Allergies in Children — Sensitive Nose, Eczema, Asthma & Food Allergies

Understanding Allergies in Children

What Are Allergies?

An allergy is an over-reaction of the immune system to a normally harmless substance — an "allergen". When a sensitised child encounters the allergen (in the air, in food, or against the skin), specific IgE antibodies trigger the release of histamine and other chemicals, producing the familiar symptoms of sneezing, itch, swelling, wheeze, or rash.

In Singapore, allergic disease in children is common and often follows the so-called "atopic march": eczema appears in infancy, sometimes followed by food allergies in toddlerhood, then allergic rhinitis (sensitive nose) at preschool age, and finally asthma in older children. Many children have two or more of these conditions at once. Recognising and treating one stage early may help reduce the severity of the later stages.

Causes of Allergies in Children

Allergies in children can have various causes, including:

• Genetics: Children with a family history of allergies are far more likely to develop allergies themselves. If one parent is atopic, the child carries roughly a 30–40% risk; if both parents are atopic, the risk rises to 60–80%.
• Environmental factors: Exposure to allergens such as house dust mites, pet dander, mould, pollen, or cockroach allergens can trigger allergic reactions. In tropical Singapore, house dust mite is by far the dominant year-round trigger.
• Immune system sensitivity: Some children have an over-active immune system that mounts a strong IgE response even to small amounts of allergen, producing more severe symptoms than peers with similar exposure.
• Early exposure to allergens: The picture here is mixed — early oral exposure to certain foods (e.g. peanut at 4–6 months) may protect against food allergy, while heavy early exposure to inhaled allergens such as dust mite in a humid bedroom may increase risk in genetically susceptible children.
• Daycare and preschool cross-infection: Repeated viral upper respiratory infections during the first years at infant care can amplify nasal inflammation and unmask underlying allergic rhinitis.
• Air pollution and haze: PM2.5 from the regional haze season and roadside vehicle emissions are well-recognised risk factors for both new-onset asthma and worsening allergic rhinitis in Singaporean children.

Signs and Symptoms of Allergies in Children

Recognising the signs of allergies in children is essential for early intervention. Common symptoms include:

• Sneezing — often in clusters, particularly first thing in the morning
• Runny or stuffy nose
• Itchy or watery eyes (allergic conjunctivitis)
• Coughing — especially at night or after activity
• Wheezing
• Shortness of breath
• Skin rashes or hives (urticaria), or chronic eczema patches in the elbow and knee creases
• Swelling of the face, lips, or tongue
• Nausea, vomiting, or diarrhoea (in the case of food allergies)

Subtler clues to look out for include the allergic salute (rubbing the nose upward with the palm), allergic shiners (dark circles under the eyes), constant mouth-breathing, snoring, and a child who never seems to have a "clear" nose between minor colds.

Why See an ENT Doctor?

Consulting with an ENT doctor is crucial for children with allergies for several reasons:

Accurate Diagnosis

An ENT specialist can conduct allergy testing, including skin prick tests or specific IgE blood tests, to identify the exact allergens triggering your child's symptoms. At CENTAS, skin prick testing for the common Singapore aero-allergens (house dust mite, mould, cat, dog, cockroach) can be done in clinic with results in 15 minutes. A flexible nasoendoscopy — a one-minute camera examination — also lets us visualise nasal swelling, adenoid enlargement, and post-nasal drip directly.

Customised Treatment Plan

Based on the allergy diagnosis, an ENT doctor can develop a personalised treatment plan tailored to your child's needs, which may include:

• Avoidance measures to minimise exposure to allergens — dust mite-proof mattress and pillow encasings, hot wash bedding weekly, removal of soft toys from the bed, regular aircon servicing and HEPA filtering in the bedroom
• Medications such as paediatric antihistamines, intranasal corticosteroid sprays, intranasal saline irrigation, or — for the right child — immunotherapy (allergy "vaccine")
• Allergy management strategies for asthma or eczema in coordination with the family's paediatrician or dermatologist
• Sublingual Immunotherapy (SLIT) — daily allergen drops or tablets taken under the tongue at home. SLIT is well-tolerated in children from around age 5, avoids injections, and targets the underlying allergic mechanism rather than just the symptoms. Dr Pang pioneered SLIT at the National University Hospital.

Prevention of Complications

Untreated allergies can lead to complications such as recurrent sinus infections, glue ear (otitis media with effusion) and conductive hearing loss, asthma exacerbations, dental and facial growth changes from chronic mouth-breathing, poor sleep, and impaired quality of life. An ENT doctor can provide appropriate treatment to prevent these complications and improve your child's overall health and well-being.

Educational Support

An ENT doctor can educate you and your child about allergy triggers, day-to-day symptom management, school accommodations (e.g. an asthma action plan or food-allergy emergency plan), and the use of an adrenaline auto-injector for severe food allergy where prescribed.

Singapore-Specific Considerations for Children's Allergies

Year-Round Dust Mite Exposure

Unlike temperate countries, Singapore has no allergy "off-season". Year-round humidity of 80–90% and ambient temperatures around 27–32 °C create ideal breeding conditions for Dermatophagoides pteronyssinus in mattresses, pillows, and soft toys. This is why most allergic children here have daily — not seasonal — symptoms.

Daycare, Infant Care & Preschool

Children entering infant care typically experience 8–12 viral upper respiratory infections per year for the first two years. In an allergic child, each viral infection lights up an already inflamed nasal lining and can trigger a 2–4 week cycle of cough, congestion, and disturbed sleep. Persistent symptoms between colds — rather than only during them — strongly suggest an allergic component.

Haze and Outdoor Air Quality

Regional haze episodes (typically July–October) and exposure to vehicle emissions along busy roads can trigger flares of both allergic rhinitis and asthma. During high PSI days, families should keep windows shut, run aircon with clean filters, limit outdoor play, and ensure reliever inhalers are within reach for children with asthma.

Hawker Centres, Outdoor Play & Cooking Smoke

Charcoal cooking smoke at hawker centres and indoor wok smoke can act as non-specific irritants that worsen baseline allergic symptoms even in children who are not specifically allergic to anything in the food. Smoking inside the home — including by visiting relatives — is one of the most consistent triggers we identify in clinic.

Adult Version of This Topic

Conclusion

Allergies are common in children and can cause a range of symptoms that affect their health and quality of life. Consulting with an ENT doctor is essential for accurate diagnosis, personalised treatment, and prevention of complications associated with allergies. If you suspect that your child has allergies — or if they are experiencing allergy symptoms such as sneezing, nasal congestion, snoring, recurrent wheeze, or troublesome eczema — consider scheduling an appointment with an ENT specialist. By seeking timely intervention, you can help your child manage their allergies effectively and enjoy a healthier, more comfortable life.

Frequently Asked Questions