When repeated fevers or coughs and diarrhea persist for a long time, parents often ask if their child’s immune system is low. When people talk about “immunity” or “immunity”, they generally refer to the body’s resistance to external infections, which is the original concept of the medical term “immunity”. However, over the past half century, the concept of “immunity” has become more comprehensive. Nowadays, immunity is considered to be “the body’s ability to recognize itself and to reject others”. This ability includes the body’s ability to defend itself against infection (medically known as immune response/resistance to infection), stabilize and regulate the body’s “internal environment”, and monitor abnormal cells (e.g., tumor cells). The three functions are immune response, immune self-stabilization and immune surveillance. “Immune disorders are the main cause of infections, allergies, and inflammation. In other words, when the immune response is too weak, recurrent infections or infections cannot be easily controlled; when the immune response is too strong or immune self-stabilization is out of control, allergic/allergic reactions or uncontrolled inflammatory reactions occur; when the immune surveillance function is insufficient, oncological diseases occur, and immune surveillance causes rejection reactions after organ transplantation often causing problems for post-transplant patients. It can be seen that immune function and immunity are double-edged swords, and the optimal immune state is the optimal immune response with a dynamic stable state of the internal environment. Immune imbalance can cause both numerous infection-allergy related diseases in pediatric outpatient clinics and is the main cause of death from serious pediatric diseases.
The immune function of the body can be roughly divided into non-specific immunity, which is inherent to the innate immunity, and specific immunity (like the integrated and special forces in combat), which is often acquired later.
1. Non-specific immunity
As our skin, digestive tract respiratory mucosa is a natural mechanical barrier, secrete a variety of chemical components such as lysozyme chemical barrier, their surface exists in large numbers of normal microflora (also known as normal micro-ecosystem) can inhibit and antagonize the growth of disease-causing microorganisms, playing an important biological barrier role. These roles play a role in the early onset of infection.
2.Specific immunity can be divided into humoral immunity and cellular immunity
(1) humoral immunity: external microorganisms or foreign substances entering the body are recognized by the body as “foreign” as “antigens”, “antibodies”, through antibody-antigen reaction “neutralize” and eventually “remove” these microorganisms or foreign substances. The body produces various antibacterial (endo/exo) toxin antibodies, antibacterial antibodies, antibodies that promote phagocytosis, antibodies that inhibit bacterial adhesion, etc. Therefore, humoral immunity is the main way to defend against bacterial infections. Vaccines such as pertussis and pneumococcal produce antibodies to prevent bacterial infections after injection. Viruses also have specific neutralizing antibodies, but humoral immunity is not the main mechanism of antiviral sense. There is a fine matching of antibodies to certain antigens, infections occurring in disorders of humoral immunity are mostly bacterial infections, allergic reactions are often rapid-onset (within minutes, hours) allergic rash, acute allergic enteropathy diarrhea, acute allergic cough. Antibodies are produced by B lymphocytes in the body, which shows that humoral immunity is also a process that requires the participation of immune cells.
(2) Cellular immunity: T-lymphocytes in the body, through the phagocytosis of various immune cells and the secretion of numerous “cytokines”, play the role of antiviral and other intracellular parasitic microorganisms. The cellular immune mechanism is more complex and is the main mechanism of the body’s resistance to many viral infections. Such immune disorders cause susceptibility to viruses (but not to bacterial infections), and the onset of allergy is mostly delayed. As cytokines secreted by the effect of cellular immunity are variously present in the fluid between blood and cells, so cellular immunity is also inseparable from the humoral component, and the so-called humoral and cellular immunity are relative concepts, which are both distinct and inseparable. The disease state mentioned above is not absolute either.
