How about this as pet peeve #2 in my allergy practice? I will share my thoughts and practice guidelines regarding the old adage is “the child too young to test for allergy”. I have heard this countless times from concerned parents. There may be some truth to this, but it depends on the situation. Oh, by the way this pertains to any type of allergy test. Let me elaborate.
First off, allergy takes time to develop. There has to be exposure to cause sensitization. Sensitization involves stimulating the immune system to make that allergy antibody called IgE. That antibody then circulates through the body and binds to cells in the gut, skin, respiratory tract, and cardiovascular system. So we need time, a genetically prone child (thank you mom and dad only please), and exposure.
Secondly the nature of the allergen is important to consider. We get a daily dose of food so food allergy has a chance of developing early in life. Inhalants such as animal dander, insect parts, mold spores, and pollen take longer. We then also need to consider the allergen of concern.
We can see food reactions beginning about 2-3 months of age and usually presenting as a form of eczema (dry, itchy, scaly skin) called ‘atopic dermatitis’. In our pediatric allergy clinic at Riley we can and do test infants with eczema looking to see if a food is a possible stimulant for the condition. We skin prick test for egg white, milk, wheat, soy, peanut, and fish (these foods account for more than 90% of food allergy in children) and provide the family with the results of the skin tests (they take only 15 minutes) and a game plan prior to leaving the office. Here the point is that food allergy can be seen in the very young and we can effectively test. So with the proper condition, that being a skin problem, allergy testing can be done and can be very helpful in the very young. Respiratory tract allergy however is a different story.
Respiratory tract illnesses- asthma, rhinitis, otitis media, and recurrent sinusitis can be due to inhalant allergy. Keep in mind that there are other things to also consider such as day care exposure, irritant responses, and possible structural problems. Inhalants act differently. The first point to be made is that the child has to be God’s earth for at least one year before inhalant allergy can appear. Furthermore, it may take two but for the most part three outdoor seasons for the child to become sensitive to the pollens of trees, grasses, and weeds. This is obviously dependent upon where you live. In Florida, California, and Hawaii for example, the pollen season tends to be all year round. But here in Indiana the pollen seasons are limited to shorter durations. For indoor allergens such as insect parts, danders of dogs and cats. and mold, it takes at least a year for the exposure, sensitization, and symptom sequence to start. Testing an infant to inhalants/pollens would not reveal clinically relevant sensitivities.
So is the child too young to allergy test? I use these general guidelines-
- Food allergy– early infancy and onward
- Indoor inhalants– needs to be at least one year old to be of value
- Pollens– usually three years old and beyond
- Too young to test for allergy? Yes/No: it truly depends upon what you are testing for.
FEL
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