Surviving Seasonal Allergies
Seasonal sniffles and sneezes triggered by blooming spring flowers and trees can leave children — and parents — feeling run down when they are ready to celebrate longer days and outdoor activities. Lingering cold-like symptoms that last for several weeks, or occur each year at the same time, may indicate your child has allergies. A persistent, recurrent cough, wheezing, chest tightness or difficulty breathing may be symptoms of asthma. Also a cough that is worse at night or with exercise is particularly suggestive of asthma.
If your child has asthma, eczema or seasonal allergies, you may hear your doctor describe this as atopy. These three common childhood issues are tied together by their common cause: an abnormally strong reaction to normal substances, or allergens, in a child’s environment.
The most common triggers for asthma attacks in children are respiratory infections, allergens, tobacco smoke, air pollution and exercise. Other common allergens include household pests such as mice and cockroaches, pollen, molds and fungi. Your physician may suggest specific allergy testing to help identify what triggers your child’s allergic responses.
Eliminating triggers is rarely easy. For example, if your child has an allergy to animal fur, you may need to find a new home for the family. Another common allergen is dust mites. Dust mites can live anywhere in the home, including bedding, furniture and carpet. Washing linens frequently in hot water, and using allergen-proof covers for mattresses and pillows can help to reduce dust mites in the house. Also avoid exposure to tobacco smoke. Cars, homes and child-care facilities should all be smoke-free to protect a child’s airway.
If outdoor allergens trigger a child’s allergies, bathing at the end of the day to remove allergens from the skin can reduce symptoms. Other helpful tips include remaining inside when the lawn is being mowed and not playing in piles of leaves.
If eliminating triggers is not enough to control symptoms of allergies and asthma, your doctor may recommend medication. Since allergies and asthma are interrelated, the same medications are sometimes used for both.
To help with itchy watery eyes, sneezing and runny noses that result from allergies, nonprescription antihistamines may help, including diphenhydramine (Benadryl), cetirizine (Zyrtec), loratidine (Claritin) and fexofenadine (Allegra). Remember that these medications can be sedating, although some children become more active after taking them. Try these medications for the first time on a non-school day to see how your child reacts.
Nasal corticosteroids are very effective for allergy symptoms, but must be used daily. They are only available by prescription. Examples include fluticasone proprionate (Flonase), triamcinolone (Nasacort), mometasone furoate (Nasonex) and budesonide (Rhinocort). If allergen avoidance and medications do not help your child’s symptoms enough, your physician may recommend allergy immunotherapy, commonly known as allergy shots.
Before starting medications for asthma, your child’s physician will want to classify the symptoms into one of four categories: intermittent, mild persistent, moderate persistent or severe persistent. Then the physician will choose medications for quick relief of symptoms and, depending on the severity of the asthma, a long-term control medication.
Control or prevention medications are used daily to reduce airway inflammation and to prevent asthma attacks in patients who have one of the persistent categories of asthma. The most common and effective daily-use prevention medications are inhaled corticosteroids such as beclomethasone (QVAR), budesonide (Pulmicort) and fluticasone (Flovent). Typically these medications are well tolerated, but rare side effects can include thrush, hoarseness and cough. Using a spacer to inhale the medication and rinsing the mouth following each dose can reduce the possibility of effects.
Other daily prevention medications include several different anti-inflammatory medications such as cromolyn, montelukast (Singulair) and zafirlukast (Accolate). Remember that these medications are meant for daily use, not as needed for symptoms.
For sudden worsening of asthma symptoms, the most common medications are short-acting beta-agonists and anti-cholinergic medications. Both types are used on an as-needed basis and work by relaxing a child’s airway so that is it easier to get air in and out of the lungs. Three common short-acting medications are albuterol (Proventil, Ventolin), levalbuterol (Xopenex) and ipratropium (Atrovent).
If your child has an asthma exacerbation, her doctor may prescribe a short course of corticosteroid medication like prednisone or prednisolone to be taken by mouth. Corticosteroid medications enhance the effects of the other medications your child is taking and can prevent relapse by reducing airway inflammation.
Eliminating triggers and ensuring that your child takes his or her medications daily can be challenging, but by working with your child’s physician, you can make a difference in your child’s ability to have an active and healthy childhood.
Dr. Shipp is a pediatric resident at Levine Children’s Hospital. Dr. Neuspiel is a general pediatrician at CMC: Myers Park Pediatrics and Director of Ambulatory Pediatrics at Levine Children’s Hospital