By: Widodo Judarwanto
Children Allergy Center, Bunda Hospital Jakarta

1. Introduction

Efforts to improve the quality of Human Resources should be done early, systematic and sustainable. Optimization of Children grow and develop early on is a top priority, so that we can prevent or find out distractions and early development of the child disorders.

Some scientific reports both at home or abroad indicate that the incidence of allergies continue to rise sharply Last post a few years. It seems that allergies are dominated case the patient’s visit in an outpatient clinic Child Health Service.

Allergies in children is not as simple as we once knew. Previously we often hear from a specialist in internal medicine, pediatricians, other specialists that the symptoms are allergic cough, runny nose, stuffy and itchy. And allergies can affect all organs without exception start from head to toe with a variety of dangers and complications that might occur. Last post was revealed that allergies can interfere with brain function, so it is disturbing the child’s development later revealed that the allergic complications caused quite dangerous, because allergies can interfere with any organ or body system including brain function disorders. Because the brain dysfunction that arises interference the development and behavior disorders in children such as concentration, emotional disturbances, delays in speaking, disturbance of concentration to autism.

Autism and other spectrum disorders symptoms child’s behavior is the most attention and the case there is a tendency to increase in recent times. Autism is believed some researchers as an anatomical abnormalities in the brain is genetically. There are several things that can trigger autism, including the influence of food or food allergies.

Risks and signs of allergy can be identified since the child was born since even sometimes been detectable. Allergies can be prevented early on and is expected to optimize child growth and development optimally.

2. PROCESS EVENT OF ALLERGIC interfere CENTRAL NERVOUS SYSTEM STRUCTURE

Pathophysiology and pathogenesis (disease process) allergies interfere with central nervous system especially the brain functions are still not uncovered. But there are several possible mechanisms that could explain, among others:

ALLERGIC disturbing TARGET ORGAN

Allergy is an inflammatory process that is not only a fast and slow reactions, but also a chronic inflammatory process is complex, influenced by genetic factors, environmental and internal controls. Various mast cells, basophils, eosinophils, lymphocytes and molecules such as IgE, mediators of cytokines, chemokines is a component of the role of inflammation.

Clinical symptoms occur because the reaction imunologik through the release of several mediators that may interfere with certain organs called target organs. Target organs such as the lungs are the clinical manifestations of cough or bronchial asthma, when the target will be visible as the skin hives, when the target organ of the digestive tract symptoms are diarrhea and so on. Composition of the Central Nervous System or the brain can also be a target organ, especially the brain is an organ that is sensitive and weak. Central nervous system is a central coordination body and noble function. So you can imagine if the brain is disrupted many resulting clinical manifestations may include behavioral disorders in children. Moreover, the common allergic chronic inflammatory process of the complex.

THEORY AND BRAIN abdominal enteric Nervous System

In allergy can cause both intestinal lining damage due pencernan or dysfunction of the immune system itself. While indigestion itself appears to affect the central nervous system including brain function.

The theory of digestive disorders associated with central nervous system is currently the main concern of the clinician. Neuropatologis research and reported imunoneurofisiologis lot. This theory also explains about one of the mechanisms of behavioral disorders such as autism through the intestinal known Hypermeability or Leaky Gut Syndrome. Golan and Strauss in 1986 reported the existence of abdominal epilepsy, which is a digestive disorder that can cause epilepsy.

Linkages hormonal WITH ALLERGIES

The linkage of hormones with allergic events were reported by many studies. Hormonal changes Sedangatan itself certainly can lead to its own clinical manifestations.

JS Lynch in 2001 suggested that the hormonal effects also occur in people with allergic rhinitis in pregnancy. While Landstra et al in 2001 reported changes were significantly decreased hormone cortisol in bronchial asthma during the night.

Significant discoveries reported Kretszh and konitzky 1998, that the hormone affect allergy as some clinical manifestations of endometriosis and premenstrual syndrome. Several other reports indicate an allergic association with hormonal changes such as are cortisol, metabolic, progesterone and adrenaline.

In allergic patients obtained reduction in hormone cortisol, estrogen, and metabolic. Decrease hormone cortisol can cause allergy fatigue stresse, while the decrease in metabolic hormone changes can cause significant weight. Another Hormona money is hormone estrogen decrease.

Allergies are also associated with increased adrenaline and progesterone hormones. Increased adrenaline clinical manifestations caused mood swings, and anxiety. While hormone progesterone cause skin disorders, Pre menstrual syndrome, Fatigue and loss of hair.

