Transcription:
Does Your Child Suffer From Asthma, Allergies, or Both? There’s Ways To Treat It.

Melanie Cole (Host): There’s no handbook for your child’s health, but we do have a podcast. Featuring world-class clinical and research physicians, covering everything from your child’s allergies to zinc levels, this is Kids Health Cast by Weill Cornell Medicine and our topic today is Children with Allergies and Their Effects on Asthma. My guest is Dr. Nicolina Wawrin. She’s an Instructor in Pediatrics at Weil Cornell Medicine and an Assistant Attending Pediatrician at New York Presbyterian Weill Cornell Medical Center. Dr. Wawrin, I’m so glad to have you with us today as this is such an interesting and important topic. So many children suffer from both allergies and asthma. Tell us what are the most common causes of allergies in children. What are some of the different types?

Nicolina Wawrin, MD (Guest): Hi, yes, it’s nice to be here. Some of the common allergens in children are typically seasonal allergies resulting from pollen from trees, grasses, weeds, dust mites are also a really common allergen as well that can cause allergy symptoms throughout the entire course of the year and all seasons. Cockroach droppings, also in areas where there’s a lot of population can also cause allergies in addition to mice droppings as well. And unfortunately, also dogs and cats are a common cause of allergies in children as well.

Host: So, Dr. Wawrin, I think the main question here is that are children that have allergies at an increased risk for asthma or are children that already have been diagnosed with asthma now at an increased risk for some of those allergens?

Dr. Wawrin: What we typically find is that a lot of children who have seasonal allergies will eventually be diagnosed with asthma rather than I think the other way around with asthma being a common risk factor for seasonal allergies. Typically, allergens can cause a lot of hyperreactivity in the airways which can trigger asthma symptoms in children. So, even in children who haven’t been diagnosed with asthma before, we are always on the lookout if they have bad seasonal allergies to make sure that their breathing is comfortable, and they are not wheezing.

Host: So, if parents are looking for some of these signs; tell us what some of the signs of seasonal allergies and at what age do they typically present themselves?

Dr. Wawrin: The most common symptoms that we’ll have with seasonal allergies is children having runny noses, cough, a lot of children also will have a lot of eye symptoms so, if you see your child scratching their eyes, or rubbing them a lot, even having red eyes, those can be symptoms of allergies as well. Lots of sneezing too. In general, most children don’t present with symptoms related to allergies until after the age of two. But it is possible that some children can have presenting symptoms earlier than that. But usually, not before the age of two.

Host: So, are there some areas. You mentioned some of the triggers. You mentioned some of the allergens. And are there areas where it’s worse? Seasons where it’s worse and what can parents do to identify some of those triggers so maybe they can head some of them off?

Dr. Wawrin: Right. So, it can be – it’s very important to identify what the triggers are so you know when to start allergy medications and get on top of the symptoms sooner. So, typically, children who are allergic to pollens from trees, grass, weeds, will have worse symptoms later in the spring, sometimes during the summer and into early fall. Now children who have allergies to dust mites or cockroach droppings or even dogs and cats unfortunately can have allergy symptoms all year long. But it can be really important to identify these triggers and we do talk about starting allergy medications sometimes one to two weeks prior to when children will typically start presenting with their symptoms just so we can dampen some of the allergic response and also help them not be so severe.

Host: So, then let’s combine these two asthma and allergies Dr. Wawrin. Tell us a little bit more about asthma and what the effect of allergies on children with asthma is. I imagine it would exacerbate many of those symptoms and why is asthma difficult to control for some children?

Dr. Wawrin: Right. So, asthma definitely can be a trigger of asthma. It’s sometimes something that parents don’t think about very much. A lot of parents will mention that the asthma gets triggered when they’re sick but around springtime, I do see a lot of children who really aren’t sick with colds representing with allergy symptoms and when I listen to their lungs, they will be wheezing.

So, just having the allergens present, for example pollen during the spring, can create an immune response with your body that results in lot of the airway being inflamed and more hyperreactive which can trigger allergy symptoms. So, the important thing is treating your child’s asthma appropriately and also being on top of the allergy symptoms as well. So, I had mentioned before, that seeing your doctor for a physical exam and also just talking about the symptoms can be really important to make sure that it actually is allergies that are triggering the asthma and then in addition to that, also making sure that your child’s asthma is well under control. So, either using the albuterol which is a quick relief medication in addition to for some children who have bad to control asthma also using a controller inhaler as well.

Host: Let’s expand on the treatment options. If a child suffers from both, what are we looking for? Because if they’ve been diagnosed with asthma as you say, there’s the quick relief versus long term control and then we go to Walgreen’s or to a pharmacy and there is eight million different allergy medications and for parents Dr. Wawrin, that can absolutely be dizzying.

Dr. Wawrin: Right. There are so many allergy medications. So, there are a couple that I recommend. One of the best allergy medications is Zyrtec. The generic name for Zyrtec is cetirizine. It’s a really good medication because it controls allergy symptoms for a total of 24 hours. So, it just needs to be taken once a day. That’s usually my go-to medication for children who have allergies. And I will recommend that it’s given at nighttime because it can sometimes cause some kids to be more sleepy. If the cetirizine or the Zyrtec is making children sleepy, another alternative is Claritin or loratadine which also is a medication that can be given every 24 hours.

