Pediatric Allergist and Asthma Specialist Questions and Answers

Asthma usually presents within the first few years of life. It commonly has its onset associated with an upper respiratory tract infection which may be caused by a variety of viruses, including the respiratory syncytial virus (RSV). Children often present with the most prominent symptom being coughing, although wheezing and difficulty breathing may be present. Frequently, asthma symptoms are worse at night, and they can be precipitated or made worse with play/exertion, or emotions such as crying or laughter. Shortness of breath and difficulty breathing are also common symptoms and may occur ten to fifteen minutes after exercise or play begins. If there is obstruction to breathing, small children may have flaring of the nostrils and some asthmatics will speak in short sentences or become agitated during episodes. It is important to note that many asthmatics, especially children, may not recognize or report the signs of an asthma attack until they become quite severe.

Upper respiratory tract infections, most frequently the common cold, are common triggers of asthma episodes in young children. Allergies also play an important role in asthma attacks and in their chronic symptoms. Common allergens include dust, dust mites, cat and dog dander, mold, cockroach, and seasonal pollens. Children with asthma are particularly susceptible to second-hand cigarette smoke. Research has shown tobacco smoke directly correlates with wheezing early in life, as well as sick visits to the doctor and hospitalizations. Poor air quality, strong odors such as household cleaners, and other airborne irritants play a role in many asthma exacerbations in young children.

Many children are diagnosed early in life with “Reactive Airways Disease (RAD) or “Recurrent Bronchitis”. It will be necessary for your allergist to take a detailed history of a child’s symptoms, perform a physical exam, and their response to medications in order to establish or confirm the diagnosis of asthma. Chest x-rays are sometimes helpful in ruling out other causes of wheezing. The allergist will also use pulmonary function testing to help decide on the diagnosis and the severity of a child’s asthma. Pulmonary function testing involves the patient blowing into a computer and can be used in children usually by the time they are over five or six years old. Allergies often play a role in asthma for young children and your allergist may use allergy skin testing in the office to dust mites, mold, pollen, etc in order to help decide on the diagnosis. Based on this information, your allergist will then recommend a comprehensive treatment plan for your child with the goal of reducing or eliminating asthma symptoms.

Your asthma specialist’s goal is to control your child’s asthma symptoms and to allow him or her to live, play, and sleep without limitations. A peak flow meter may be recommended as well as an asthma action plan. Often times the specialist will educate parents on the proper use of inhalers, spacer devices such as the aerochamber and nebulizers. Reliever medications such as beta agonists may be prescribed. For chronic symptoms, controller, or asthma preventative medications such as inhaled steroids on leukotriene blockers are often used. Your asthma specialist follows specific guidelines set forth by the National Institutes of Health for young children with asthma. Prevention or further control of symptoms is helped by avoiding allergens and other airborne irritants, such as cigarette smoke and air pollution.
If it has been determined that you or your child is allergic to dust mites, then it is imperative that you do everything possible to minimize exposure to these troublesome creatures.

Recognize, however, that it is impossible to totally avoid exposure to dust mites and it is unreasonable to expect one to “dust proof” one’s entire house. However, there are some very important things which can and should be done in one’s bedroom to significantly reduce exposure to dust mites and their allergenic waste products. Put all of your efforts into eliminating dust mites in the bedroom of the allergic individual. We all deserve to sleep in a healthy and allergy-free environment!

We strongly recommend the following guidelines.

PREPARATION

– Completely empty the room, just as if you were moving.
– Empty and clean all closets and, if possible, store unused contents elsewhere.
– Keep clothing in zippered plastic bags and shoes in boxes off the floor.
– Remove carpeting, if possible.
– Clean and scrub the woodwork and floors thoroughly to remove all traces of dust.
– Wipe wood, tile, or linoleum floors with water, wax, or oil.
– Keep the doors and windows closed until the dust-sensitive person is ready to use the room.

MAINTENANCE

– Wear a filter mask when cleaning.
– Clean the room thoroughly and completely once a week.
– Clean floors, furniture, tops of doors, window frames and sills, etc., with a damp cloth or mop.
– Carefully vacuum carpet and upholstery regularly.
– Use a special filter in the vacuum or a HEPA vacuum cleaner.
– Wash curtains often at 130 degrees Fahrenheit.
– Air the room thoroughly.

CARPETING AND FLOORING

– Carpeting makes dust control almost impossible. Although shag carpets are the worst type to have, if you are dust sensitive, all carpets trap dust mites and are potentially problematic. Therefore, your allergist will likely recommend hardwood, tile, linoleum, or any other hard surface floor.

– Treating carpets with a commercially available tannic acid solution can be helpful in eliminating some dust mite allergen. Tannic acid, however, is not as effective as removing the carpet, is irritating to some people, and must be applied repeatedly.

BEDS AND BEDDING (This is very important!)

– Encase mattresses and all pillows in zippered, dust-proof or allergen-proof!
– Use only washable materials on the bed. Sheets, blankets, and other bedclothes should be washed frequently in water that is at least 130 degrees Fahrenheit. Lower temperatures will not kill dust mites.
– If you set your hot water temperature lower (commonly done to prevent children from scalding themselves), wash items at a laundromat which uses high wash temperatures.
– Use only synthetic mattress pads.
– Avoid fuzzy wool blankets or feather or wool-stuffed comforters and mattress pads. Hypo-allergenic blankets and comforters are recommended.

FURNITURE AND FURNISHINGS

– Keep furniture and furnishings to a minimum.
– Avoid upholstered furniture and blinds. Use leather furniture, when possible.
– Use only a wooden or metal chair that you can wipe with a wet cloth.
– Use only plain, lightweight, washable curtains on the windows.
– Keep clutter to a minimum.

AIR CONTROL

– Although air filters are not directly helpful for dust mites (since they are not airborne), they can reduce the levels of allergens in the bedroom. Electrostatic and HEPA (high-efficiency particulate absorption) filters can effectively remove many other allergens from the air.
– A dehumidifier may helpful as house mites require high humidity to live and grow.

CHILDREN’S ROOMS

– Keep toys that will accumulate dust out of the child’s bedroom.
– Limit the number of stuffed animals and toys to a very few favorites. Wash them frequently in hot water, as described above.
– Optimally, use only washable toys of wood, rubber, metal, or plastic.
– Store toys in a closed toy box or chest.

PETS

– Keep all animals with fur or feathers out of the bedroom. If you are allergic to dust mites, you could also be allergic or develop an allergy to cats, dogs, or other animals.

Although these steps may seem difficult at first, experience plus habit will make them easier. The results—better breathing, fewer medicines, and greater freedom from allergy and asthma attacks—will be well worth the effort.