3. ALLERGIES, CENTRAL NERVOUS SYSTEM FORMATION AND DISORDERS-DEVELOPMENT BEHAVIOR

Central nervous system is the most vulnerable and sensitive than other organs. The brain is the central coordination of all body systems and functions of the sublime. Meanwhile, due to allergies to various organs that can interfere with central nervous system and dysfunction of the immune system itself seems to cause many clinical manifestations that can interfere with the development and behavior of a child.

There are 2 different things between allergic disorders and relationship disorders central nervous system. Difference depends on the presence or absence of organic brain disorder. If there is organic brain disorders such as autism or any other brain-focus on the process is only aggravate allergies or trigger symptoms. If there is no anatomical abnormalities of the brain is most likely an allergic process is closely associated with these disorders. Usually when there is no brain organ abnormalities or other disease is allergic effects on the brain is usually a good prognosis and the symptoms are not severe.

But when acquired autism or other brain organic disorders the worse the prognosis. However, if the interference is exacerbated by the treatment of allergic triggers allergies to diabetes management can reduce the symptoms.

Allergic Disease Impact on Brain Function, observed by G. Kay, Associate Professor of Neurology and Psychology at Georgetown University School of Medicine Washington. The impact of allergic disease on brain function manifest as decreased quality of life, decrease in good working atmosphere, and decrease the efficiency of cognitive function. Patients with allergic rhinitis reported decreased quality of life similar to that experienced by patients with asthma or other serious chronic diseases. Allergic diseases is not only disrupt the social and work function but also interfere with leisure activities.

Several empirical studies show the effect of allergy to mood and cognitive function. Marshall and Colon in 1989 proved that the group of patients with seasonal allergic rhinitis has a function of verbal learning and mood worse than the group of patients without an allergy attack. In two studies conducted by Vuurman, et al demonstrated that the ability of homework on students’ allergy sufferer worse than the ability of other students by age and IQ are appropriate but do not have the talent allergic (non-atopic).

Several other researchers showed a connection between allergic diseases with personality disorders such as shyness and aggressiveness. On personality tests can be seen that patients allergic to prioritize action is more physical, more difficult to adjust themselves in the social environment, and have defensive mechanisms that are less good. The number of allergy attacks reported by patients was associated with increased anxiety, depression, difficulty concentrating, and difficulty adjusting to the social environment.

Allergic disorders associated with central nervous system can cause several clinical manifestations, among neuroanatomi and can interfere with functional neuroanatomi.

A. INTERFERENCE NEUROANATOMI

Allergy to various mechanisms associated with disorders of the body can cause neuroanatomi some clinical manifestations such as headaches, migraines, vertigo, loss of memory for a moment (forget). Some studies show that, for example, in 1992 said Krotzky migraines, vertigo and headache can be caused by food allergies or any other chemical.

Strel’bitskaia in 1974 suggests that the interference with asthma found in the brain electrical activity, even though it was not able to do with the reported clinical manifestations.

B. DISORDERS FUNCTIONAL ANATOMY Neuro (DEVELOPMENT AND BEHAVIOR DISORDERS)

Allergic reactions with various clinical manifestations to the central nervous system can interfere with functional neuroanatomi, would interfere with further development.

What is meant by developmental disorder is a disorder that includes psychomotor function of mental function and motor function. Our limbs or organs of our skeleton can also be affected by developmental disorders.

Motor EXCESSIVE INTERFERENCE

In the newborn characterized by leg movements and hand over, babies do not want to look covered or dibedong. If worn often asked to move down or frequently. At the age of 4 to 6 months have been trying to roads, whereas the ability to walk normally at age 12 months. Sometimes stamped into the back of the head-hit knock heads. At the age of bigger is not going quietly appeared, moving aimlessly on purpose. Accompanied by loss dropped the habit is hard to bed (smack down).

COORDINATION AND BALANCE DISORDERS

Coordination disorders that can be observed is usually the child does not follow or through a normal developmental phase in accordance with age. The pattern of disturbed motor development is usually alternating body, sitting, crawling, standing or walking. Some children sometimes do not follow the pattern, for example, children do not have to sit or crawl, but immediately walked or stood before a new bias to sit. Also children do not follow the normal pattern of age-appropriate motor development, such as new bias new alternating above age 5 months or 11 months of age sitting.

At age or older on 1 year, marked by aftifitas walk like a hurry or quickly that the ability to walk too late. When you walk often fall, or hit a nearby object. Another habit is that when walking on tiptoe, or when sitting cross-legged position back legs like the letter W.

SLEEP DISORDERS

Lots of sleep disturbance causes, allergies in children seem to be one of the most frequent cause. Tirosh in 1993 in his study mentioned that in asthma and allergy sufferers are often accompanied by sleep disturbance in the form of frequent waking sleep, shorter sleep time and other sleep disorders.

