are allergic to dust mite allergens. Dust mites are widely distributed in China and are the most important indoor allergen, causing perennial rhinitis and asthma symptoms. The detection rate of indoor dust mites in Beijing is 92.8%, and the average detection rate of dust mites in hotels in Guangxi is 80.6%. Allergy symptoms can vary throughout the day and are generally heaviest in the bedroom, especially when going to bed and waking up in the morning. It is difficult to completely avoid exposure to dust mites even if the patient takes good mite control measures. Dust mites are arthropods that cannot be seen by the naked eye and feed mainly on human and animal dander. They are most prevalent in beds, dead corners of the house, carpets, bedding and pillows, and are breeding grounds for dust mites. Live mites, dead mites, and mite excrement are all very strong allergens that fly in the air as they make beds and clean, and can trigger allergic reactions when inhaled by people with allergies.
3.How to detect allergens?
Allergens can be identified by skin prick and serum specific IgE test, which are similar in sensitivity and specificity, i.e., the same level of accuracy.
The skin prick is used to determine whether the child is allergic to a specific allergen by comparing the size of the wind cluster produced by pricking the specific allergen on the skin.
The following should be noted.
(1) All antihistamines must be stopped 5 days prior to the test.
(2) Systemic adrenocorticosteroids must be stopped 72 hours prior to the test.
(3) Cortisone cream should not be applied to the skin (dorsal or forearm palmar skin) where the puncture test will be performed 3 days prior to the test.
(4) The use of beta blockers and ACE inhibitors is prohibited before the test.
(5) Do not do the skin test if the site has severe skin infection or eczema, and do not do the skin scratch test if it is positive.
(6) Acute asthma attacks and systemic infections should not be performed.
A positive reaction is a localized swelling (edema) or erythema of the test site. Referring to the instructions of the puncture fluid kit, the size of the skin erythema or wind mass due to allergen reagent is used as the criterion: a wind mass with a diameter (S) greater than 3 mm of the negative control is considered positive. If the intensity of skin reaction is similar to histamine as (+++); skin reaction is stronger than histamine as (++++); weaker as (+) or (+++), equal to or smaller than saline as negative. Possible adverse reactions during puncture include eye allergy, nasal allergy, itchy throat; shortness of breath, aggravation of asthma; dizziness and weakness; nausea and vomiting; rash; generalized itching; and shock. However, adverse reactions are relatively rare, and parents need to accompany the test throughout and should observe for 30 minutes after completion.
The serum specific IgE test requires 2 ml of blood collected intravenously, does not require fasting, and is not affected by drugs. Normal reference range of specific IgE: <0.35 is negative, grade I is mild (≥0.35), grade II is moderate (≥0.70), grade III is severe (≥3.50), grade IV (≥17.5), grade V (≥50), and grade VI (≥100) are all extra severe.
Parents should be reminded that allergen check is for better treatment of diseases. I have met several parents who ran from one hospital to another, repeatedly checking allergens, but refused medication for fear of drug side effects. In fact, the treatment of allergic diseases cannot rely on environmental control alone, for example, dust mites are difficult to isolate completely, and medication is necessary. Likewise, it is not possible to rely on medication alone; environmental control is also very important. Inhalant allergens are usually reviewed once every 2 to 3 years. Other parents have told me that they would like to check hundreds of allergens, but in fact the common inhalant allergens and food allergens are listed in question 2 and are not needed unless the condition and the current test results do not match. Some parents are also overly obsessed with laboratory indicators, in fact, all test results have false positives and false negatives, but also need to stimulate the test and combined with the actual condition of the professional doctor to determine.
4.How to control the environment for inhalant allergens?
