Friday Dr Q&A with Dr Liew – Managing Allergy & Eczema at Childcare

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: Suppose a child who has an allergy has to have alternative care-giver, say at child care centre. What would you recommend a parent to do and is there any initiative already taken in Singapore to increase awareness of allergy?

Dr Liew: Your allergist should be able to advice what the caregivers be taught. Written action plans for eczema are useful for daily skin care instructions, whilst food allergy/anaphylaxis action plans provide information on treatment in emergencies. There is continued public education regarding allergic conditions via hospitals and societies like AAA.

MarcieMom: For Food Allergy – How should a parent besides obviously telling the teachers/ care-givers of the allergy, help to make it easier for the school to prevent contact with the food? In there a need to warrant 0% contact, for instance, the whole school shouldn’t even bring the food in?

Dr Liew: After a diagnosis of food allergy, it would be important to relay the importance of food avoidance and emergency care plans with the care-givers. Written food allergy/anaphylaxis plans are useful. The degree of strict avoidance varies accordingly to the food allergen and severity of allergic reaction. It would be better to discuss specific advice with your allergist.

MarcieMom: For Non-Food Allergy – What are the common non-food allergens? And if it’s dust mite, how can a parent tell the school to keep the dust mite level low since house dust mite is something that can’t be totally eliminated? And if it’s dog droppings allergy, should a parent not even sign up a child care centre where teachers or even classmates have dogs at home? For common skin allergen like soaps and detergents, should a parent go as far as to monitor what detergent the child care centre or caregiver is using? (And the bigger question is – how can a child care centre with 70+ kids cope with so ‘many requests’ of a parent?)

Dr Liew: The most common environmental allergen is house dust mites in Singapore. House dust mite avoidance measures are useful to reduce the levels of protein, but results variable. I would not recommend schools to implement house dust mite avoidance measures as they are time-consuming and difficult to implement in the long term. Dog sensitisation is usually to the hair epithelia, rather than poo, and is not common in Singapore. Irritants like harsh soaps and detergents should be avoided in children with eczema and dry skin. It may be helpful to provide the school with your child’s soap substitute and moisturisers, and get the teachers assistance for application.

MarcieMom: Thank you Dr Liew! Next friday, we’ll learn more on recognizing allergic reactions.

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