Allergy sleep disturbance can occur in infancy. In our research shows that babies who are at risk and have allergy symptoms since birth is often the first 3 months of having trouble sleeping, especially at night. Usually the baby is often awake until midnight, especially the morning, sometimes accompanied by frequent fussing and crying in the night heavy hari. If complaint is usually accompanied with colic (crying hysterically unknown reason). At the age of bigger is usually marked by the initial hours of sleep a night, sleep is often restless (his position back and forth), sometimes in a state of sleep often delirious, crying and screaming. Position of sleep often move from one end to the other end of the bed. Middle of the night often waking sleep until morning, suddenly sat down and then sleep again, often prone sleeping position.

At school age children, adolescents and adults is usually characterized by bad dreams at night. The most common nightmare is a dream experienced such horrible visited people who have died or met the scary animals like snakes.

Judarwanto W in 2002 suggests that the observations on 245 children with digestive disorders due to allergies, get 80% of children experience sleep disturbance at night. After treatment of allergy diet, showed that 90% of patients have improvement of sleep disorders.

CONCENTRATION DISORDERS

Children impaired concentration, often tire of a job or activity unless they watch television. Children seem not sit long in a chair. In the class can not calm a lesson, often talking, annoying friends, etc., when a hearing can not hear or follow in a long time. Prominent though seem not to notice when communicating, but the child can respond with good communication and quick.

DELAY OR INTERRUPTION TALK TALK

One of the manifestations of allergies in children are late to talk. The delay in talking when accompanied by a dominant allergic manifestations in children should be further evaluated whether there are linkages between these 2. Some studies indicate a dominant hemisphere disorder. These deviations usually refers to the left brain. Some children are also found irregularities right hemisphere, the corpus hearing kalosum and related trajectories. Suspected allergic manifestations take the role aggravate existing problems such.

Talk on allergic disorders are usually improved rapidly after the age of 2 years. This could perhaps explain the indigestion will link to a disturbing allergy brain function. Indigestion where to allergy sufferers will get better at the age of 2 years as well.

The possibility of language difficulties should thought when a child reaches late stages of language units suitable for her age. Language unit may be voice, words, and sentences. Further language functions are governed by the rules of grammar, which is how sounds form words, words form sentences correctly and so on.

Talk delay occurs in 3-15% of children, and is a development disorder that most often occurs. As many as 1% of children experiencing delays still can not talk talk. Thirty percent of children who have mild delays will heal itself, but 70% of them will have difficulty speaking, less intelligent, or other learning difficulties. Usually mild complaint is directly related to allergic disorders

Allergic manifestations that arise repeatedly and continuously for more than 2 weeks, can affect the disruption to talk on a particular baby under 1 year. Ability to speak to the evaluation since birth. The ability to speak has to be considered carefully by observing carefully disappeared or decreased sounds in the mouth (babbling). Some common words pronounced as ba, da, ma, or pa suddenly disappeared at a certain age. Allergic manifestations improved after the management of the diets was the ability to improve again. This shows clearly that the delay was influenced by talking to an allergic disorder.

Another talk interference can happen is dyslexia, echolalia (mimicking every word of others) and stuttering (stammering).

AGGRESSIVE

Sign aggressive in infants could be observed in the habit of biting and excessive licking. In young infants seen from the habit of entering all the babies even hand to mouth insert foot. At the age of more than 6 months have seemed excessive biting activity is marked by a bite on the hand, shoulder or mouth of someone who wears. While excessive licking habits characterized by licking activity on all items held, on the sheet and the surface of the table.

Another tendency is the age of 6 months beginning often hit front, the head of another person or the head itself. Another habit is his own hair or someone else’s hair. If the larger age not only hit with the hand but also the habit of hitting with a stick on the body nearby. At the age of 1 year in addition to hitting coupled with scratching and pinching habits of others. Sometimes, too, looked habit throw toys or objects that hold excess.

EMOTIONAL DISORDERS

Emotional disorders common in allergic children. In infants it appears that the baby was screaming so loud that, if asked to drink often impatient. In older children seem easily upset, easily shouted, when angry often hysterical, throwing objects held to temper tantrums, often hitting the head or hit my head.

HIPERKINESIA

Hiperkinesia interference happens is overactive, it is difficult to control his body to be quiet, children are always moving and looking ill at ease, difficult concentration, to ADHD. Although ADHD is the possibility of suspected organic disorders of the brain.

AUTISM AND ALLERGIES

Autisma is pervasive developmental disorder in children characterized by the disruption and delays in cognitive, language, behavior, communication and social interaction.

