Baby food allergy medicine

Most of the second-generation oral antihistamines, topical/systemic glucocorticoids, epinephrine, online probiotics, herbal anti-allergic creams, anti-allergy drops, etc. have no clear indications for the treatment of food allergy and cannot replace conventional drugs.

Not long ago, my best friend's 1-year-old baby took two mouthfuls of mango, and the area around his mouth instantly turned red and a dense rash broke out. She panicked and took out half a bag of the "anti-allergic probiotics" that the maternal and infant group had stocked up on, and applied the so-called "hormone-free instant" to the baby. "Desensitizing" herbal ointment, within half an hour half of the baby's face was swollen, and he could hardly open his eyes. He was rushed to the emergency room, and the doctor prescribed cetirizine drops. Within two hours of taking it, the swelling was gone. This kind of misuse of medicines occurs almost every week when I follow up in the pediatric allergy department.

Many people have asked me, at what age can a baby take antihistamines? There is actually an information gap here: the domestic instructions for cetirizine indicate that it is suitable for those over 1 year old, and loratadine is for those above 2 years old. However, the 2022 version of the Chinese Children's Food Allergy Diagnosis and Treatment Guidelines, as well as the European and American Allergy Society guidelines, mention that if a baby over 6 months old has a clear mild food allergy, that is, only skin rash, itching, swelling around the mouth, and no breathing or gastrointestinal discomfort, it can be used as needed after a doctor's evaluation. There is no need to force the baby to be itchy and unable to sleep. Oh, by the way, don’t give your baby first-generation antihistamines like chlorpheniramine, which can cause drowsiness and affect cognitive development. They are no longer among the recommended medications for children with food allergies.

Having said this, I can’t help but mention that when many parents see their children with rashes, their first reaction is to apply ointment. This idea is actually correct, but you have to choose the right medicine. If your baby's red rash persists, or even scratches, and it goes away slowly with oral medication, you can apply a weak glucocorticoid ointment, such as desonide cream. If the rash is on the trunk and limbs and is relatively thick, you can also use medium-potency mometasone furoate. As long as you follow the doctor's instructions and use it within 1 week, there will be no "hormone dependence" or "developmental impact" problems. Don’t believe the propaganda about “anti-allergenic cream” made by Internet celebrities. Last year, I met a mother who applied a popular anti-allergenic cream on Douyin to her baby for half a month. The skin on her baby’s cheeks became thinner and shrunk. When she sent it for testing, she found out that powerful hormones were secretly added to the cream, which was more than ten times stronger than the medicine prescribed by the doctor.

If the above are all for mild cases, then in a real life-saving situation, there is only one option - epinephrine. Nowadays, many parents have a very deep misunderstanding of this medicine. They always feel that "it cannot be used until it is almost suffocating." However, in fact, the consensus of domestic and foreign guidelines is that as long as the child develops throat tightness, shortness of breath, frequent vomiting, and confusion after eating suspected allergens, intramuscular injection of epinephrine (just on the front and outside of the thigh) is the first priority, rather than calling 120 and other first aid calls. The American Allergy Association even recommends that parents of children with a history of severe allergies should carry two epinephrine pens with them to avoid the failure of the first shot. After all, a severe allergic reaction can cause suffocation in as little as a few minutes, and the side effects of adrenaline are nothing compared to the danger to life.

After talking about the serious medicines, we have to talk about the "allergy miracle medicine" that is now very popular among mothers and infants. For example, the most hyped probiotics are not to say that they are completely useless. Currently, only a few strains of Lactobacillus rhamnosus GG and Lactobacillus reuteri have been confirmed by some studies to have an auxiliary effect on babies with mild to moderate milk protein allergy, but they are only auxiliary and cannot be used. It can replace antihistamines or deeply hydrolyzed milk powder, not to mention "taking it for three months to cure allergies". Previously, a mother gave her baby imported anti-allergic probiotics for half a year, but the baby still swelled into a pig's head after touching an egg, which delayed the pace of adding complementary foods. There are also allergy drops and herbal allergy sprays imported from Japan. I read many instructions and found that they are either for alleviating pollen allergies or there is no clinical trial data on children at all. Giving these to babies is really not as reliable as prescribing Cetirizine for a few dollars as prescribed by the doctor.

In fact, what I tell parents most often during follow-up visits is that medicines are always for emergency use. The core response to food allergies is to first find the specific allergen and avoid eating it. Don’t just blindly give medicines as soon as there is a rash, and don’t wait until the baby can’t breathe. After all, children are already suffering from allergies. As parents, we should not cause any more trouble for our children when it comes to medication.