Child allergy symptoms: how to spot a reaction and what to do

Most child allergy symptoms are mild: hives, an itchy mouth, puffy lips or eyes, tummy pain or vomiting. HealthHub says they usually start within minutes and up to 2 hours after eating. Stop the food, take photos and see your doctor. If your child wheezes, sounds hoarse, has a swollen tongue or looks pale and sleepy, use their adrenaline auto-injector if one has been prescribed, then call 995.

What to do when your child has an allergic reaction, step by step

1. Stop the food, or move your child away from whatever set it off. HealthHub says to keep that food out until you've seen a doctor.
2. Check breathing, voice and colour first. HealthHub says to call 995 if your child gasps for air, wheezes, coughs nonstop with a hoarse voice, has a swollen tongue, struggles to swallow or talk, or looks pale, bluish or sleepy.
3. Use the adrenaline auto-injector straight away if your child has one, as their action plan shows. KKH says time is critical in anaphylaxis, because prompt adrenaline can stop a reaction getting worse.
4. Call 995 and note the time you gave the injection. HealthHub says the reaction can come back later, so your child needs a hospital check even if they look better.
5. Stay close and watch if the signs are mild, such as hives, swollen lips or eyes, or a single vomit. NUH says mild reactions usually show within 2 hours and a GP or paediatrician can manage them.
6. Take photos of the rash and write down what your child ate, how much and when. NUH says a food diary and pictures help the doctor.
7. See your GP, polyclinic doctor or paediatrician about any reaction, even one that has settled. KKH says your family or polyclinic doctor can refer your child to KKH if needed.
8. Tell everyone who feeds your child what happened and which food to skip: grandparents, your helper and the preschool.

Mild reaction or anaphylaxis: how to tell them apart

Egg is the most common food allergen in Singapore children, HealthHub says. Hives can show up in both columns, so look past the skin to breathing, voice and alertness. The signs below come from HealthHub and NUH.

A mild first reaction doesn't promise a mild next one. KKH says a child who has only had mild reactions can still have anaphylaxis after a bigger amount, or when illness, exercise or lack of sleep add to it. HealthHub warns that symptoms in the throat, lungs and heart can quickly become life-threatening.

Timing varies too. NUH says delayed reactions are rare, but they can start more than 2 hours and up to 48 hours after the food. Look for repeated vomiting, diarrhoea or a flare of eczema your child already has.

Not every red mark is an allergy. NUH says minor redness around the mouth that fades by itself is usually skin irritation from the food. For other rashes, our baby rash guide shows which is which.

Allergy symptoms in the nose, skin and chest

An allergy is the immune system overreacting to something harmless. HealthHub names food, some medicines, insect venom and dust mites as examples.

NUHS says allergic rhinitis means nose or eye symptoms at least once a week, often in the morning and evening. It's common here: NUHS puts it at as high as 42% of Singaporean children up to 2 years old. House dust mites are the top trigger in Singapore.

To cut dust mites, NUHS suggests washing sheets, pillowcases and covers in hot water at 60 degrees C every week or two. Use fewer carpets, soft toys and thick curtains, and clean with a damp cloth. Vacuum when your child is out, then let the air settle for about 2 hours before they come back in.

NUHS says antihistamines are safe even in very young children. Get a diagnosis first. The doctor or pharmacist picks the medicine and the dose.

Eczema and food allergy are linked, though less often than many parents think. HealthHub says most eczema isn't an allergy, and food allergies don't commonly trigger it. KKH adds that babies with moderate to severe eczema are more likely to develop food allergies. Our baby eczema guide covers skin care in our heat. For wheeze and night cough, see our asthma guide. Red eyes can also be an infection, and our pink eye guide covers how to tell.

How allergies are tested in Singapore

Start with your GP, polyclinic or paediatrician. They can handle mild reactions and refer your child on. At KKH, children with food allergies see a team of paediatric allergy specialists, gastroenterologists, allergy nurses and dietitians.

KKH says the doctor diagnoses a food allergy from your child's history of reactions, plus a skin prick test or a blood test for allergen-specific IgE. When that still isn't clear, the allergy clinic may give the food under medical supervision and watch.

A positive test on its own doesn't prove an allergy. KKH says it only shows sensitisation, and some children test positive yet eat the food without trouble.

