Allergies, Immunology & Rheumatology

It’s not always easy to say which child will develop an allergy and which child won’t. However, research shows that if a parent or close relative of a child has allergies, the risk the child may also develop the same allergy is greater.

Having said that, 15% of children with allergies don’t have a history of allergy in their families. Speak to your doctor about the potential risk and things you may be able to do to minimise the allergies.


Childhood allergic disorders include:

  • Atopic dermatitis
  • Food allergies
  • Allergic rhinitis
  • Atopic asthma

Adverse reactions after drugs and vaccines can also sometimes cause allergic reactions. Common symptoms include:

  • Recurrent itchy rashes
  • Urticaria (hive-like rashes)
  • Angiodema
  • Recurrent sneezing
  • Rhinitis
  • Wheezing
  • Chronic cough

There are many reasons that can cause a persistent cough in a child. This could include:

  • Post-infectious cough
  • Asthma
  • Rhinitis

Is asthma hereditary?

Some allergies may be hereditary. For example, if a parent is diagnosed with an allergy, the chances of the child developing the allergy can be up to 40%. If you or your husband has asthma, consider consulting a specialist to determine if the reason for your child’s condition is due to allergies present in the family.

Does my child have a food allergy?

Coughing may not and often is not due to food allergies. In fact, there is little evidence that a dietary change will actually improve the cough for your child.

Soy formula or goat’s milk should not be used for allergy prevention. There are currently no studies that show that the use of soy formula or goat’s milk formula can help prevent or change the course of allergies such as eczema, asthma and rhinitis. Consulting a specialist for proper diagnosis of food allergy if you suspect that your child may have food allergies. Your doctor may perform some skin or blood tests to rule out food allergies.

Investigations that can be performed to check for food allergies include:

  • Skin prick test
  • Blood tests for IgE mediated allergies
  • Skin patch testing
  • Food and drug provocation
  • Pulmonary function tests
  • Management of allergy includes
  • Allergen avoidance
  • Medications and specific written action plans
  • Adrenaline auotinjectors (Epipen)
  • Specific allergen immunotherapy may be prescribed

allergies diagnostics and skin prick test

Paediatric Immunology

The immune system is the body’s defense mechanism; it protects the body from harmful, infectious agents. Immunological disorders such as primary immunodeficiencies where there is an inborn defect of immunity that resulted in recurrent fevers and infections.

A lot of children who have recurrent fevers don’t have an immune defect but rather exposure to multiple new infections in childcare centres or schools. Immune boosting strategies can be discussed to improve this condition.


  • Evaluation of recurrent fever
  • Specialized immunological testing
  • Intravenous immunoglobulin replacement

Other immune dysregulation disorders include:

  • Chronic idiopathic urticaria
  • Immune mediated thrombocytopenia
  • Anaemia

Your Baby and Immunisation

In the first few years of life, infants and children face many potential dangers from various infectious diseases. They miss out on learning opportunities and playtime and can affect their overall growth and development when they fall sick often. A major contributing factor to improving your child’s health is the availability of vaccines.

What is immunisation?

When vaccine is given to protect them from a particular infectious disease. The vaccine works to encourage the body’s immune system to produce antibodies to fight the disease. It’ll help your child combat the disease if they come into contact with it.
Why is childhood immunisation important?

It provides protection against serious diseases, which can otherwise lead to lifelong complications and even fatality. If enough children are protected and immunised against a particular disease; then the risk of it spreading is lowered and the disease may be eradicated altogether.

How long are vaccines effective for?

Some vaccines provide lifelong immunity upon completion (Hepatitis B vaccine). Other vaccines have to be administered again later in life to maintain immunity to the disease (Diphtheria and tetanus).

What Are ‘5-in-1’ and ‘6-in-1’ vaccines?

There are newer formulations that combine vaccines against 5 or 6 diseases into one single injection; they’ve been proven to be safe and effective. The 5-in-1 injection combines vaccines against:

  • Diphtheria/Pertussis/Tetanus (DPT)
  • Polio and Haemophilus Influenzae type B (Hib)

This is provided free of charge for Singapore citizens at polyclinics.

The 6-in-1 injection combines vaccines against:

  • Diphtheria/Pertussis/Tetanus (DPT)
  • Polio
  • Haemophilus Influenzae type B (Hib)
  • Hepatitis B into 1 injection

The cost of this injection is not subsidised.
Your decision to get your child immunised against infectious diseases will not only help protect their health but it will also help create a safer and healthier community.

Paediatric Rheumatology

Rheumatological disorders include:

  • Kawasaki disease
  • Henoch Scholein purpura
  • Juvenile idiopathic arthritis

Arthritis including Juvenile Idiopathic Arthritis, Reactive Arthritis are secondary to other causes such as:

  • Connective Tissue Disease
  • Systemic Lupus Erythematosus
  • Mixed Connective Tissue Disease
  • Undifferentiated Connective Tissue Disease
  • Scleroderma (localized and systemic form)
  • Juvenile Dermatomyositis, polymyositis, idiopathic inflammatory myopathies
  • Neonatal Lupus Erythematosus
  • Sjogren’s Syndrome
  • Systemic Vasculitis
  • Kawasaki Disease
  • Henoch Schonlein Purpura
  • Takayasu Arteritis
  • Polyarteritis Nodosa
  • Behcet’s Disease
  • Other vasculitis i.e. granulomatosis with polyangiitis, Microscopic polyangiitis
  • Prolonged or Recurrent Fever
  • Periodic Fever Syndrome or Autoinflammatory Disorder
  • Kikuchi Disease
  • Kimura Disease
  • Inflammatory or autoimmune disorders of the eye, brain, liver, blood etc.
  • Unexplained chronic musculoskeletal pain
  • Amplification pain syndrome
  • Hypermobility Syndrome
  • Unexplained systemic symptoms i.e. loss of appetite, fatigue, loss of weight
  • Unexplained rash

Rheumatology Services Provided Include:

  • A comprehensive evaluation (diagnosis and management)
  • Immunosuppressive therapy (includes biologic treatment)
  • Arthrocenthesis and intra-articular injection
  • Paediatric musculoskeletal ultrasound (diagnostic and therapeutic purposes)
  • Multidisciplinary management with physiotherapist and occupational therapists
  • Co-management with other relevant subspecialties (gastroenterology, ophthalmology, nephrology, dermatology)
  • Raise public awareness about paediatric rheumatic conditions through education