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Dr. Ashley Jerath Tatum is an allergy specialist at Northwest Asthma and Allergy Center.

Q:  How do parents know if their child is suffering from allergies and/or asthma?

Children with respiratory allergies, or allergic rhinitis, will experience nasal congestion and discharge, eye redness, tearing, and/or itching, as well as sneezing during specific times of the year (for example, in the early spring if allergic to tree pollens) or when exposed to cats or dogs.

Children allergic to dust mites, indoor molds, or pets in the home may experience chronic nasal congestion and throat clearing. Other allergy symptoms include headache and fatigue.

Allergies should be considered in children with a history of recurrent ear or sinus infections, eczema, and/or asthma.

About 1 in 10 children has asthma. Children with asthma will experience recurrent episodes of cough, wheeze (a high-pitched whistling sound when breathing out), chest tightness, and/ or shortness of breath. Symptoms can worsen at night, awakening the child.

In young children, a persistent or chronic cough may be the only sign of asthma. Triggers for such symptoms can include pollens, animal dander, dust or dust mites, molds, air pollution, upper respiratory infections and exercise. Symptoms may also occur or worsen upon exposure to cold air, second hand tobacco smoke or wood smoke, strong smells and chemical sprays, perfumes, paints, cleaning solutions and chalk dust.

A child with exercise-induced asthma, or exercise-induced bronchoconstriction, or may complain that his or her chest “hurts” for “feels funny” during or after physical activity. You may also suspect asthma in a child if he or she is more easily fatigued during exercise (slows down or stops playing) compared with his or her peers, seems to run at a different pace than others or than what seemed to be his or her norm in the past, or avoids physical activities and sports altogether.

Q: What’s the connection between allergies and asthma?

Allergies are an important trigger for asthma in about 70% of children. Risk factors for asthma in children include respiratory allergies, atopic dermatitis or eczema, food allergy and a parental history of asthma.

The expression of asthma, respiratory allergies, or allergic rhinitis, and other allergic diseases (food allergy, atopic dermatitis or eczema) is the result of a complex interaction between a person’s immune system and genetics and environmental exposures.

Infections in early childhood may influence the development of the immune system (the “hygiene hypothesis”). Environmental factors include allergen exposure, viral infections such as respiratory syncytial virus (RSV), air pollution (in particular, ozone), dietary habits and use of acetaminophen.

Q: How do allergies begin in children?

Respiratory allergies and asthma develop due the effects of environmental factors in a genetically susceptible person.  An allergic reaction begins in the immune system. Our immune system protects us from invading organisms that can cause illness.

In a person with allergies, the immune system mistakes an otherwise harmless substance, such as pollen, as an invader. This substance is called an allergen. The immune system overreacts to the allergen by producing Immunoglobulin E (IgE) antibodies. These antibodies trigger cells to release histamine and other chemicals causing symptoms of itching, congestion, discharge, cough, etc.

Q: What are the most common allergens for kids?

Common respiratory allergens are proteins produced by dust mites, mold spores, cat and dog dander, and pollens.

Approximately 30% of allergic persons react to cats and/or dogs. Cat allergy is twice as common as dog allergy, although some people are more sensitive to dogs than cats.

Generally, the pollen season lasts from February or March through October. Each plant has a period of pollination that does not vary greatly from year to year. However, weather conditions can affect the amount of pollen in the air at any given time. Early spring allergies are triggered by pollens of trees such as alder, birch, cottonwood, poplar, juniper, cedar, oak, and elm. In the late spring and summer, pollinating grasses, including timothy, orchard and rye, often trigger symptoms. Weeds usually pollinate in late summer and early fall.

Exposure and allergy to dust mites, alternaria mold and cockroach (in inner-city dwellings) can influence the development of asthma in children.

Q: What are parents’ treatment options for allergies and for asthma?

Reduction of exposure to pertinent allergens is most important in the treatment of allergies.

In dust mite allergy, removal of carpeting, controlling indoor humidity ( below 45%), and encasing mattresses, box springs and pillows in allergen-proof covers, and washing the top sheets, covers and blankets in hot water (130 degrees) weekly is beneficial.

If a child is allergic to pets in the home, the pets should be kept out of his or her bedroom and a HEPA (high efficiency particulate air) filter should be used to help remove circulating animal dander.

If a child is allergic to pollen(s), it is best to keep windows closed at night to prevent pollen from drifting into the home and to keep car windows closed while traveling.

Medications used to reduce symptoms include non-sedating oral antihistamines, nasal corticosteroid or antihistamine sprays, oral anti-inflammatory pills, and antihistamine eye drops.

If symptoms persist or occur for many months of the year, immunotherapy treatment, or allergy shots, may be considered to help the immune system become more resistant to specific allergen(s), lesson symptoms and reduce need for medications. Allergy shots in children may play a role in the prevention of the development of asthma and new allergies.

Asthma treatment follows guidelines published by the National Heart, Lung, and Blood Institute, of the National Institutes of Health. Treatment focuses on asthma symptom control; medications are prescribed in a stepwise approach and therapy is adjusted (stepped-up or stepped-down) based on the severity of asthma and frequency of symptoms. Again, environmental control measures to minimize exposures to pertinent allergens and irritants are most important.

There are two types of asthma medications that may be prescribed by a child’s physician, quick-relief medications (also called short acting beta agonists, such as Albuterol) which allow for bronchodilation and relaxation of lower airway smooth muscle and which provide prompt symptom relief, and long-term control medications (such as inhaled corticosteroids and leukotriene modifiers) which reduce airway inflammation, prevent symptoms, and must be taken daily.

Short acting beta agonists may be used prior to exercise to prevent or reduce symptoms of exercise induced bronchoconstriction, or exercise-induced asthma. If a short acting beta agonist is required more than twice weekly, not including before exercise, to relieve symptoms, then long-term control medication is added.  The goal of asthma therapy is maintenance of (near) normal lung function and maintenance of normal activity levels, including exercise and attendance at school.

Q:  What impact do allergies and asthma have on kids?

Respiratory allergies can cause nasal congestion, sleep disruption, fatigue, and poor concentration during the school day. Treatment of such allergies, including use of medications, can improve cognitive function and school attendance and thus improve school performance.

Asthma symptoms can lead to reduced participation in active play at recess and in athletics, and asthma exacerbations are a common cause of missed school days. Control of asthma symptoms can allow for full participation in physical activities with peers and maintenance of school classwork, which can permit physical and emotional development in parallel with peers who do not have allergies or asthma.

Q:  What resources should parents seek out?

Parents should discuss concerns, triggers, prevention, and treatment options regarding their child’s asthma and allergies with the child’s primary care physician in conjunction with the child’s school nurse and a local board-certified allergy and asthma specialist.

There are many online resources which address concerns of parents as well as contain information targeted specifically to children with asthma and allergies.

Online Resources for Parents of Children with Asthma and Allergies

Here’s a short list of websites recommended by Dr. Ashley Jerath Tatum:

American Academy of Allergy Asthma and Immunology

American Lung Association

National Heart, Lung, and Blood Institute