Skip home and online kits. KKH warns that food IgG blood tests sold online don't confirm a food allergy. They can lead to cutting out foods your child needs to grow. To find a children's doctor near you, use our paediatrician map.

Peanut allergy and introducing peanut to your baby

Early peanut is now the advice. NUH says to introduce egg and peanut once your baby has started solids, around 6 months. HealthHub says to give the common allergy foods by 12 months, because delaying them has been shown to raise the chance of food allergy.

For the form, NUH suggests sugar- and salt-free peanut butter mixed into cereal or spread on baby bites. Never a whole nut: NUH calls it a choking hazard. If the first taste goes well, NUH says to give it daily for the next two days. After that, keep it in the diet.

Some babies need a doctor's view first. KKH counts babies with egg allergy or severe eczema as high risk, and says introducing peanut early may help prevent peanut allergy in them. HealthHub says to talk to your doctor about allergy prevention. KKH also notes studies linking peanut oil on the skin to a higher chance of peanut allergy, so read the label on your baby's moisturiser.

Our allergy-friendly eating guide walks through introducing egg, peanut and the other allergens one at a time. Starting solids covers first foods and textures.

Living with a diagnosed allergy

Once an allergy is confirmed, KKH gives your child an individual Allergy Action Plan. Families also learn to read food labels, since the allergen can hide in the ingredients. Keep the plan with the auto-injector, and give a copy to everyone who minds your child.

HealthHub says to carry the auto-injector at all times and check its expiry date. Keep it in a cool, dry place away from heat, and don't put it in the fridge. In Singapore, that means not leaving it in a parked car. The doctor picks its strength by your child's weight.

Hawker centres and food courts don't give you an ingredient list, KKH points out. Our allergy-friendly eating guide has tips for eating out. Add your child's allergy medicines to our baby medicine and first aid kit checklist.

When to see a doctor

Call 995 straight away, after the auto-injector if your child has one, for any of these:

• Wheezing, noisy breathing or gasping for air (HealthHub)
• A nonstop cough with a hoarse voice, a swollen tongue, or trouble swallowing or talking (HealthHub)
• Looking pale or bluish, sleepy or unconscious (HealthHub)
• Vomiting more than once or severe tummy pain after a food, or turning limp or drowsy (NUH)
• Drooling and unable to swallow, or too breathless to talk, drink or play (KKH)
• Any time the auto-injector has been used, even if your child looks better: they still need hospital care (HealthHub)

For urgent problems that aren't an emergency, KKH says to go to the nearest paediatric emergency department: KKH Children's Emergency, or NUH Children's Emergency, which NUH lists as open 24 hours. See your GP or polyclinic for a mild reaction that has settled, a delayed reaction, a nose that runs every week, or eczema that won't calm down. KKH says that's faster and cheaper for non-emergencies.

Frequently asked questions

What are the first signs of an allergic reaction in a child?

Usually skin and mouth signs: hives, an itchy mouth, or swelling of the lips, eyes or face. HealthHub says these show within minutes to 2 hours of eating. Wheezing, a hoarse voice or a swollen tongue means call 995.

When should I introduce peanut to my baby?

NUH says around 6 months, once your baby has started solids, and HealthHub says by 12 months. Use sugar- and salt-free peanut butter mixed into porridge or cereal, never whole nuts. If your baby has severe eczema or an egg allergy, talk to your doctor before the first taste.

How is peanut allergy in a child treated in Singapore?

KKH says strict avoidance is the main treatment, with an action plan and an adrenaline auto-injector for accidents. For some children, oral immunotherapy is an option: the child eats the food daily in slowly larger amounts. Only an experienced paediatric allergist should start it, KKH says.

Will my child grow out of a peanut allergy?

Less often than with egg or milk. KKH says peanut and shellfish allergies tend to persist into adulthood, while up to 80 per cent of children outgrow egg and milk allergies. Don't retest at home; your allergist decides when.

Is it a cold or an allergy?

NUHS describes allergic rhinitis as nose or eye symptoms at least once a week, often in the morning and evening. Sneezing with an itchy nose and eyes points to allergy. Fever? Try our fever checker. Our guide to common childhood illnesses covers colds.

Can I test my child for allergies at home?

No. KKH says online food IgG tests don't confirm an allergy. Real testing is a skin prick test or a specific IgE blood test, which a doctor reads with your child's history.