Paediatric Allergy and Immunology

Parents often wonder whether a runny nose or a rash needs a specialist. Reactions that keep happening with the same trigger are signs that suggest it is time to see a paediatric allergy specialist. For example, this could be a child who breaks out in hives every time after eating eggs or who starts wheezing when staying at a house with a cat. Medical attention should be sought if any episode such as difficulty breathing, throat tightness or swelling of the lips or tongue after eating or an insect sting, immediately.

Another reason is eczema that cracks, weeps or keeps a child awake despite regular moisturisers and creams. If they follow a seasonal pattern, frequent nasal congestion, chronic cough, or recurrent "colds" that actually turn out to be allergy symptoms should be evaluated. For possible immune deficiency, there are red flags. This includes two or more pneumonias in a year, recurrent deep abscesses, needing intravenous antibiotics to clear common infections or unusual infections like fungal overgrowth in the mouth beyond infancy.

A careful dive looking into patient history is the start. The specialist asks exactly what happens. This looks into how soon after exposure and whether symptoms resolve with antihistamines or avoidance. A food and symptom diary is often very helpful, over two to three weeks. Skin prick testing is the most common allergy test and is when tiny drops of purified allergen extracts are placed on the forearm or back, and a small prick introduces them just under the skin. A raised, red bump, if appearing within 15 minutes, indicates sensitivity. An alternative is also blood tests for specific IgE antibodies to individual allergens. This is particularly useful for children with extensive eczema or those who cannot stop antihistamines.

For delayed reactions that appear 48–72 hours later, patch testing is used. This is especially useful for contact dermatitis. Pulmonary function tests are possible in older children who can cooperate with breathing into a machine. For younger children, the response to medication is often observed clinically. The standard for suspected immune deficiency are a complete blood count with differential, quantitative immunoglobulins (IgG, IgA, IgM, IgE) and antibody response to vaccines. We arrange advanced flow cytometry for lymphocyte subsets or genetic testing when specific disorders are suspected.

• Food allergies
• Allergic rhinitis and hay fever
• Allergic conjunctivitis
• Atopic dermatitis (eczema)
• Allergic asthma
• Acute and chronic urticaria (hives)
• Anaphylaxis and severe allergic reactions
• Drug allergies and drug desensitisation
• Insect venom allergy
• Primary immunodeficiency disorders
• Recurrent or unusual infections
• Eosinophilic oesophagitis and other eosinophilic disorders
• Hereditary angioedema

Treatment is tailored to the child's age, the specific condition and the family's daily routine at NMC. The first pillar is allergen avoidance. This is balanced however, against over-restriction that might affect nutrition or social development. The team educates families on reading labels, recognising early symptoms of a reaction for food allergies and using emergency medication including adrenaline auto-injectors. Oral food challenges – where a child eats a gradually increasing amount of a suspected allergen under medical supervision – are performed.

Medications include non-sedating antihistamines, nasal corticosteroid sprays and topical steroid or calcineurin inhibitor creams for respiratory allergies and eczema. Asthma is managed using reliever and controller inhalers. Age-appropriate devices like spacers and masks are also used. For dust mite allergy or venom allergy, allergen immunotherapy is offered for severe hay fever, also known as desensitisation. Either as regular injections or as drops/tablets under the tongue, this involves giving gradually increasing doses of the allergen. This helps retrain the immune system to tolerate the trigger.

Treatment may include regular immunoglobulin replacement infusions, antibiotic prophylaxis for primary immunodeficiencies. In severe cases, a referral is made for haematopoietic stem cell transplantation. For severe eczema, biologic therapies such as omalizumab (for allergic asthma) or dupilumab (for severe eczema) are available for children who do not respond to standard treatments.

NMC's paediatric allergy and immunology team consists of consultant paediatricians with additional subspecialty training in allergy and clinical immunology. Supporting them are teams with different expertise. Our paediatric nurses are trained in emergency allergy management, and our dietitians help families navigate food avoidance without nutritional gaps. Respiratory therapists across NMC educate on inhaler technique and lung function testing.

Our specialists take time during every consultation. Explaining test results and demonstrating how to use auto-injectors or inhalers correctly are a standard part of care. Written emergency action plans for schools and nurseries are also offered by our team with every family receiving a clear plan, not just a prescription. Patients can expect the same consistent, practical and compassionate approach to children with allergies and immune problems across every NMC facility in Dubai, Abu Dhabi and the wider UAE.