Childhood Asthma

The Rites of Spring

Stravinsky had other things in mind when he wrote, “The Rites of Spring”.  For many, however, the rites of spring (and summer and fall) includes sneezing, nasal congestion and eye itching.  These symptoms, often called “hay fever”, are seasonal allergies due to the reproductive cycle of plants and mold which results in the dissemination of pollens and spores in the atmosphere.  Allergies are in a sense an over-reaction of the body to foreign substances which are perceived as being potentially harmful.  This form of response actually is an important defense mechanism in parts of the world where parasitic infestation is a problem.  In effect, the body reacts to pollen and molds as if they were parasites, with good intention but harmful results!

Allergies vary from being a mild nuisance to disabling, with extreme itching of the nose and/or eyes, roof of the mouth, throat and ears.  They often can involve great fatigue due either to the hay fever itself or medications used to combat it.  They can be associated with other respiratory illnesses, giving rise to sinus or recurrent ear infection and also may be associated with asthma.

If symptoms are mild, they may be tolerable even without treatment, or may be reduced satisfactorily by the occasional use of antihistamines, many of which are sold over-the-counter.  Antihistamines make many people sleepy, and may not be tolerated or may be ineffective.  They are best used a preventatives — that is, antihistamines are most effective if used in anticipation of symptoms rather than after symptoms have begun.  In recent years, various other medications including the newer none sedating antihistamines, nasal sprays that contain weak anti-inflammatory agents, and drugs which block the release of histamine a nd similar chemicals which actually are responsible for allergy symptoms, have become available.  These can be used safely under medical supervision for prolonged periods of time with virtually no side-effects.

If symptoms are severe, the cause of the allergies should be determined with the aim of eliminating sources of allergens where possible, and, if necessary, immunizing against the non avoidable allergens to decrease sensitivity to inadvertent exposure to them.  Any evaluation should involve a thorough history and appropriate physical examination, and allergy tests (usually “skin tests”) for detecting allergic antibody.  Although other kinds of allergy blood tests (sometimes called RAST tests) are available and have been highly publicized in recent years, unfortunately they still are less sensitive and less revealing
than skin tests.  Because of this and the fact that they are less cost-effective, skin testing is preferred to the blood tests by the vast majority of knowledgeable allergists certified as experts in this field by The American Board of Allergy and Immunology.  Allergy tests and allergy immunization procedures are under constant research and refinement.

Here are simple procedures for hay fever sufferers to do for themselves:  Keep the windows in the bedroom closed overnight where feasible to cut down overnight pollen and mold exposure, keep any clothes used for gardening or playing outside during the day out of the bedroom at night, and shower at night, thereby minimizing pollen and mold exposure in the bedroom.  (The average person spends a third of his or her life in the bedroom!)  Air conditioning is a useful device to filter pollens and molds and decreases exposure to these allergens.  It is wise to remember that exposure to allergens and irritants ordinarily tolerated the rest of the year, but present indoors, may greatly intensify symptoms from exposure to the seasonal pollen and mold allergens, and avoidance of these substances during the hay fever season is helpful in diminishing symptoms.  This is particularly true of animals which not only can induce symptoms themselves, but carry pollens and molds indoors as well.  Consequently, it is especially important to keep animals out of the bedroom in particular, and out of the house as much as possible.

Finally, the impact of allergies on function at school and at work, and on general well-being including fatigue and irritability should not be underestimated.  Help is available, and there is no reason to suffer!

 

 

Allergy Injections– More than a “Shot in the Arm”

Allergy injections, a long used treatment for allergy and asthma sufferers are getting a “shot in the arm” from recent research. For over a century, we have known allergy immunotherapy (AIT) is highly effective and improves quality of life. This recent research brings immunotherapy to the forefront of patient-centered, cost-effective care and furthers our understanding of the immune system.

Research:

Allergy immunotherapy is the only allergy treatment available that actually changes the immune system, making it possible to prevent development of new allergies and asthma. According to this recent research, allergy immunotherapy also significantly reduces healthcare use and cost for prescription medications, outpatient visits and hospitalizations. Seven million patients in the U.S., children and adults with allergies were enrolled in this research from 1997 – 2008. Allergic patients receiving allergy shots were compared with similar patients who did not receive this treatment.