3.The overall concept of immunity
Immunity functions through different levels (different lines of defense) such as immune barrier organs and various immune cells and immune molecules. What is worthy of attention is that people have increasingly realized that the real immunity (i.e., the broad concept of immunity) is regulated by the “psycho-neuro-endocrine-immune network system”, which is the survival ability acquired by human beings in the course of billions of years of evolution. This function is complex and delicate, yet fragile and prone to dysregulation, so when it comes to immunity, we must not think that it is just a few immune indicators in blood tests, which are far from being clear in medicine. The intervention of children’s immune function should start from the overall diet, exercise, rhythm of life and environmental control, and also from the training of children’s psychological and personality qualities, not simply from the injection or oral administration of certain drugs. The above measures are not easy to implement and are mainly implemented in the parents’ home, but they are indeed the best solution for the vast majority of children with allergic inflammatory infections in pediatric clinics.
There are currently three categories of problems in pediatric clinics: (1) infection problems: pneumonia, recurrent respiratory infections, infected hyperthermic states, enteritis, other systemic infections; (2) allergy problems: severe eczema, respiratory symptoms due to food allergies, diarrhea, dysentery-like stools allergic cough, infection, allergy, inflammation, immune – immune chapter When anti-asthma, other allergies; (3) infection/allergy mutual causation problems : Pneumonia syndrome in small infants, delayed/recurrent febrile cough, recurrent wheezing in infants, cough after respiratory infection, enteritis/allergic delayed diarrhea, complex infection-allergy related diseases or syndromes.
First of all most outpatient children are not born with an innate immune deficiency, but rather a problem in the course of pediatric growth and development of immune function, and should not be overly worried about fear or overtreatment (of course as a physician one should be alert to innate immune genetic deficiency diseases, chronic autoimmune diseases or inborn metabolic genetic diseases starting with general infection allergy manifestations), even if pediatric asthma is not a generalized ” incurable”. Some are early transient wheezing, others are mainly related to viral infections. Therefore, parents should correct some unnecessary concerns. This will help to eliminate medically induced pathogenic factors due to overtreatment.
Secondly, the choice of immunomodulators and vaccinations should be carefully analyzed and judged: different age groups; infection or allergy oriented? ; whether bacterial or viral susceptibility; what is the level of nutrition and growth and development; whether in the acute or remission phase; can be selected from natural or synthetic, herbal or western preparations. It is important to make a comprehensive observation based on individual efficacy after application rather than a generalized fixed course of treatment, or all selective vaccination vaccines. Do not think that the stronger the immune response is the better and apply immune boosters casually, and there should be sufficient understanding of the adverse effects of immune preparations.
As far as I know, the concept of allergy appears after the concept of infection and inflammation. Allergy is a type of allergic reaction and is one of the most common causes of pediatric visits to pediatric clinics, but many parents are not aware of it. The World Allergic Organization (WAO) announced on the first World Allergic Disease Day the results of an epidemiological survey of allergic diseases in 30 countries: 22% to 25% of the world’s population currently suffers from allergic diseases, with the largest number of children, and it is estimated that the prevalence will reach 40% by 2010.
Allergy, as one of the types of allergic reactions (generally classified as type IV), is a pathogenesis, a dynamic process; statically it can also be considered as an etiology and as a diagnosis of disease. However, the severity of the disease varies considerably. If both parents have allergies, 75% of the children will be allergic, if one of them has allergies, 50% of the children may be allergic, and if both parents do not have allergies, the children may be allergic as well, but of course, if allergies occur occasionally, it is not necessary to have allergies. The relationship between allergy and immunity (narrowly defined as “resistance”) is complex and cannot be generalized because the mechanism of allergy is complex. Some allergic children have immune deficiencies and are susceptible to certain microorganisms, while others are overly reactive to microorganisms or external stimuli. Therefore, for children who are both susceptible and allergic, careful immunomodulatory treatment should be taken based on careful observation and analysis of the mechanism by the physician, rather than generalized immune boosting or immunosuppressive treatment.
Allergies are often a part of the growing experience of children seen in pediatric outpatient clinics. My implications of this statement are 3: First, there are distinct age-specific features. From newborns to school-age children, allergy symptoms are prevalent in the skin, gastrointestinal tract and respiratory tract, respectively. In young infants, the respiratory and gastrointestinal tracts are often involved at the same time, and as they get older, they present with allergic cough or asthma (note that even asthma is relieved or cured in more than half of the older children). Second, most have a good prognosis. For example, eczema and food allergies tend to heal on their own and do not develop into a serious condition requiring hospitalization or even ICU. Thirdly, allergies coexist with infections and medical factors. Imagine in today’s “highly developed” medical society, where there are children who do not go to the hospital and never take antibiotics and other medications for fever. So I seem to have the impression that all outpatient visits are for children with acute infectious, allergic and infection/allergy related illnesses.
