Friday Dr Q&A with Dr Liew – Common Allergens in Children

Dr Liew Woei Kang

Marcie, who inspired MarcieMom to start this blog, doesn’t have any allergy and thus, this blog has been focused on eczema. Recognizing that there are many parents whose child also have allergy, MarcieMom invites Dr Liew Woei Kang, Paediatrician with special interest in Allergy, Immunology & Rheumatology to share more about managing allergy for eczema children.

More about Dr Liew: Dr. Liew practices at the SBCC Baby & Child Clinic and is also a visiting consultant to KK Hospital. He was also awarded several research grants from the National Medical Research Council, Singhealth Foundation and KKH Research centre to pursue clinical research in paediatric anaphylaxis, drug allergy, primary immunodeficiencies and Kawasaki disease. He is also the President of Singapore’s Asthma & Allergy Association which is currently administering the very first eczema fund (initiated by MarcieMom’s donation) for low income patients in Singapore.

MarcieMom: Based on your experience and knowledge of research studies, what are the common allergens in children? Also, we’ve been using an allergic reaction to food interchangeably with eczema, is it possible to have an allergy that’s not manifested on the skin? (We know the vice versa is possible, i.e. a child can have eczema without an allergy).

Dr Liew: The most common allergens depend on the allergic conditions. For eczema, older patients tend to be sensitised to house dust mites, but not food allergens. Some young infants with eczema has food sensitisation and trigger. The most common food allergens in eczema children include egg, cow’s milk, wheat, peanuts and soy. Some forms of food allergy eg, allergic enteropathy presents with isolated intestinal symptoms without skin involvement.

MarcieMom: If a parent suspect a food is causing an allergy, should the parent insist on it being an item to be included in allergy test?  As a pediatrician, would you test the child on what the parent suspect?

Dr Liew: A detailed history would be obtained prior to allergy testing. If there is a suspected food trigger, I would usually test it. I would usually encourage targeted testing, whereby only the relevant food items are tested. For eg, should the child be tolerating cow’s milk formula for the past 3 years, and eczema commenced after 3 years old, cow’s milk protein is unlikely to be a food trigger, and should not be tested.

MarcieMom: Gluten has been gaining more awareness and with many food packaging labeling gluten-free, some parents may think it’s gluten that’s causing the eczema. Again, how can a parent identify if it’s gluten (is it even a common trigger?) that’s triggering the eczema? How can this be differentiated from celiac disease?

Dr Liew: There should be a close temporal relationship between food ingestion and eczema flare. If there is inconsistent relationship, it is unlikely a food allergy. Celiac disease is an immune-mediated reaction to glutens, resulting in malabsorption in the gut, and resultant bloatedness, diarrhea and weight loss.

MarcieMom: Thank you Dr Liew, for our next DR Q&A series in July, we’ll learn some practical insight into how to manage our child’s allergy and eczema if our child is taken care by another care-giver.

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