Results:

Adults and children combined showed that AIT-treated patients incurred 38% lower average total 18-month health care costs ($6,637 versus $10,664), as well as significantly lower costs for hospitalization (41% lower), outpatient (57% lower), and pharmacy services (18% lower), than patients who did not receive allergy immunotherapy. Average cost savings per patient were $4,397 (30%) for adults and $3,965 (42%) for children.

Conclusions:

Allergic rhinitis (allergies that affect the nose, eyes, throat and sinuses) affect approximately 1 in 5 Americans, and is associated with substantial clinical and economic burden.  Allergy sufferers can experience disturbed sleep, decreased energy, poor performance at school and work, and millions of lost work and school days annually.  In 2005, the estimated total direct U.S. cost of allergic rhinitis exceeded $11 billion. Prescription medications accounted for more than half of these costs, although over the counter allergy medications were not included in this cost assessment.

How does the allergy sufferer begin treatment? The first step for the health care provider is the review of the patient’s history followed by allergy testing for common, specific allergens such as house dust mites, grass, tree, weed pollen, animal dander and mold spores.  Once the specific allergen is identified the health care provider should provide education regarding the most efficient methods for avoiding environmental triggers.  Allergy injections made up of allergens that the patient demonstrated as positive on skin testing will be started first at low dosages gradually increasing as the patient tolerates. Allergy medications may also be used until the allergy injections are increased to a maintenance dosage.

Allergy immunotherapy is the only preventive allergy treatment that changes the immune system preventing the progression of new allergies and the allergic progression from allergic rhinitis to asthma.

Allergy immunotherapy is a well-established, safe and effective treatment. This recent research clearly shows that allergy immunotherapy is cost effective and these cost benefits occur within a short period of time. Allergies and asthma are serious, high cost, debilitating, chronic illnesses that can be treated and controlled with patient-centered allergy and asthma care.

Reference: American Academy of Allergy, Asthma and Immunology, www.aaaai.org Allergen-specific Immunotherapy decreases medical costs in allergic children and adults, Hankin, Journal of Allergy and Clinical Immunology

Classroom Lessons about Asthma

Recently one of our R.N. Asthma Educators was invited to speak to a classroom of third graders about asthma.  One boy in the class who was known to have asthma told his teacher that he felt his classmates didn’t like him because he had asthma. He even felt they made fun of him when he was having difficulty breathing or when he could not run fast due to his asthma.

Our nurse started her class presentation by comparing the bronchial tubes with the branches of a tree, larger near the trunk, getting smaller near the end of the branches. She next asked what they thought might trigger asthma. One by one the children named triggers: cigarette smoke, car exhaust, having a cold, exposure to animals, grass pollen, house dust, feathers, playing in leaves, running or playing hard, cold air, strong smells.

The next question came from a classmate who wanted to know if you can catch asthma from someone like you catch a cold. Another student asked if you can die from asthma, still another wanted to know if you ever get over asthma. One child asked what you can do to help someone who is having difficulty with asthma.

She told them that their suggestions for triggers were exactly correct; no, asthma is not contagious like a cold or strep throat, you can’t catch asthma from another person.  Death from asthma can happen, but is rare if treatment is followed as directed by the patient’s doctor. Helping someone with asthma is a matter of understanding and realizing the asthmatic person wants to be treated just like anyone else.

This third grade class taught their own lesson about asthma!

Prepare for a Sneeze and Wheeze-Free Holidays

The holiday season, the most wonderful time of the year can also be the “most stuffiest” time of the year for the more than 40 million Americans that suffer from allergies and asthma. By planning ahead and treating symptoms before they start, you can enjoy a sneeze and wheeze free holiday season.

Allergy and asthma triggers can be difficult to escape during the holidays.  Visiting family and friends, exposure to burning candles, strong odors, indoor pets and dusty holiday decorations can all serve as triggers for increased allergy and asthma symptoms.

