This is the most common chronic disease in childhood and is present in 15-20% of all children. Chronic diseases are frustrating to parents and doctors, because they last a long time. Although this group of diseases cannot be cured, allergic diseases can be managed well with modern medicines. Allergic Airway Diseases may be called Reactive Airway Disease, Infantile Bronchiolitis, Asthma, Sinus congestion or sinusitis, Hay Fever, Cedar Fever , and Allergic Rhinitis. However, all these diseases have a common cause:
- An unusually reactive immune system which overreacts to common foods and inhalants.
- The substances which cause this overreaction are called allergens.
- Common allergens are usually house dust, pollens, molds and other every day substances we breathe in all the time.
- Some foods also act as allergens and cause respiratory allergy in the young child.
- An allergic child’s airway is lined with antibodies, which set off a reaction when the allergen is inhaled.
- The net result of this reaction is to produce chemicals like histamine (You know histamine, because you take anti-histamines to fight it!) Histamine-like substances affect the lining of the airway by causing swelling, excess mucous production and contraction of the muscle lining the respiratory tract.
Sinus
If this swelling occurs in the nose, we say we have hay fever or sinus.
Asthma
If the same process occurs in the very small branches of the lung called bronchioles, we say we wheeze, have bronchiolitis or asthma. Different words say the same thing. Unfortunately, the word "asthma" is unfairly associated with a very sickly child. No parent likes to hear this word. Actually most children with asthma are not sickly at all, but lead very productive, even athletic lives. Many Olympic Gold Medal athletes have had asthma. Allergic diseases usually cause "attacks" of symptoms lasting between 5-10 days. In between attacks, allergic people are completely normal. I, too, have asthma, but have never felt sickly! We now know that asthma, if not managed well, can cause permanent scarring and loss of lung function as an adult.
Symptoms of Allergic Airway Disease
- Nasal Congestion and Runny Nose
- Frequent Runny, Itchy, Red Eyes
- "Allergic Shiners," Dark Circles under the Eyes
- An "Allergic Salute" ...always rubbing the nose
- Clear Nasal Discharge
- Snoring and Noisy Breathing
- Shortness of Breath at Rest
- Shortness of Breath only while Exercising
- Persistent Cough
- A Wheeze or Whistle, especially Breathing Out
- More frequent colds and respiratory infections
- A Seasonal Variation in all the above
Management of Allergic Airway Disease---Allergy cannot be cured. Allergy can be managed.
Avoidance
- Keep the environment as dust, mold, and pollution free as possible. Begin with where the nose spends most of its time, on the pillow. General rules include:
- Use synthetic foam pillows with an allergen-proof casing. Wash the pillow often.
- Cover the mattress with plastic or a dust proof cover. Air frequently.
- Avoid stuffed toys in the bedroom. Keep them in the closet, or wash them often.
- Keep pets out of the bedroom and the house, if possible.
- Use washable curtains or simple shades on the window.
- Vacuum carpet frequently with the child out of the room.
- Experiment with foods you suspect may be causing symptoms. Avoid the suspected food for 14 days and then reintroduce the food to decide if they really worsen symptoms.
- Avoid excess exposure to infection where practical. The excess mucous produced by allergy is a preferred breeding ground for bacteria causing ear infections and pneumonia. This may force you to reconsider daycare enrollment and other group activities, when your child is having an allergic attack.
- Avoid all pollution in the air, especially tobacco smoke. Even if you’re not allergic to tobacco, the smoke paralyzes tiny hairs that continuously clean the nose and lungs. Breathing “second-hand” smoke starts many allergic attacks.
Medicines
Nasal Decongestants and Antihistamines help the symptoms of runny nose, itchy nose, and stuffy nose. There are hundreds on the market. However, there are only 5-6 different classes of these. If the over the counter medicines, such as Actifed, Sudafed, Dimetapp, Benadryl, Entex, or their generic equivalents don’t help, see your doctor. One of the newer, non-sedating drugs may be helpful. Frequently, you and the doctor will need to experiment to match a drug and the dose to your child’s symptoms without undue side effects like drowsiness or irritability.
- Bronchodilators, represented by Albuterol (Ventolin, Proventil) work by relaxing smooth muscle in the tiny branches, or bronchioles, of the lung. The histamine-like substances produced during an allergy attack tighten these muscles and make breathing difficult. An inhaler or nebulizer to avoid stimulant side effects best administers these. However, the oral route may be successful in un-cooperative children.
- Corticosteroids are best used as either a spray for the nose, or an inhaler for the lungs. These and a similar drug, Intal, are now thought to be the first-line of defense against severe allergic disease. They are safe for children and very effective. Steroids are the only drugs which prevent permanent airway damage from asthma.
Allergy Evaluation
Allergy Testing: Frequently parents say they cannot say their child has allergic airway disease because they have never been tested. If your child has allergic symptoms, you do not need allergy tests to determine if they have allergies. Indeed, most children with allergies do not need allergy tests. For children who have severe problems, uncontrolled by avoidance and medication, skin tests may determine specific allergens. Allergy tests are not 100% reliable because they usually rely on a child’s sensitive skin. The younger the child, the less reliable the tests are.
Allergy Shots: The allergist will then begin a series of allergy shots to teach the child’s immune system to accept the allergen without having an allergy attack. Allergy shots are given 1-2 times a week usually over 3 or more years. Obviously, this is a big, uncertain step for a mild problem. We usually recommend allergy shots if the symptoms cannot be managed with medicine and avoidance.