First of all, it is necessary to clarify the allergens by skin test or serum specific IgE test. For example, for patients allergic to pollen, patients can be advised to go out as little as possible during pollen season, wear a mask or use a pollen nasal barrier when going out, and wash hands and face and change clothes immediately after returning home. Avoid planting flowers indoors and exercising on grass. Patients allergic to dust mites are advised to avoid carpets and playing with stuffed toys, and to use vacuum cleaners weekly. Cover pillows and mattresses with dust mite covers and wash bed sheets in hot water every 1-2 weeks. Do not store old newspapers and magazines. Do not use wool blankets, down comforters and down pillowcases. Wear a mask when cleaning regularly. Clean the air conditioning filters frequently. Patients who are allergic to mold are advised not to put too many plants indoors, as moist soil can produce mold. Do not use indoor humidifiers to maintain 30-50% humidity. Clean showers and sinks frequently and air conditioning filters frequently. Avoid spending more time in indoor swimming pools, greenhouse flower rooms, and basements. Keep garbage cans outside. Patients allergic to pets are advised not to have pets, or at least keep them outside the bedroom and avoid letting them lick you. Patients allergic to cockroaches should keep the kitchen clean and dry, do not have exposed food, and use cockroach killers.
5.What is the danger of allergic rhinitis and asthma to children?
Allergic diseases are currently the most common diseases in the world and have been listed by the World Health Organization (WHO) as one of the top three diseases to focus on in the 21st century. The incidence of allergic diseases has increased significantly in the past few decades, and the incidence of asthma is also increasing year by year, and World Allergic Diseases Day is celebrated on July 8 every year. Allergic asthma mostly develops in childhood, and about 30% to 50% of children with the disease will continue into adulthood. Recurrent asthma attacks can seriously affect the lives, studies and work of children and parents, and endanger the physical and mental health of patients. For example, it can lead to growth and developmental disorders in children and can gradually evolve into chronic obstructive pulmonary disease or pulmonary heart disease, and children with the disease often refuse to participate in social activities because of reduced mobility or fear of illness, thus causing psychological disorders. Allergic rhinitis, if not treated correctly and in a timely manner, can lead to memory loss, affect the intellectual development of children and may develop into asthma. According to statistics, the risk of asthma in patients with allergic rhinitis is 8 to 10 times higher than in normal people, and a significant number of asthma patients are accompanied by allergic rhinitis. According to statistics, the prevalence of allergic rhinitis is 10%-25% worldwide, and the prevalence of allergic rhinitis in children is 7.5%. There are 300 million asthma patients worldwide and about 30 million in China. Asthma causes 180,000 cases per year or 1 million cases per decade of unnecessary thinking. At present, the prevalence of childhood asthma in Shanghai has reached about 6%.
6.What is desensitization therapy?
The professional term is called specific immunotherapy, which is mainly used for allergic reactions caused by inhalant allergens, and is specifically for IgE-mediated type I allergic diseases. After a certain period of desensitization treatment, the immune tolerance to the allergen can be improved to the extent that no more allergic reactions occur after exposure to a certain amount of allergenic antigen, or the degree of reactions is significantly reduced, and allopathic medication can be reduced or discontinued. Desensitization therapy generally takes 3-5 years, and 90% of patients can have 50%-75% improvement in clinical symptoms 1 year after the maintenance dose of desensitization, and nearly 90% of patients can maintain improvement in clinical symptoms after completion of desensitization therapy (still effective 3-4 years after stopping treatment). However, desensitization therapy has certain limitations. First of all, the allergens should be clearly identified, some patients can only partially identify the allergens through current testing methods, some patients overreact to desensitization therapy, and some patients have complications other than type I allergic reactions during the treatment process, which interrupt the desensitization therapy. Doctors should develop a desensitization plan taking into account the patient’s condition and inform the possible adverse reactions.
7.Why should desensitization treatment be carried out?
Asthma is a common allergic disease in clinical practice that is difficult to cure and recurrent. However, with the continuous development of medical science, the understanding of the pathogenesis, pattern and treatment of asthma has been greatly improved, and new drugs and measures that are really effective have emerged. Among them, desensitization therapy is becoming more and more popular among doctors and patients.
”In its latest edition, the Global Initiative for Asthma (GINA) emphasizes the importance of desensitization in asthma treatment, stressing that “symptomatic plus cause-specific” treatment is the fundamental solution for asthma patients to get rid of the disease, and is the only way to change the natural course of allergic diseases. It is the only treatment that can change the natural course of allergic asthma and allergic rhinitis, and is the only allopathic treatment recommended by the World Health Organization and the global societies for allergic reactions, asthma and immunology, and may completely cure allergic diseases.
Its immune mechanism is more agreed in academic circles as follows.
