Allergy to a drug assumes one of these forms:

a.     A local inflammation and itching (for example, at the site of a penicillin injection)

b.     A fixed reaction caused by swelling and itching which appears in the same place each time the drug is used ñ Hives

d.     Anaphylaxis

e.     Serum sickness

Drug allergy is usually less severe in children than in adults; drugs sensitize when first used, but open the door to dangerous reactions later on. A good example of this is anaphylaxis caused by a second injection of penicillin.

Anaphylaxis

This is a dangerous allergic reaction which may occur after an allergy injection, a bee sting, the eating of allergenic foods, an injection of horse serum, or an injection of penicillin. The symptoms may be shock, hives, congestion in the nose, or asthma. To prevent anaphylaxis, a careful history (to avoid a potential allergen) should be taken by the child’s allergist.

A child who has had a slight reaction to penicillin should avoid its use. In case it is imperative to use it, it is much safer to have it taken by mouth than by injection. Furthermore, injections of penicillin are to be given in the arm and not in the buttocks, so that a tourniquet may be placed above the place of the injection to slow down the passing of the injected material into the circulation (in case of a reaction).

The treatment of anaphylaxis consists of:

a.     An injection of adrenalin to relax the spasm of the bronchi and to diminish the secretions of the mucus glands

b.     An intravenous injection of calcium gluconate

ñ     Monitoring of the blood pressure so that another injection of adrenalin can be given if it becomes necessary

d.     Hospitalization

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Psychogenic reactions of this type are most likely to occur in those whose symptoms are purely psychosomatic, but who prefer to think they are ‘allergic’ to food, because they see this as being a more respectable sort of illness. The medical neglect of psychosomatic illness and hypochondria must shoulder some of the blame in such situations, because the stigma attached to these disorders owes much to doctors’ negative attitudes.

Patients who mistakenly believe that they are sensitive to food often put themselves on increasingly strict diets as their symptoms persist, and they may become seriously malnourished. They are in need of sympathetic professional help to identify the true causes of their malaise, and should be persuaded to undertake psychotherapy or some other form of psychological treatment. Such treatment can be valuable even where foods are a major cause of symptoms, so undertaking this type of therapy is worthwhile for a whole range of patients, not just for those whose problems are purely psychosomatic.

Psychogenic reactions to food are important in the diagnosis of food allergy and intolerance, because a challenge with any food may produce symptoms if the patient is expecting symptoms. In order to separate real responses from psychogenic ones, dummy challenges, with foods that are known not to cause any reaction, are included in the double-blind trials. Most patients are expected to respond to some of these dummy challenges, but they should respond to significantly more of the real ones. These dummy challenges are also known as placebos.

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