Autism until now still not clear why. But research has biomolekular can identify DNA patterns of people with Autism, that is probably already have the talent of this genetic abnormality. But several studies showed the complaint Autism influenced and exacerbated by many things, one because of allergic manifestations. Renzoni A et al in 1995 reported autism is closely related to allergies. Ménage P in 1992 suggests that the obtained relation with patient IgE Autism.

This can also be proved in several studies showing improvement of symptoms of autism in children who suffer from allergies, after handling elimnasi allergy diet. Some other reports say that autism symptoms get worse when it comes allergic manifestations.

4. ALLERGIC RELATIONS WITH OTHER FUNCTIONS OF THE BRAIN

Storfer et al in 2001 in his study of 2720 child patients with asthma and other allergies, there is a tendency intelegensianya higher capacity compared with other children.

Hazzel in 2000, adding a good intellectual than is usually the child has allergies and asthma outstanding initiative and creativity skills are good. Another tendency is 2 times greater occurrence of Myopia in children with multiple allergic asthma, hubuhngan though it can be linked directly.

5. Management

Handling allergies in children must be done correctly, complete and continuous. Continuous drug delivery is not the best way of handling allergic, but the ideal is to avoid the causes that can cause allergies such complaints.

Special handling allergy in children with developmental disorders and other behavioral disorders should involve several disciplines, because it must be ensured that no organic abnormalities, other systemic or psychological. So if necessary in consultation on child neurology, child psychiatrists, pediatricians interest growth, endocrinology child and the child gastroenterologist.

But if the opinion of several experts in conflict and other allergic manifestations in children is clear, then there is no harm in us doing the management of food allergy with an open elimination. Such treatment should be evaluated in 2 or 3 weeks using a diary. If development and behavioral disorders such improvement then there can be certain that such interference is the cause or triggers allergies.

Meanwhile, to overcome the symptoms of developmental disorders and behavioral existing therapy approaches can be done with occupational therapy, speech therapy, sensory integration therapy, hearing or vision therapy and so on.

6. CAUSE ALLERGIES OTHER THAN EATING

There are also some foods that can interfere with the brain but not the immunological reaction but because the food or raksi intersection of food intolerance include the salicylates, tartarzine (food dyes), nitrates, amines, MSG (monosodium glutamate), antioxidants, yeast, lactose, benzoate,

Salicylates; found in fruits, Saur, peanuts, the, coffee, beer, wine and drugs such as aspirherbs, spices, spreads, Teas & Coffee, juices, beer and wines and medications such as aspirin. High Konsestrasi found in dried fruits such as sultanas.

Amines; produced during fermentation and protein breakdown is found in cheese, chocolate, wine, beer, tempeh, vegetables and fruits such as bananas, avocados and tomatoes.

Benzoates; found in some fruits, vegetables, nuts, wine, coffee and so on.

Monososodium glutamate (MSG); often found in food flavorings: MSG, soy sauce, or other foods

Lactose: often found in cow’s milk

Glutamate; many found in tomatoes, cheese, mushrooms, sauce, meat and mushroom extracts.

7. Prognosis

The prognosis for the development and behavioral disturbances associated with allergic depends on the presence or absence of organic brain disorders such as autism or a focus on the brain. If confirmed there is no anatomical abnormalities of the brain then the prognosis would be better. Usually if the interference is controlled it will look drastically perbaikkan developmental disorder and behavior. In this type of disturbance on the age of 2 to 5 years there is a tendency to improve.

But when acquired autism or other brain organic disorders the worse the prognosis. However, if the interference is exacerbated by the treatment of allergy triggers allergy with diabetes management would be very much help.

8. CLOSING

Allergy problems in children seem not as simple as is well known. Frequent recurrence of the disease, so the extent of the affected body system and the danger of complications that occur seem to be due to more attention for the formation of plants and flowers optimal child.

Allergic disorders with a variety of allegations turned out to be menggganggu mechanism neuroanatomis and mengkibatkan functional neuroanatomis development and behavior disorders in children.

Risks and allergy symptoms can be identified and detected in the womb and at birth, thus preventing allergy symptoms can be done as early as possible. The risk of complications and disorders central nervous system is expected to be reduced.

Special handling allergy in children with developmental disorders and other behavioral disorders should involve several disciplines, because it must be ensured that no organic abnormalities, other systemic or psychological. If you need consultation on child neurology, child psychiatrists, pediatricians interest growth, endocrinology child and the child gastroenterologist. If the opinion of several experts is contradictory and anatomical disorders of the brain is not clear, could have done with the management of food allergy elimination diet changes open evaluation or improvement of behavioral disturbances that arise.

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