Anaphylaxis detectives: case closed
My son has had two anaphylactic reactions. His first, when he was 20-months-old, happened when he bit into a peanut butter cookie. It was his first known exposure to peanut. The allergic reaction was immediate and severe and resulted in a four day spell on the intensive care ward. Cause? Peanut.
The second reaction, in May this year, was not so clear cut. It was a hot summer’s day. He was playing in his friend’s garden. I slathered him in sunscreen. He ate some (supposedly nut free) snacks. The allergic reaction began with a rash and hives. He then got extremely upset and began clawing at his neck and pulling his ears. His face and tongue appeared swollen. Finally, he started coughing. I used the EpiPen. The reaction stopped. He was kept in hospital for 24 hours, purely as a precaution. Cause? Unknown.
We’ve now had challenges at the hospital in respect of the sun tan lotion and the biscuits and crisps he ate that morning. He passed them all.
Shortly after the second reaction, the hospital carried out skin prick tests for various environmental allergens and we discovered he was sensitised to grass, cat, dog and house dust mite (HDM). Our doctors have now concluded that the main cause of the second anaphylactic reaction was likely to be grass.
Before this latest spate of hospital appointments, I personally had no clue that a grass allergy could provoke such a severe reaction. However, I understand from our doctors that some children have been in intensive care following reactions to grass. For us, it is now a case of watching and waiting to see if he has another reaction. In the meantime, we need to reduce D’s exposure to his environmental allergens wherever we can. This will hopefully keep his “allergy cup” as empty as possible, and avoid it overflowing to the point where he has a reaction. I’ve set out below some of our doctors’ tips for reducing D’s exposure to grass, pets and HDM.
What is montelukast?
Following the second reaction, we had to start giving D a daily dose of both anti-histamine and montelukast.
I hadn’t heard of “montelukast” before we were prescribed it. I understand that it is also known as “MSD” or the brand name “Singulair”, and the NHS Choices website states:
“In asthma, Singulair relaxes the air passages of the lungs to make breathing easier and to help prevent asthma attacks…
Singulair also reduces your body’s response to allergens and to certain situations which trigger asthma attacks. In this way it can help prevent asthma which is triggered by exercise. In people with asthma it can also help relieve the symptoms of seasonal allergic rhinitis.”
D has montelukast chewable tablets now. However, we started off with montelukast sachets, which need to be mixed in with food. At first, I stirred the sachet of granules into a pot of yoghurt and then spent the next half hour trying to cajole D into finishing off the yoghurt, so I knew he’d taken his medicine. I then realised this was a bit of a school girl error and it’s easier if you put a spoonful of yoghurt in a separate pot and stir in the granules, so he then only needs to be persuaded to have the one spoonful to get the dose.
Hearing that D had had an anaphylactic reaction to grass initially made my head spin: how do you even start avoiding grass? The answer is, with great difficulty. Grass pollen season tends to be from end of April to early October, with the pollen levels peaking between late May and early July. The tips we were given for grass allergy management included:
- Keeping D’s bedroom window closed at night.
- Keeping the windows closed in the car.
- Not letting him play on freshly mown grass.
- After he’s played outside on the grass, to wash his clothes and give him a bath to wash the pollen off his body and out of his hair.
- Avoiding drying his clothes and bedding outside, when the grass pollen levels are high.
Aside from that, it’s a case of hoping that the daily dose of anti-histamine and montelukast keep things under control.
Cat and dog allergies
We keep D away from cats where possible and don’t let him pet them when visiting friends and family.
We’ve got a 7-year-old beagle. He was part of the family before D arrived and, until the skin prick tests this summer, we had no idea that D was sensitised to him. However, our doctors’ view is that Bailey will be aggravating D’s asthma. We’re not searching for a kindly relative to take Bailey on just yet, as we’re trying to control D’s exposure to him in the following ways:
- As there’s no such thing as a hypoallergenic dog (see Mayo Clinic, Are there any hypoallergenic dog breeds?), we need to bath our dog regularly (ideally weekly).
- We keep the dog downstairs, out of bedrooms and definitely off beds.
- We try not to let Bailey lick D.
- We should go for wooden flooring wherever possible and regularly shampoo any rugs and carpets.
House dust mite allergy
Revolting things, house dust mites (HDMs). They live in your bedding, carpet, curtains, soft toys and clothes, and feed off your shed skin. The thing which triggers an HDM allergy is the protein in HDM faeces. How lovely.
HDM allergy can be a problem year round and apparently the UK has the perfect climate for them. The tips we were given for controlling the triggers include:
- Having wooden floors instead of carpets (luckily we had this already).
- Regularly hoovering D’s mattress. I haven’t tried this myself, but a friend of mine from the Manchester Allergy Support Group swears by regularly steaming her mattress using a wallpaper steamer.
- Washing bedding weekly at 60 degrees. (You need it to be hot – washing at 40 degrees won’t kill the HDMs).
- Investing in a pillow and mattress protector. Although you can get duvet protectors too, I’ve heard they can feel a bit like sleeping under a crisp packet! So I’ve decided to stick to just hot washing my son’s duvet and blanket. The pillow and mattress protector I purchased from Allersafe are pictured below.
- Keeping soft toys on the bed to a minimum. I’ve weaned my son down to just his beloved Monkey, who is washed fairly regularly (Monkey is definitely slimming down…). Our doctors also suggested putting soft toys in the freezer overnight to kill off any lurking HDMs.
- Opening the window whilst hoovering D’s bedroom.
- Wiping his bedroom surfaces with a damp cloth (rather than using a dry duster, which just sends the dust up into the air rather than removing it).
Allergy UK leaflet, Four Seasons
The North West Allergy & Immunology Network has a series of paediatric patient allergy information leaflets, including leaflets on: