What is the recommended treatment for a one-year-old patient with allergies?

Treatment of Allergies in a One-Year-Old Child

For a one-year-old with suspected allergies, prescribe both an antihistamine and an epinephrine autoinjector immediately, provide education on recognizing severe reactions, and refer to a pediatric allergist for diagnostic confirmation and long-term management. 1, 2

Immediate Prescriptions and Safety Measures

Emergency Medications

• Prescribe an epinephrine autoinjector (0.01 mg/kg, up to 0.3 mg maximum) for any child presenting with likely food allergy, regardless of reaction severity 1, 3
• Dose the epinephrine at 0.01 mg/kg intramuscularly into the anterolateral thigh, which can be repeated every 5-10 minutes if symptoms persist 3
• Prescribe antihistamines for mild symptoms such as a few hives or mild nausea 1
• Advise parents to carry two epinephrine autoinjectors at all times, as some children may require a second dose before emergency services arrive 1, 4

Critical Parent Education

• Direct parents to use epinephrine immediately for severe symptoms including diffuse hives, any respiratory symptoms, shortness of breath, obstructive swelling of tongue/lips interfering with breathing, or circulatory symptoms 1
• Antihistamines must never replace epinephrine in severe reactions—this is a critical safety point 1
• Epinephrine can be dosed every 5-15 minutes if symptoms are not responding 1

Diagnostic Approach

Understanding Test Results

• A positive allergy test result alone does not establish the diagnosis of clinical food allergy—it only provides evidence of sensitization (an immunologic response) 1
• Skin prick testing has a negative predictive value >95% but a positive predictive value <50%, meaning many false-positive results occur 1
• All test results must be correlated with the patient's clinical history to determine if they represent true clinical allergy 1, 2

When to Test

• Allergy testing should only be performed when there is suspicion of a symptom-provoking episode that has already occurred 1
• Testing without a clear history of allergic symptoms is discouraged and can lead to unnecessary dietary restrictions 1, 4
• Children with persisting, recurrent, or severe symptoms suggestive of allergy should undergo appropriate diagnostic work-up, irrespective of age 5

Specialist Referral

Indications for Allergist Consultation

• Refer all children with suspected food allergy to a pediatric allergist for comprehensive evaluation and diagnostic confirmation 2, 6
• The allergist will perform detailed clinical history to correlate positive test results with actual symptoms 2
• The allergist may perform oral food challenges in controlled settings when necessary to verify clinical relevance of positive tests 2

What the Allergist Will Provide

• Formulation of an emergency anaphylaxis action plan 2
• Education on food avoidance strategies and label reading 2
• Longitudinal care with yearly follow-up for retesting, as some food allergies resolve over time 2

Interim Management Before Allergist Visit

Food Avoidance

• Food avoidance is the first-line treatment for children with food allergies, as there are no recommended preventive medications 1
• Instruct temporary avoidance of suspected allergen(s) until allergist evaluation 2, 4
• Schedule allergist follow-up within 1-2 weeks to ensure timely evaluation 2

Common Pitfalls in Infants Under 1 Year

• For infants <1 year presenting with colic, irritability, constipation, or watery stool: provide reassurance and treat the underlying issue (e.g., stool softener, normal variation)—there is no need to change formula at this time based on these symptoms alone 1
• The diagnosis of food allergy is unlikely with these nonspecific symptoms, which provide no evidence of an immunologic disorder 1
• Avoid implementing overly restrictive diets based solely on sensitization without clear clinical symptoms of allergic reactions 4

Treatment of Acute Reactions

Mild Reactions

• Use antihistamines for mild symptoms: a few hives, mild nausea, or mild discomfort 1
• Antihistamines reduce itching and skin lesions within 30-40 minutes 7
• Typical dosing is 1-2 mg/kg for diphenhydramine, adjusted by weight 7

Severe Reactions (Anaphylaxis)

• Immediate intramuscular epinephrine is the priority—do not delay for antihistamines 7, 3
• Delay in epinephrine administration is associated with fatal reactions 7
• Adjunctive treatments include bronchodilators, H1 and H2 antihistamines (coadministration is emerging focus to prevent severe cardiac deficit), corticosteroids, vasopressors, glucagon, and atropine 1
• Corticosteroids have limited immediate benefit but prevent late-onset biphasic reactions by blocking recruitment of immune mediators like leukotrienes 1, 7

Special Considerations for Young Children

Safety of Immunotherapy

• Immunotherapy can be initiated in children <5 years of age if indicated, based on severity of disease and risk/benefit ratios 1
• Studies demonstrate safety with only 1 systemic reaction among 6,689 injections in 239 patients under age 5 1
• However, for a one-year-old with newly diagnosed allergies, immunotherapy is not first-line treatment—focus on avoidance, emergency preparedness, and specialist evaluation 1

Age-Appropriate Management

• Clinical use data support weight-based dosing for treatment of anaphylaxis in pediatric patients 3
• Adverse reactions in children are similar in nature and extent to those in adults 3
• Young children rarely present difficulties in diagnosis of systemic reactions, and there are no studies indicating children are at greater risk from conventional treatment 1