Atopic eczema is a common condition affecting up to 1 in 5 infants.  While the "cause" is generally not known, having a family history of eczema and allergies is very common for those affected.  Especially when eczema is severe, families and patients generally want to know the "cause" and identify a "cure", but most often neither of these is possible.  For patients with eczema however it is useful to identify triggers that aggravate eczema, and in infants with severe eczema food is sometimes one of these triggers.  There are generally many other potential triggers which can include soaps and detergents, other illnesses, scratching, changes in temperature and (in babies) teething. 

Since there is no cure for eczema, management generally involves:

• Identifying and avoiding triggers where possible. This might include:
• Keeping fingernails short to minimise scratching
• Use of loose cotton clothing
• Keeping bathwater tepid not hot
• Skin care which will generally include:
• Avoiding soaps and detergent
• Appling copious moisturiser
• Using topical steroids for flares in eczema. There is a lot of anxiety about use of topical steroids
• Identifying and treating secondary infection.

Allergic rhinitis occurs when there is inflammation of the lining of the nose (nasal mucosa) due to an allergen. The commonest allergens causing allergic rhinitis in New Zealand are dust mite, pets and grasses.  Sometimes rhinitis can be caused by other things, with the other very common cause in children being viral infection. 

Where allergy is the most likely cause of allergic rhinitis, the specific allergen can be indentified by allergy tests (most often skin tests), which helps you know what things it may be useful to try and avoid.

Treatment of allergic rhinitis generally involves avoidance of the responsible allergen if possible, and the use of medications such as nasal steroid sprays and antihistamines to control symptoms.   

Food allergy is a common problem, affecting up to 5% of children.  Many food allergic reactions in children are mild and many children outgrow their food allergies with time.  A small range of foods are responsible for most food allergic reactions some of which have a good chance of going away with time (e.g. milk, egg, wheat, soy) and some of which are more likely to persist into adulthood (e.g. peanut/nut and fish/shellfish).  

 Food allergic reactions can cause a variety of signs and symptoms, including:

• Skin – rash, itching, redness, swelling
• Gut – tummy pain, vomiting, diarrhoea
• Respiratory tract – runny nose, sneezing, shortness of breath, cough, wheeze
• Cardiovascular system – faintness, collapse.

A severe food allergic reaction or anaphylaxis will result in difficult/noisy breathing, swelling of tongue, swelling/tightness in throat, difficulty talking/hoarse voice, wheeze or persistent cough, dizziness (loss of consciousness and/or collapse), and becoming pale and floppy in young children.  Anaphylaxis is a medical emergency – an anaphylaxis plan should be followed if there is one available and an ambulance called.  

Most often the cause of a food allergic reaction is apparent as there is prompt reaction after ingestion of a new food.  Allergy tests (skin tests or blood tests for specific IgE) will generally be done to confirm the cause of a food allergic reaction.  Ongoing management involves avoidance of the food in question, with follow up to determine whether an allergy has resolved.  All patients with food allergy should have a plan for management of any further reactions.  In the longer term food challenge may be needed to determine if a food allergy has resolved.  

Anaphylaxis is a severe allergic reaction which can be life threatening.  Triggers of anaphylaxis can include insect stings, drugs and foods.  Anaphylaxis is a medical emergency and urgent medical attention should always be sought.

Common signs and symptoms of anaphylaxis are listed on the ASCIA anaphylaxis plans and these are:

• difficult/noisy breathing
• swelling of tongue
• swelling/tightness in throat
• difficulty talking and/or hoarse voice
• wheeze or persistent cough
• loss of consciousness and/or collapse
• pale and floppy (in young children).

If there is a history of an anaphylactic reaction, management generally involves:

• identifying the trigger - this may be obvious on history, and will often require confirmatory tests
• education on avoidance to try and prevent further episodes
• development of an anaphylaxis action plan, which will most often include the use of an adrenaline autoinjector (EpiPen or AnaPen).