(1) suppression of allergen-induced mucosal eosinophil and basophil levels
(2) Reducing the release of early and late allergic mediators
(3) Reducing TH2 cytokine levels and increasing TH1 cytokine levels
(4) Decreased T-cell response to allergens
(5) Decrease the level of allergen-specific IgE and increase the level of allergen-specific IgEG4
8.What are the indications for desensitization therapy?
Indications for desensitization therapy include clinically significant IgE-mediated diseases (allergic rhinitis, allergic conjunctivitis, mild to moderate allergic asthma, hay fever), and inhalation of clear allergens that are difficult to effectively avoid (e.g., pollen, dust mites). Other indications include medication and avoidance of allergens but still poorly controlled disease, medication with high side effects, and patients with fear of medication. Patients with insect venom allergy are also suitable for desensitization. Patients are required to be compliant, cooperative, and able to clearly communicate changes in symptoms.
9. What are the contraindications to desensitization therapy?
Contraindications include severe uncontrolled asthma, immunodeficiency, combined severe autoimmune disease, malignant disease, severe cardiovascular disease, acute and chronic pneumonia, major organ failure, use of beta blockers (such patients should not be given epinephrine first aid if systemic allergic reactions occur), poor compliance, age less than 5 years, and a history of anaphylaxis. Urticaria, allergic bronchopulmonary aspergillosis, and hypersensitivity pneumonitis are also contraindications to desensitization therapy.
Desensitization is also not indicated if serum-specific IgE is negative, or if IgE is positive but there is no history of associated allergies. Patients with mild asthma are better treated with desensitization than moderate to severe patients. Asthma cannot be desensitized if the FEV1Q is 70% after medication (suggesting that there is already irreversible airway damage). Sublingual desensitization can be used in children older than 4 years.
10.What are the current methods of desensitization treatment?
There are two methods of desensitization therapy that are commonly used and have proven efficacy, namely subcutaneous injection or sublingual administration. The desensitization drug should be a standardized water-soluble vaccine, which needs to be stored in a refrigerator at 0-8℃.
Injectable desensitization therapy: This refers to intradermal injections with allergen extracts. Desensitization injections start with small doses and gradually increase the dose to increase tolerance to the allergen. Compared to sublingual desensitization, the disadvantage is that long-term injections may be painful. Moreover, more adverse reactions have been reported. Patients need to go to the hospital regularly during the administration of the drug by a health care professional and need to stay in the hospital for at least half an hour after the administration. The literature reports that serious adverse reactions may occur on average once in every 10,000 injections and anaphylaxis approximately once in every 250,000 injections in Germany. The advantages are longer-lasting efficacy, higher patient compliance, and the presence of a health care professional to monitor adverse reactions each time.
Sublingual desensitization: The allergy-inducing substance (e.g., dust mite active protein) is made into different concentrations of desensitizing solution and is administered daily in small doses that the patient can adapt to (the desensitizing drops are placed under the tongue, absorbed slowly, and swallowed after 1 to 3 minutes), and the dose is gradually increased to a maintenance level for a sufficient time to improve the patient’s tolerance. The advantage of sublingual desensitization therapy is that it is easy to use, and patients can take it themselves at home, eliminating the pain and fear associated with injections. Moreover, the adverse effects of sublingual desensitization are mild, and no cases of serious systemic adverse reactions or anaphylaxis have been reported so far as long as the drug instructions are strictly followed. The most common adverse reactions reported in foreign literature are itching of the mouth and sublingual area, gastrointestinal discomfort, and also headache, constipation or urticaria after taking the drug. Severe allergic reactions are mostly associated with incorrect parental dosing.
In my clinical practice, I have encountered parents of children with sublingual desensitization who often forget to give their children the medication, ask their children to give the medication themselves, or ask their grandparents to give the medication so that the dose is wrong. We have also met parents who are overly nervous and stop giving the medication as soon as their child coughs a few times, but we hope that after reading our article they can eliminate their worries and persevere.
11. Is it better to start desensitization at a younger age or at an older age?
Children’s immune system is not yet well developed and is very malleable. The earlier the allergic disease is treated, the better, and the effectiveness of desensitization treatment will be more significant. The current recommended age for sublingual desensitization is 4 years of age or older, and the current recommended age for subcutaneous desensitization is 5 years of age or older. Successful desensitization can prevent the development of new allergies and the further progression of allergic rhinitis to allergic asthma. Patients with allergic rhinitis can significantly reduce the symptoms of sneezing, runny nose, nasal congestion and nasal itching after sufficient courses of desensitization therapy, and some patients can achieve a completely symptom-free state with long-term stable efficacy. After regular desensitization treatment, allergic asthma can significantly reduce or even eliminate the symptoms of wheezing and shortness of breath, and the efficacy will be maintained for a long time, even for a lifetime, even after the course of treatment.
12.How long is the course of desensitization treatment?
According to the World Health Organization, desensitization is an allopathic treatment, and it usually takes 3-6 months for desensitization to take effect, and to maintain long-term effects, the medication should be continued for a period of time after the symptoms disappear. The recommended duration of treatment is 3 to 5 years, with a minimum of 2 years. Early treatment and an adequate course of treatment are the keys to successful desensitization therapy.
13.What is the cost of desensitization treatment?
The current cost of sublingual dust mite desensitization treatment is $6,000 (2 years) and the cost of subcutaneous injection dust mite desensitization treatment is $15,000 (2 years).
14.What is the medication regimen for standard subcutaneous injection desensitization treatment?
The whole course of treatment is divided into an initial treatment phase and a maintenance treatment phase. In the initial treatment phase, the interval between injections is 1-2 weeks (6 months in total), the concentration increases from level 0 to level 3, and the dose increases from 0.05ml, 0.1ml, 0.2ml…0.8ml each time. The interval between injections in the maintenance phase of treatment is 4-6 weeks (1 year to 2 years), and the level 3 concentration is maintained at the maximum dose tolerated by the patient. Clinically, the maintenance dose is usually prescribed at a concentration of about 1:102.
15. What is the dosing regimen for standard sublingual desensitization therapy?
The whole course of treatment is also divided into the initial treatment phase and the maintenance treatment phase. Take the sublingual dust mite desensitization preparation “Changdi” produced by Zhejiang Wewu Company as an example.
Initial incremental period: Changdi 1-3. Week 1 – No. 1; Week 2 – No. 2; Week 3 – No. 3.
Maintenance period: 3 drops once a day from week 4 onwards.
The specific dosage can be referred to the drug instructions of the desensitizing preparation.
16.Does sublingual desensitization do well in the morning or in the evening?
Both can be done. Dosing method: Put the drug drops under the tongue and swallow after containing it for 1~3 minutes, once a day, and give it at a fixed time every day, either before breakfast or one hour before bedtime. Do not let children give the medicine by themselves, parents need to personally put the medicine drops under the child’s tongue, the dosage should be strictly in accordance with the drug instructions. It is necessary to stay for 1 hour to observe the child for any adverse reactions. If there are adverse reactions, a professional physician should be consulted and the dose should not be increased or decreased at will.
17.What adverse reactions may be caused by subcutaneous injection desensitization therapy?
Subcutaneous injection can cause local and systemic adverse reactions, but in most cases it can be recovered soon after suitable treatment. It should be carried out in medical institutions with suitable emergency resuscitation equipment and treatment conditions, and equipped with medical personnel who can recognize and handle adverse reactions in a timely manner.
Local reactions refer to a 2 cm post-injection lump that lasts for 2 days, which is relatively common and has no adverse consequences. The rapid-onset phase occurs mostly within 30 minutes after injection, and the late-onset phase occurs mostly 3 to 12 hours after injection. Large local reactions (lumps >4 cm in diameter) are best treated with oral antihistamines and local cold compresses and, if necessary, local hormonal creams. There is no information that large local reactions can cause severe systemic allergic reactions (urticaria, angioedema, conjunctivitis, laryngeal edema, vomiting, bronchospasm, hypotension, shock or even death after injection). Large local reactions necessitate dose adjustment and maintenance of the original amount for the next injection.
