Childhood Allergy, Immunology & Rheumatology

Managing childhood allergies can pose significant challenges for parents. Identifying flare-up triggers and determining the most suitable treatment options can be daunting. Yet, gaining a solid understanding of childhood allergies, immunology, and rheumatology is essential for safeguarding your children’s health and wellness.

Childhood allergy

A childhood allergy is an abnormal immune response to a typically harmless substance (allergen) that the body perceives as harmful. When a child with allergies has contact with an allergen, their immune system reacts, leading to allergic symptoms.

Childhood allergies can develop due to a combination of genetic and environmental factors. Some children may inherit a predisposition to allergies from their parents, making them more susceptible to allergic reactions. Environmental factors such as exposure to allergens at a young age or early life events like viral infections may also play a role in the development of allergies.

Childhood allergies encompass a range of conditions that can manifest in various ways. Here are some of the most prevalent ones.

Food allergies

Food allergies happen when the body’s immune system reacts abnormally to certain foods. Peanuts, tree nuts, eggs, milk, soy, wheat, fish, and shellfish are common food allergens in children. Food allergic reactions in children can be mild itching or swelling, to severe reactions such as anaphylaxis, which is a life-threatening emergency.

Atopic dermatitis (eczema)

Eczema is a common ailment in children. This chronic skin condition is characterised by red, itchy, and inflamed skin. It often begins in infancy or early childhood and can be triggered or exacerbated by dust mites, pet dander, pollen, or certain foods.


Asthma, a persistent respiratory ailment, results in inflammation and constriction of the air passages, resulting in wheezing, coughing, chest discomfort, and breathing difficulties. Asthma attacks in vulnerable children can be prompted by allergens like pollen, dust mites, mould, and pet dander.

Allergic rhinitis

Allergic rhinitis presents as inflammation of the nasal passages. This allergic reaction can result in sneezing, runny or stuffy nose, itching, and nasal congestion. Common triggers include pollen, dust mites, mould, pet dander, and air pollution.

Insect sting allergies

Some children may develop allergic reactions to insect stings, particularly those from bees, wasps, hornets, or fire ants. Symptoms can range from localised swelling and redness to more severe reactions such as hives, difficulty breathing, and anaphylaxis.

Drug allergies

Children can also develop allergies to certain medications. These reactions can vary among children and may present as rashes, hives, swelling, or anaphylaxis.

Childhood Allergy Screening

Early identification is critical to effectively managing your child’s allergies. Allergies are determined through allergy testing for children. Here are some standard assessments:

Skin Prick Test (SPT)

Skin prick testing involves applying an allergen extract to the skin and then pricking it to allow it to enter. A small raised bump or wheal will appear within 15-20 minutes if a child is allergic to the substance.

Patch testing

Patch testing is used to identify allergic contact dermatitis. Patches with small amounts of potential allergens are placed on the skin for 48 hours. A reaction will occur at the contact site if a child is allergic to any substances.

Blood tests (specific IgE testing)

Blood tests determine the levels of specific IgE antibodies in the blood, which the immune system produces in response to allergens. This can help identify potential allergens triggering allergic reactions in children.

Oral food challenge

An oral food challenge involves gradually introducing small amounts of a suspected food allergen to the child under medical supervision to test if they have a true allergy.

Elimination diet

An elimination diet involves removing potential allergens from a child’s diet for a specific period, then slowly reintroducing them to identify which foods may trigger allergic reactions.

Component-Resolved Diagnostics (CRD)

CRD is a blood test that can identify specific components of allergenic proteins, allowing for more accurate diagnosis and management of food allergies.

Nasal smear or nasal cytology

Nasal smear for cytology involves collecting a sample of nasal secretions and examining them under a microscope to identify allergic cells, such as eosinophils, associated with allergic rhinitis.


Spirometry is a lung function test measuring how much air a child can inhale and exhale and how quickly they can do so. It can help diagnose and monitor asthma in children.

Fractional Exhaled Nitric Oxide (FeNO) Test

FeNO testing measures the nitric oxide levels in the breath, which can indicate airway inflammation associated with asthma.

Challenge tests

Challenge tests involve exposing a child to a suspected allergen in a controlled environment under medical guidance to confirm or rule out an allergy.

Provocation testing

Provocation testing confirms a diagnosis of drug allergy by administering small doses of the suspected medication and monitoring for allergic reactions.

Environmental allergen testing

Environmental allergen testing can identify common allergens in a child’s environment, such as pollen, dust mites, mould, and pet dander, which may trigger allergic reactions.

Childhood immunology

Childhood immunology involves diagnosing and managing immune-related disorders and conditions. It focuses on understanding how components of a child’s immune system develop, interact, and respond to various challenges, including infections, vaccinations, and environmental exposures. 

