A mild allergic reaction is one that stays contained to one part of the body and does not progress rapidly. A child who develops a few hives on their arm after touching a food they are allergic to, who remains alert, continues breathing normally, has no swelling of the face, lips, or tongue, and whose hives do not spread, is having a mild reaction. An antihistamine is the appropriate treatment and the child should be observed, but this is not an emergency. Anaphylaxis is categorically different. It involves symptoms appearing across more than one body system together, progressing rapidly within minutes of exposure to the trigger, and involving at least one of the following: the airway, the circulation, or both. The airway signs are wheeze, cough, hoarseness, stridor, or difficulty breathing. The circulatory signs are pallor, limpness, loss of consciousness, or a sudden drop in blood pressure. When these signs follow allergen exposure, particularly in a child with a known allergy to the trigger, anaphylaxis must be assumed and adrenaline given without delay. The critical thing I want every parent in Guwahati to understand is this: you do not need to be certain it is anaphylaxis before giving adrenaline. In a child with a known allergy who is developing breathing difficulty or circulatory signs after allergen exposure, waiting to confirm the diagnosis by observing progression is dangerous. Adrenaline given unnecessarily in a mild reaction causes a brief period of increased heart rate and anxiety but causes no lasting harm. Adrenaline given late in a true anaphylaxis can be the difference between survival and death. When in doubt, give the adrenaline and call 108 immediately.
Written by Dr. Nayan Mani Deka, MBBS, MD (Paediatrics), Diploma in Allergy and Asthma (CMC Vellore), Certified PALS, APLS, NSSK, Consultant Paediatrician, Asthma Allergy Specialist and Immunotherapist, Pratiksha Rainbow Children's Hospital, VIP Road, Borbari, Guwahati, Assam 781036. Phone: +91 9436732863 / +91 6000714825 / +91 8812866239.