Most systemic allergic reactions occur in the initial phase and in highly sensitized patients. Incorrect dosing can lead to severe or fatal systemic allergic reactions, which are usually classified as mild or severe. Mild systemic reactions manifest mainly as urticaria, mild chest tightness and breath-holding, and are usually controlled by oral antihistamines, injectable glucocorticoids (antihistamines prevent early allergic reactions; intravenous hormones prevent delayed reactions after 3-6 hours) and nebulized inhaled asthma medications; severe adverse reactions include systemic urticaria, angioedema, laryngeal edema, acute attacks of severe asthma and even shock, which They can be life-threatening and require immediate subcutaneous injection of 0.1% epinephrine (0.3-0.5 ml in adults, 0.01 ml/kg in children, maximum 0.5 ml), which can be repeated 15 min later if necessary, and can be repeated several times until blood pressure rises again. Epinephrine constricts blood vessels, relaxes respiratory muscles, improves breathing, and stimulates heartbeat. Antihistamines and glucocorticoids are also used. Supportive therapy includes opening the airway and maintaining circulation. Oxygen is administered, breathing is improved with short-acting β2 agonists, intravenous fluids are given to improve hypotension, and warmth and reduced mobility are used. If necessary, cardiopulmonary resuscitation is performed. The patient should be continuously observed for 8-12 hours to monitor vital signs, as there may be a delayed anaphylactic reaction.
Although allergic reactions to subcutaneous injections can be serious, the chance of systemic allergic reactions is generally low as long as care is taken not to mistake the concentration and dose of the injection, lung function is tested before and after the injection, and is observed and judged by a medical professional. We have done dozens of cases of subcutaneous injection desensitization treatment, and finally only 2 cases were abandoned due to more than 2 systemic allergic reactions, and there was only one case of mild systemic reaction, and they were all related to excessive fatigue the day before the injection.
18.What adverse reactions may be caused by sublingual desensitization therapy?
A small number of patients may experience mild adverse reactions during the initial incremental period due to intolerance of the drug dose, which may manifest as rash, gastrointestinal discomfort, itching and swelling of the oral mucosa, headache, fatigue or mild attacks of asthma and rhinitis, especially rash. Most of the adverse reactions can be relieved by themselves. Patients with obvious symptoms can take antihistamines and maintain the original dose or reduce the desensitization dose temporarily, and then gradually increase it after the situation improves. If the adverse reaction is more serious, you should immediately visit the hospital and inform the doctor of the desensitization treatment currently being carried out and further discuss the future treatment plan with a professional allergist. The occurrence of adverse reactions will be significantly reduced during maintenance treatment. I have encountered two cases of children with more severe allergies during the initial incremental period who developed a generalized rash with swelling of the oral mucosa at drop 1 and had to abandon the treatment, but the vast majority of children tolerated it well and the treatment was effective.
19.Will the desensitization treatment affect the growth and development?
No. The World Health Organization clearly states in its guiding document on immune desensitization therapy that “desensitization therapy is the only fundamental treatment for bronchial asthma that is likely to be complete”. Desensitization improves the desensitization of the patient and is the only etiological treatment for allergic diseases. In foreign countries, subcutaneous desensitization therapy has been carried out for more than 100 years, and sublingual therapy has also been carried out in Europe for more than 20 years, and there are no reports of “affecting growth and development”.
20.Does the desensitization preparation contain hormones?
No, it does not contain hormones. Desensitizing drugs are standardized water-soluble vaccines, such as dust mite desensitizing vaccine which is only dust mite extract.
21. Can vaccinations be given during desensitization treatment?
It is possible to suspend sublingual desensitization on the day of the vaccination and the next day; the subcutaneous desensitization treatment should be separated from the vaccination for one week.
22.What should I do if I have a fever or cold during desensitization treatment?
You should go to the hospital to clarify the cause of the fever and cooperate with anti-infection treatment. Patients with subcutaneous injection should suspend 1 time. Patients with sublingual desensitization can be suspended for several days during the fever.
23.What should I do if I have an asthma attack during desensitization treatment?
During desensitization treatment, if a mild asthma attack occurs, it can be combined with symptomatic treatment, such as inhaled bronchodilators to calm wheezing. If severe wheezing and shortness of breath occur, you should go to the hospital immediately and suspend the desensitization treatment at the same time, and continue the treatment when the condition is stable. The subcutaneous injection is suspended for one time, and the sublingual is discontinued on its own.