It also investigates the factors influencing immune system development, such as genetics, nutrition, and early-life experiences.

Childhood rheumatology

Childhood rheumatology focuses on the diagnosis and treatment of autoimmune and inflammatory conditions that affect children’s joints, muscles, and connective tissues. Common conditions include juvenile idiopathic arthritis, lupus, and juvenile dermatomyositis.


Once childhood allergies are diagnosed, appropriate treatments can be initiated to manage symptoms and improve quality of life. Here are some standard treatment options.

Immunotherapy for allergic conditions

Immunotherapy, also known as allergy shots, involves gradually exposing a child to increasing doses of allergens to desensitise them and reduce allergic reactions over time.

Oral food immunotherapy

Oral food immunotherapy is a treatment option for food allergies that involves gradually introducing small amounts of allergenic food under medical supervision to build a child’s tolerance and reduce the risk of allergic reactions.

Inpatient drug desensitisation

Inpatient drug desensitisation is a procedure used to safely reintroduce medications to children who have experienced allergic reactions to them. Under supervision, the doses of medication are gradually increased to induce tolerance.

Functional immunity tests

Functional immunity tests assess the immune system’s ability to respond to infections and vaccinations, helping identify potential immune deficiencies that may require intervention.

Genetic testing for primary immunodeficiency diseases

Genetic testing can identify mutations or abnormalities in genes associated with primary immunodeficiency diseases, which are disorders that impair the immune system’s ability to fight infections.

Intra-articular joint injections

Intra-articular joint injections deliver medications directly into the affected joints to reduce inflammation and relieve pain in children with juvenile idiopathic arthritis.

Immunosuppressants and biologics

Immunosuppressants and biologic medications may be prescribed to children with autoimmune or inflammatory conditions to suppress the immune system’s abnormal response and reduce disease activity.

Childhood allergy, immunology & rheumatology by SWC Medical Group

Childhood allergies, immunology, and rheumatology are complex paediatric healthcare areas requiring specialised expertise and personalised care. 

At Singapore Women’s & Children’s Medical Group, we provide paediatric allergy services and expert guidance for your child’s health and well-being. Our team of specialists works collaboratively to deliver screenings, personalised treatment plans that address each child’s unique needs, helping them live healthy, happy, and fulfilling lives.

Schedule an appointment today.

Frequently Asked Questions

Children can develop allergies at any age, but are more commonly diagnosed in infancy or early childhood. Some allergies may manifest soon after birth, while others may develop later in childhood or adulthood.

Yes, genetics can play a role in the development of childhood allergies. Children with a family history of allergies are at a higher risk of developing allergies themselves. However, not all children with a family history of allergies will develop them, and environmental factors also play a significant role.

Some childhood food allergies, such as milk or egg allergies, may be outgrown over time, while others, such as peanut or shellfish allergies, tend to persist into adulthood. The likelihood of outgrowing an allergy depends on various factors, including the type and severity of the reaction.

While it’s not always possible to prevent childhood allergies entirely, there are steps parents can take to reduce the risk:

  • Breastfeeding exclusively for the first six months of life
  • Introducing solid foods one at a time and observing for any allergic reactions
  • Minimising exposure to known allergens, such as dust mites, pet dander, and pollen
  • Keeping living spaces clean and well-ventilated
  • Consulting with a paediatric allergy specialist for advice on allergy prevention strategies

It can sometimes be challenging to distinguish between cold and allergy symptoms in children, as they overlap. However, there are some key differences to look out for:

  • Cold symptoms are a sore throat, cough, and fever, whereas allergy symptoms typically involve sneezing, itching, and nasal congestion.
  • Cold symptoms usually last one to two weeks, whereas allergy symptoms may persist for longer periods, especially if the child is continually exposed to allergens.
  • Allergy symptoms may worsen in specific environments or during certain times of the year when allergen levels are high.

If you’re unsure whether your child’s symptoms are due to a cold or allergies, it’s best to consult a paediatric allergy clinic for an accurate diagnosis and appropriate treatment.

Our child allergy specialist

Dr Liew Woei Kang

Paediatrics, Allergy, Immunology & Rheumatology

At Singapore Women’s & Children’s Medical Group, we are proud to have Dr Liew Woei Kang leading our team. Dr Liew Woei Kang is a consultant in paediatric Allergy, Immunology, and Rheumatology

He is an expert in treating various paediatric allergy disorders such as asthma, allergic rhinitis, eczema, food and drug allergies. He also manages immunological and rheumatological disorders. Dr Liew is experienced in various therapies, providing well-rounded patient care.

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