A large body of literature and national and international clinical evidence shows that the number of allergic children, the phenomenon of allergy and the incidence of allergic diseases are now significantly increasing, what is the reason for this? There have been many theories or hypotheses, such as environmental deterioration related to respiratory allergy: natural air pollution, indoor air conditioners, nebulizers and other household appliances, inappropriate use of various disinfectant purifiers), pets, fur clothing and furniture odors, etc.; digestive allergy related to the diversification of artificial food ingredients, changes in infant feeding practices, and the rapid growth of infants with anatomical structures and physiological functions of the digestive and respiratory tracts. Theories such as lagging maturity. The increase in the number of allergic children is a matter of reflection, in which scientists have traced a series of nutritional and medical causes during the mother’s pregnancy (in utero) and early life (after birth), and, of course, “genetics”, “hygiene doctrine”, and “frequent vaccination”. “, “frequent preventive vaccinations”, “food allergy” and other speculations, and genetic foods have also become the object of suspicion.
The symptoms and dynamic clinical manifestations of outpatient pediatric allergy I have covered in several articles. I can give an overall impression: among the children I see (please note that I specialize in infections and infectious immune disorders, and difficult diseases), infection, allergy, and infection + allergy each account for 30%. The remaining 10% are other (congenital anatomical and physiological factors, metabolism, etc.) and also include “infection-related” ones, i.e. those for which no evidence of infection or allergy has been found, but for which there is a relationship in the pathogenesis.
The main problems related to the perception of the concept of allergy in pediatric clinics are (please note that infection and allergy can be separate or coexistent/alternating): differentiation between cold and allergy; viral infection rash and allergic rash; food allergy and dysentery/enteritis; mycoplasma infection and allergic cough; food allergy and anaphylactic pneumonia syndrome in small infants and of medical origin (mainly antibiotics, antipyretic and cough expectorant drugs and psychosomatic). expectant).
The common features of pediatric allergy can be summarized: recurrence, variability and diversity of symptoms (which makes the diagnosis of allergy “uncertain” due to the low sensitivity of allergen determination in small children), ineffectiveness of antibiotic treatment or continued ineffectiveness or aggravation of the initial treatment, heavy symptoms but light or no symptoms of fever and other infections, and the need to pay attention to blood tests and the presence of a large number of blood tests. No, it is important to note that the white blood cells in the blood and stool routine are high in certain allergies as usual.
How parents of children with outpatient allergies can respond.
(1) Take the initiative to review, analyze, and describe the relevant medical history to the physician. The history of allergy is an important basis for the physician to analyze the cause, pathogenesis and diagnosis, especially the causative factors (complementary foods, history of unclean diet), feeding history, specific environmental time of cough onset, and the total course of antibiotics applied.
(2) Parents of children with chronic allergies can be selective in their consultation. This includes the choice of hospital, specialty (including Chinese and Western medicine), physician and treatment, as well as the frequency (number of days between visits) and laboratory tests. Some people say that a long illness becomes a doctor, and some say that it is better to seek a doctor than to seek oneself with some truth. I have said that pediatric allergy signs require a joint response from physicians and parents, and in some ways, parental observation is more important and more scientific! About 30 to 50% of allergic coughs in young children have both psychological, regularity of life and how they adapt to adjust to the home and kindergarten environment.
(3) To improve our treatment concept, allergy is a comprehensive treatment. Currently it is a medical problem, medical helplessness, but the prognosis of children with outpatient allergy signs is good. Do not overstress nor give excessive pressure to the child. Do not pursue the panacea, high-tech and drugs, to prevent over-treatment over-visits. Feeding of small infants, care is very important. Allergy is memorable and cumulative, a very small amount of allergen food contact together with sensitization, when re-exposure that presents allergy.