24.Can eczema patients be desensitized?
Desensitization therapy can be recommended for children with allergic rhinitis and asthma combined with eczema. Clinical observation shows that such patients have improved respiratory symptoms and skin allergy symptoms at the same time.
25. Can food allergy patients be desensitized?
At present, desensitization treatment for food allergy is only available in animal experiments or early clinical trials. Because of the high prevalence and danger of food allergy, in addition to training children with food allergy to strictly avoid allergic foods and self-help for anaphylaxis (EPIPEN), clinicians and researchers have tried many new treatment methods, including heat-treating milk and eggs and giving them to children as a natural form of immunotherapy; injecting peanut-allergic patients with anti-IgE antibodies; herbal treatments ( such as oral administration of goldenseal); peanut desensitization vaccine has achieved remarkable efficacy in the treatment of peanut allergy in rats, etc. However, at present, in clinical practice, avoidance of allergic foods is still the most important method for treating food allergy, especially milk protein allergy.
26.What should I pay attention to in desensitization treatment for children?
Specific desensitization therapy using allergen preparations is to improve the patient’s symptoms of allergic reactions by giving the patient incremental doses of allergens to which the patient is allergic.
Subcutaneous desensitization therapy should be performed in a hospital with monitoring by a health care professional because allergic reactions may occur and require immediate treatment. Possible allergic reactions include itchy eyes, throat obstruction, itchy and stuffy nose, runny nose; chest tightness, severe cough, aggravation of asthma; dizziness and weakness; nausea and vomiting; skin rash; generalized itching; and shock. Anaphylaxis is a rare occurrence, but may cause death. It should be observed for at least 30 minutes after the injection and accompanied by a parent throughout. Physical activity and hot baths should be avoided on the day of injection. Overexertion should be avoided the day before the injection.
Patients with sublingual desensitization should be given the medication strictly according to the drug instructions. If there is a slight overdose of the medication (for example, parents give 4 or 5 drops when there should be 3 drops of No. 4), there is no need to panic, and most of them can be relieved by themselves by drinking more water and taking anti-allergy medication at the same time. However, a serious overdose of the drug can also lead to aggravation of the disease or even death.
27.My child had an asthma attack recently, can I start desensitization treatment right away?
Asthma is a chronic recurrent disease and desensitization is necessary to reduce the body’s sensitivity to allergens and should not be rushed. It is recommended to start desensitization therapy after 1 to 3 months of asthma control, together with asthma control medications such as inhaled hormones/bronchodilators.
In the early stages of desensitization, if the child has allergic symptoms, it is also still necessary to combine the use of symptomatic medications under the guidance of a physician. The root cause of symptoms of allergic diseases is often due to the accumulation of inflammation in the airways. Desensitization reduces and avoids the development of new inflammation by improving the body’s tolerance; medication addresses the symptoms that have developed and controls the inflammation. Therefore, if symptoms still exist, medication should still be administered according to medical advice and should not be stopped without authorization.
28.What if desensitization treatment is interrupted for any reason?
Patients with subcutaneous desensitization should be injected every 1-2 weeks during the incremental period. If the incremental treatment period is interrupted for 2-4 weeks, the next dose should be reduced to 1/2 the amount of the last injection; if it is interrupted for 4 weeks, the dose should be restarted. For maintenance treatment, injections are given once every 4 weeks. If the period is exceeded by 2 weeks, the next dose is 1/2 of the last injected dose; if it is interrupted by more than 4 weeks, the dose is 5% of the last injected dose; if it is interrupted by more than 1 year, it is restarted. If intolerance occurs during the injection, choose according to the actual situation. For example, if a strong local reaction occurs, repeat the last tolerated dose; if a mild systemic reaction occurs, lower the last dose by 2-3 levels. For severe systemic reactions, restart. If necessary, do not continue the treatment. The specific situation is determined by a medical professional.
Do not stop medication for more than 4 weeks in children with sublingual desensitization. If more than 1 week, a medical professional needs to be consulted. Beyond 4 weeks, desensitization treatment needs to be restarted.
