© 2018 by Worthington Pediatrics. 

Worthington Pediatrics

5528 NW 43rd Street

Gainesville, FL 32653

Tel: (352) 371-3604

Fax: (352) 371-4865

 

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Asthma and Allergy

ALLERGY

An allergy occurs when the immune system reacts to a normally innocuous threat such as a food or environmental exposure. An allergen is the substance that causes the allergic reaction. In a person with allergies, a type of antibody called  immunoglobulin E (IgE) causes excessive activation of certain white blood cells called mast cells and basophils. This triggers an inflammatory cascade. Common symptoms and management as recommended by the American Academy of Pediatrics is summarized below: 

 

WHEN TO SUSPECT AN ALLERGY 

Here are some common clues that could lead you to suspect your child may have an allergy:

  • Frequent or chronic cold-like symptoms that seem to linger, or symptoms that may develop at the same time each year. Classic symptoms include an itchy, runny nose, nasal stuffiness, sneezing, throat clearing, itchy/watery eyes, and an "allergic" looking face that may include dark circles under the eyes (allergic shiners) and open-mouthed breathing.

  • Recurrent coughing, wheezing, chest tightness, shortness of breath, and other respiratory symptoms may be a sign of asthma. Cough may be an isolated symptom, but it is important to discuss this with your child's provider, particularly if the cough is worse through the night or with exercise. 

  • Recurrence of red, itchy, dry and sometimes scaly rashes. Rash may be to the crease of the elbows and/or knees, back of neck, buttocks, wrists, or ankles. 

  • Recurrent symptoms after eating a particular food. These may include hives, swelling of the face, gagging, cough/wheeze, vomiting, or abdominal pain. 

  • Itching or tingling to the mouth, throat, or ears after eating certain foods, particularly raw fruits. 

 

COMMON ALLERGENS ON THE HOME FRONT

  • Dust mites (microscopic organisms found in bedding, upholstered furniture and carpet as well as other places)

  • Furry animals (dogs, cats, guinea pigs, gerbils, rabbits, etc.)

  • Pests (cockroaches, mice, rats) 

  • Pollen (trees, grasses, weeds) 

  • Molds and fungi (nearly ubiquitous in Florida due to our humid temperatures) 

  • Foods (cow's milk, eggs, peanuts, tree nuts, soy, wheat, corn, fish and shellfish)

 

MANAGING ECZEMA (ATOPIC DERMATITIS):

  • Frequent application of moisturizers (at least twice daily) is important

  • Steroid creams may be indicated for some patients

  • Antihistamine medication may relieve the itching and help break the "itch-scratch cycle"

  • Lukewarm soaking baths for 10-20 minutes are good ways to treat the dry skin/eczema. Epsom salts in the bath water may be of additional benefit. After the bath, gently pat your child dry to avoid irritating the skin with rubbing. Then, while skin is still moist, liberally apply moisturizing cream right away while the skin is still damp. This is called the "soak and smear" technique. Long-sleeved sleepwear may also help prevent nighttime scratching

  • Soaps containing perfumes and deodorants may be too harsh for children's sensitive skin. We always recommend unscented  fragrance-free products. 

  • Launder new clothes before your child wears them and avoid fabric softeners which may be irritating. 

  • Use laundry products that are free of dyes and perfumes.

  • Eczema may be associated with food allergies (e.g., milk, egg, peanut), yeast, etc.  Further evaluation may be indicated to identify the triggers. 

 

MANAGEMENT OF ALLERGIES: 

  • If you suspect your child may have allergies, please make an appointment to discuss this with your child's provider. When indicated, management of allergies may include blood testing to identify specific allergens. Referral to a specialist may be considered. 

  • If your child has allergies, medication may be considered. This may include: Singulair, Claritin, Zyrtec, and/or Benadryl. Together with your child's clinician, you will be able to decide which may be best for your child. 

 

 

ASTHMA

Asthma is a common chronic inflammatory disease of the airways. Symptoms include airway flow restriction, chest tightness, cough and wheeze.  Childhood asthma continues to be a major reason for emergency department visits, missed school days, and hospitalizations. There are four categories of asthma severity: intermittent, mild persistent, moderate persistent, and severe persistent. The most important distinction is between intermittent and persistent asthma, as patients who have persistent asthma will usually be started on long-term control medication. Regular follow-up appointments are needed in order to assess and monitor asthma control, review medication technique and adherence, establish/update asthma action plans, etc. 

 

ESTABLISHING AN ASTHMA DIAGNOSIS

  • Review history of cough, recurrent wheezing, recurrent difficulty breathing, chest tightness, etc. Symptoms may occur or be worsened by exercise, exposure to allergens, changes in weather, viral infection, etc. 

 

MANAGING ASTHMA:

  • Our office has a spirometry machine available for our patients with asthma. This test measures pulmonary function, especially lung volume and speed of air exhaled. Spirometry is recommended to be administered at least every 1-2 years, but at more frequent intervals as necessary. Usually children will need to be at least five years old to be able to properly complete a spirometry test.

  • Our long term goal is to reduce impairment and prevent chronic symptoms.   Spirometry enables us to do this much better by providing an objective number to  view small airway function which cannot be heard on exam.

 

MEDICATIONS FOR ASTHMA: 

  • Quick Control Medications: These medications are used to control an acute exacerbation of asthma symptoms. They work by relaxing the airways to relieve constriction. These medications will not provide long-term asthma control. Examples of quick control medications include albuterol and Xopenex (levalbuterol tartrate). These can be administered via the nebulizer machine or with an inhaler and spacer.

  • Long-term Control Medications: these medications include inhaled corticosteroids. They work by preventing airway inflammation, thus relieving symptoms for children with persistent asthma. Your child's provider will review medication options to find the best one for your child.  This is where spirometry can help us in decision making.

 

DEVELOPING AN ASTHMA ACTION PLAN: 

 BRING THESE TO YOUR NEXT OFFICE VISIT: 

 

For children with asthma that is well-controlled, our office recommends an office-visit every six months. This is in line with the American Academy of Pediatrics' recommendation, and designed to ensure proper medication dosing, adherance, and control of symptoms. 

 

Please bring the following to your child's next asthma recheck appointment:

 

1. The Asthma Control Test (click appropriate option below)

 

Asthma Control Test (for ages 12 and up)

 

Asthma Control Test (for ages 4-11)

 

2. A completed Asthma Action Plan. Please fill this out according to your current understanding and use of medications for your child's asthma. We will review this at your upcoming appointment and make changes together, if indicated. 

 

Asthma Action Plan 

 

3. Please make a list of your child's current medications including supplements, and any questions you  have for us.