Achoo! It’s the time of year when seasonal allergies peak. But in reality, allergic symptoms can happen year round. That’s because there’s just as many indoor allergens as there are outdoor. And for kids with asthma and allergies, this can add another layer of complexity to their treatment plan.
In fact, about 80-90% of kids who have asthma also have allergies, or allergic asthma.
When kids with allergic asthma are exposed to an allergen, they can develop inflammation in their lungs. This may cause asthmatic symptoms such as nighttime awakenings, coughing, wheezing and shortness of breath. It may also contribute to more trips to the doctor’s office, urgent care visits and missed days of school. The good news is that when you treat allergies, asthma is much easier to control.
Studies show that a single intervention (such as an over-the-counter medication) isn’t effective in treating allergic asthma. In order to control it, kids need a comprehensive, multi-faceted plan targeted at all their allergies. So what could this treatment look like? Here are six steps we outline for families in our allergy clinic:
6 Steps to Help Control Allergic Asthma in Kids
1. Watch for symptoms
For kids with allergic asthma, the classic symptoms include nasal and oral itching, sneezing, and itchy, watery eyes. However, sometimes young children won’t blow their nose, but rather snort and sniff. Or they’ll make a clicking noise from trying to itch the roof of their mouths. These allergic symptoms can lead to asthmatic symptoms, such as coughing, wheezing, shortness of breath, and daily/nightly rescue inhaler use.
2. Learn what your child is allergic to
If you or your primary health care professional think your child has allergic asthma, it is important to perform allergy testing. An allergist can identify potential allergic triggers for asthma by either skin and/or blood testing. This will include a wide variety of environmental allergens, such as local flora and home exposures. Allergens fall into two general categories:
– Indoor/perennial: indoor molds, dogs, cats, dust mites and pests such as cockroaches. Indoor allergens can be problematic for kids year round.
– Outdoor/seasonal: trees, grasses, weeds, and outdoor molds. Outdoor allergens tend to peak during certain seasons in the year. In the Midwest, trees pollinate February through the end of May. Grass pollinates between May and mid-July. Weeds from August to mid-October (generally around the first frost). And molds tend to peak in spring, summer and fall. Unfortunately, these patterns may change as the Earth warms. For example, in southern parts of the US, grass is a perennial allergen. This same phenomenon could happen in Northern states.
3. Limit indoor exposures
The next step is to develop a comprehensive plan to control environmental triggers. Remember that implementing only one intervention is not effective. Following all parts of the environmental control plan can make a huge difference for your child and potentially reduce the need for medications.
Controlling Dust Mites. Dust mites live in woven material like carpeting, fabrics, mattresses, stuffed animals and couches. They do not bite, but feed on dead skin and absorb humidity from the atmosphere as a source of food and water.
- Create physical barriers by purchasing dust mite covers for pillows, comforters, mattresses and box springs.
- Wash sheets and comforters once a week in hot water and/or dry on the hottest setting.
- Keep your child’s room clean and clutter free.
- Maintain humidity below 50%, by either regular opening of windows in a dry climate or running AC in a humid climate (68 – 72 °F).
- If it’s feasible, remove the carpeting from your home, or at least where your child sleeps. This is not necessary if cost is an issue.
Controlling Pet Allergens. If your child is allergic to the family pet, the most effective step is to remove it from the home. However, if that is not practical, isolate the pet to one room in the house and keep it out of your child’s room. There may be some evidence that washing dogs one to two times weekly may reduce allergens.
Also remember exotic pets such as birds, ferrets, monkeys, guinea pigs can cause allergies so make sure to tell your doctor if you have one. Unfortunately, the existence of “hypoallergenic” breeds of cats and dogs has never been confirmed. So this is not recommended as a replacement for a pet-allergic child.
Controlling Pests. For pests such as cockroaches and rodents, professional extermination with comprehensive pest management is recommended. This includes keeping food and trash in covered containers, fixing cracks in the walls and floors, and keeping the house clean.
4. Limit Outdoor Exposures
Allergists want kids playing outside, as exercise is great for asthma. However, when allergen levels are at their highest, it’s sometimes not practical nor safe to spend long periods of time outside. This is especially true if asthma is severe. Here are a few recommendations for limiting exposure:
- Check the air quality of the area you live in to avoid the trigger when it’s peaking. Those who live in Southwest Ohio, check the levels of allergens in the air on this website.
- Keep your windows closed in the car and at home.
- Shower after outside time and/or before bedtime. This will help remove the allergens from his skin, eyes and hair so that your child’s not sleeping with it.
- Use a saline spray for the nose and saline drops for the eyes. This will help flush pollen out of the linings of the nose and eyes. Do not use Visine or a Visine-like drop, as this causes rebound redness. Ask your pharmacist if you need help.
5. Try medication
In addition to allergen avoidance, medication may be needed. If your child’s symptoms are mild, loratadine, cetirizine or fexofenadine can help. However, if your child is having moderate to severe symptoms, such as difficulty sleeping, missed days of school, or shortness of breath, we recommend a nasal corticosteroid spray. For kids with the most severe allergic asthma who are failing the strongest asthma medications, a medication called Xolair is an option. This once-to-twice monthly shot blocks Immunoglobulin E (IgE), the main antibody that causes allergies. It has been shown to decrease asthma attacks and improve quality of life for those with the most severe asthma.
6. Consider allergy shots
If your child’s symptoms aren’t controlled with the above steps, or you don’t want your child to take medication, allergy shots are an option. This is where we inject a tiny, progressive amount of your child’s allergies into the skin, in order to build up her immunity. Typically, we’ll start with weekly visits and then move to monthly. This process can take anywhere from 3-5 years. The effort can be well worth it – some children can achieve allergy tolerance for up to 10 years. It is important to note that allergy shots are not recommended for kids with severe or life threatening asthma.
Hope on the Horizon
The exciting news is that there is a lot of research happening related to allergic asthma. At Cincinnati Children’s, we’re conducting multiple studies, seeking better treatments, especially for severe asthma. Further, we are now studying two treatments in early childhood to prevent asthma from happening in the first place.
If you are concerned about your child’s allergic asthma, please contact his doctor. If his symptoms are not well-controlled by an oral antihistamine, if you’re interested in identifying potential triggers, or if your child’s symptoms are moderate to severe, your doctor may recommend a referral to an allergist.