Those are my typical go-to oral medications that children can take for allergies. Another option too in addition to the oral medications is a nasal spray. One of the best medications for controlling sneezing or runny nose is a medication called Flonase or even a similar medication called Nasonex. These are both nasal steroids that are safe in children and can be given every day once spray in each nostril and can really help dampen the amount of swelling and inflammation in the nose which effectively decreases sniffling, sneezing, runny nose.

Host: What a great explanation. So, that is for the allergy control and now there are also working on their asthma. Please speak a little bit about inhalers and do some children use them wrong? Tell us a little bit about how these all work together.

Dr. Wawrin: Right. So, one of the most important medications for asthma is albuterol which is a quick acting medication that children can be given if they are experiencing wheezing, shortness of breath, prolonged cough, which are really common symptoms of asthma. So, that’s typically the go-to medication which can be given as often as every four hours in children who are having asthma symptoms. However, if parents are finding that they are having to give the albuterol inhaler more frequently as in every four hours they should definitely be going to the emergency department and letting their pediatrician know. Because that means that their asthma is not well-controlled.

So, children who are using the albuterol inhaler multiple times a week for months on end, we will recommend that they use an additional inhaler called a controller medication inhaler which is an inhaled steroid which can really help children from having flares of their asthma. One of the typical ones that we will use are Flovent for example which can be really helpful in controlling the disease.

Host: So, we’re talking about all the medications available for both asthma and allergies. Now at home, what can parents do and lifestyle changes that they can make. What would you recommend and speak about nasal lavage or Neti pots, windows, air filters, pillow cases, vacuum cleaners. What can we do?

Dr. Wawrin: So, controlling the environment at home can be really important in terms of controlling allergy symptoms and therefore asthma. It can also be really tricky to control as well. So, some of the general recommendations that I will tell parents is to use a vacuum with a heap filter to vacuum their carpets at least once a week. If they are able to do it more often than that, that’s perfect. Because a lot of pollen, dust, dust mites, can hold in the carpet. Also another thing that a lot of parents don’t realize is that after kids have spent a lot of time outside, particularly during the pollen season, like during spring and summer; is that children can retain pollen in their hair, on their clothes, also in their nostrils as well.

So, after they have had a long day at the park or have been playing outside; it’s really important that as soon as they come inside, they wash their hands and before they go up to bed at night, that they wash their hair. That way, we are preventing any pollen, and even mold that has been retained in the hair from earlier in the day of coming out and not rubbing all over the child’s pillowcase. Which brings me to another important point that sheets, pillow cases should be changed at least once a week in children who have bad allergies as well.

Some other modifications that can help with allergies that you had mentioned were nasal sprays. Just a standard nasal saline can be really helpful using it one, two times a day in terms of removing some of the pollen that’s built up in the nasal passages as well.

Host: Have you ever tried Neti pots with children? I mean it’s not easy to wrestle them down and try and get to use something like that, but a lavage, some kind of a shower for the nose. Do you recommend trying that with our kids?

Dr. Wawrin: You are very right. It can be very difficult to hold the child down to get the – to use that, even nasal sprays, those can be difficult. But an older child, in an older child a Neti pot could be really helpful especially in children who have really severe allergy symptoms or have facial tenderness or headaches, just because of the increased mucus production from their allergens.

Host: Well it sure can clear them out and help, it’s just as you say, not easy. Let’s summarize Dr. Wawrin, what is your best advice for children that have asthma and allergies both, the effects that each have on the other and what you would like parents to know about treating those children as keeping them healthy.

Dr. Wawrin: Right. So, if there’s any concern that your child might have allergies and you’re not sure whether or not they do, it’s always good to see the pediatrician. Just really teasing out the symptoms and also a physical exam can be really important in diagnosis. And then if the child does have seasonal allergies or asthma; the pediatrician can best give guidance about the medications that should be used. As I had discussed before, an oral medication and also a nasal steroid for controlling the symptoms. And then once you have an idea of what the actual allergens might be and what season the allergens might be more present; it’s really important to get on top of the allergy symptoms. So, starting that Zyrtec or that Claritin two weeks before even sometimes a month before we anticipate that the pollen levels will be high for example can help control seasonal allergies and also really help control a child’s asthma as well.

Host: What great information so timely and so important, really usable information Dr Wawren. Thank you for coming on and sharing your expertise and that wraps up this episode with pediatric experts at Weill Cornell Medicine. Please visit our website at weillcornell.org for more information and to get connected with one of our providers. Please visit our patient care blog at  www.weillcornell.org/news Please remember to subscribe, rate and review this podcast and all the other Weill Cornell Medicine podcasts.

For more health tips and updates on the latest medical advancements and breakthroughs, follow us on Facebook and Twitter. I’m Melanie Cole.