29. Is desensitization effective for children with multiple inhalant allergen sensitivities?
Desensitization therapy is not recommended for patients with allergic rhinitis and asthma who have more than 3 completely unrelated allergens or allergens that are difficult to identify, or allergens that can be effectively prevented.
Nowadays, more and more families have pets, and many children have cat and dog allergies, but some parents cannot afford to send their pets away, and their children’s condition always recurs. Parents hope that desensitization therapy will not only make their children well but also satisfy their desire to have pets. Here is an appeal to parents: any medicine has side effects. Please share a little of your love for your pet with your child and curb your playfulness. Instead of letting your child lose at the starting line in terms of learning, you should give your child a healthy body first.
30.Why does my child still have frequent asthma attacks after 1 year of desensitization treatment?
The keys to successful desensitization treatment are: environmental control, avoiding exposure to dust mite allergens as much as possible; adherence to standardized medication and adequate course of treatment; early and symptomatic medication in combination.
If, after more than one year of desensitization, there is no significant change in the frequency and extent of the child’s symptom attacks, and the amount of allopathic medication is not reduced, it can be considered a failure of desensitization treatment. The reasons for the failure of desensitization should be discussed with a medical professional. The main reasons that may cause failure are.
1. The original allergen test report is inaccurate or there are too many types of inhalation allergies, such as using dust mite desensitization preparations when they are not actually dust mite allergies; for example, there are strong pollen allergies in addition to dust mites; for example, the allergen report is several years old and the current allergy situation has changed.
2, Not adhering to standardized desensitization treatment, parents often forget to give their children medication.
3, neglect environmental control, still large doses of exposure to dust mites, for example, some parents forget to replace the pillowcase, quilt core, children do not want to abandon plush toys; poor living environment, have encountered the family opened furniture processing plant, the child all day exposure to a variety of chemical harmful substances and dust.
4, often take children to and from public places, group housing, etc., resulting in repeated respiratory infections. Have encountered the family opened restaurants and mahjong parlors, children live all day in the smell of cigarettes, oil and smoke, and contact with a large number of foot traffic.
5.Start desensitization treatment when the disease is not under control, such as when asthma has frequent attacks in a short period of time, or when lung function has failed to return to normal after regular asthma medication.
6.Uncoordinated with other symptomatic drugs, such as refusing to spray nasal drugs during severe rhinitis attacks, parents or children of patients with uncontrolled asthma unwilling to inhale hormones at the same time.
7. Misdiagnosis of diseases, such as diagnosing non-allergic rhinitis as allergic rhinitis, or combining with other diseases at the same time.
For example, I have met several cases of patients with frequent asthma attacks, whose parents refused to inhale hormones and asked their children to swim for more than half an hour or practice long-distance running every day, resulting in a relapse of the child’s condition for three days.
31.What hospital should my child go to for desensitization treatment? What doctor should I go to?
You can go to a specialized children’s hospital and see an allergist or a respiratory or quintuplegic doctor to find out if the disease is allergic or not. What are the allergens? Is it an indication for desensitization? Which desensitization method is better? What medications are needed to complement the treatment? A professional doctor will give you a plan. Desensitization medications are not OTC. Some children actually cannot be desensitized, may not need desensitization, or may not be suitable for immediate desensitization treatment at this time. Blind desensitization may worsen the condition, so remember to always seek a professional doctor.
The allergy and immunology clinic at Shanghai Children’s Medical Center is open on Tuesday and Friday mornings, and the respiratory asthma clinic is open from Monday to Saturday. You are welcome to bring your child to the clinic.
32.Can children who receive subcutaneous desensitization be switched to sublingual desensitization?
If you want to switch to sublingual desensitization during the initial incremental period of subcutaneous injection, you should start from the beginning; if the child is already in the maintenance period of subcutaneous injection, you can start directly from Changdi 4 3 drops for children under 14 years old and from Changdi 5 2 drops for children over 14 years old. If intolerance occurs in patients who have started medication from the maintenance phase, treatment still needs to be started from No. 1 1 drop.
33. Can a child receiving sublingual desensitization be switched to subcutaneous desensitization?
To switch to subcutaneous injection, regardless of whether the child receiving sublingual desensitization is in the initial incremental phase or the maintenance phase, it is necessary to start at the beginning.