Insure that your holidays are enjoyable and symptom-free by following these tips:

  • Be Selective with Decorations: Everyone loves a festive home, but watch out for hidden allergens that can lurk in the decorations. Decorations may be dusty and loaded with allergy-triggering dust mites especially if they have not been stored in airtight plastic containers. Some people are allergic to terpene found in the sap of Christmas trees, or are bothered by the mold that lurks on the trees. Consider artificial trees, wreaths and garland. Also watch out for poinsettias which can be problematic for people with latex allergies since the plant is part of the rubber tree family.
  • Be Alert for Hidden Food Allergens: Food allergens can show up in the strangest places- peanut butter in chili, ground nuts in pie crust, shellfish in stuffing, even turkey can be a landmine. Allergens in the stuffing can absorb into the meat, so try cooking the bird unstuffed. Also stick to a natural turkey, which contains only turkey and water, since self-basting turkeys can contain soy, wheat and dairy.
  • Sugar and Spice and Everything Nice: Pine-scented candles and strongly scented air-fresheners can provide and inviting aroma, they can also act as  a trigger for increased allergy and asthma symptoms. About one-third of people with asthma report health problems from air fresheners, which contain volatile organic compounds (VOCs). Studies show VOC exposure even below accepted levels can increase the risk of asthma in children. Open the windows to air out the house, or let the scents from the oven provide natural aromas.
  • Beware of the Thanksgiving Effect: Even if you can tolerate your own cat or dog, you may find yourself sneezing and wheezing when you return from visiting friends or relatives homes for the holidays. This flare-up of pet allergies in called the Thanksgiving Effect. Pretreat with medications that your allergist has prescribed before visiting homes known to have pets that you are allergic to.
  • Allergen Free Home Sweet Home: Change furnace filters at least monthly, make sure fireplaces and wood burning stoves are well vented to prevent fine particulate matter from entering your living spaces, do not allow anyone to smoke cigarettes or cigars indoors and use artificial Christmas trees and garland to help reduce the indoor allergens and irritants that can trigger allergy and asthma symptoms.
  • Preventive Measures Work: Talk with your physician regarding preventive treatment that may include avoidance of triggers and medications. If you haven’t already done so, get your flu shot, maintain a healthy diet, get plenty of rest and avoid as much stress as possible.

Have a happy, healthy sneeze and wheeze-free holiday season!

Asthma Patients: Exercise is Good for You!

Does walking, running or jumping cause you to have a tight chest, shortness of breath or wheezing? Do you often cough or wheeze after you’ve exercised.  If the above statements sound familiar, you may have exercise-induced bronchoconstriction (EIB). This happens when the tubes that bring air into and out of your lungs narrow during exercise making it difficult to move air out of your lungs.

What is exercise-induced bronchoconstriction?  EIB is a temporary narrowing of the airways caused by strenuous exercise or activity. It may begin during exercise or after exercise has ended. Some people say it feels as if their chest is too small for their lungs.  Others experience cough, wheeze or chest tightness. EIB occurs in 80-90% of people with asthma and in almost 50% of people who have nasal allergies.

What are the most common triggers of EIB? People with EIB are very sensitive to cold temperatures and dry air. Air is usually warmed and humidified by the nose, but during strenuous exercise people breathe more through their mouths allowing cold, dry air to reach the lower airway and lungs without passing through the nose. Air pollution, high pollen levels and viral respiratory infections may also trigger EIB. In addition increased breathing problems during exercise may be triggered by being out of shape, having poorly controlled nasal allergies, poorly controlled asthma or vocal cord issues.

How is exercise-induced asthma diagnosed? Wheezing or tightness in your chest can be serious, let your physician know about your symptoms and the type of activity that triggers your symptoms.  Your physician can help you by reviewing your health history, reviewing the medications that you have used and by doing a breathing test (called spirometry) at rest and also a follow-up exercise challenge test measuring spirometry before and after exercise.

Can exercise-induced asthma be treated?  One of the first steps for controlling EIB is finding the correct medical help and confirming the diagnosis based on your medical history and spirometry/exercise challenge testing. Using this information your physician will create an individual treatment plan with you.  Which activities may be more suitable for you?  Medications, treatment of allergies and modified warm up, cool down methods can be used to control EIB.

The American Academy of Allergy Asthma and Allergy estimates that 1 in 6 (17%) of the U.S. Olympic athletes who competed in the 2012 Summer Olympics in London, have EIB  but were able to control their EIB and successfully win numerous gold, silver and bronze medals.

The goal of an asthma treatment plan is to keep your EIB symptoms under control so that you can enjoy exercising or sports activities. Studies show that exercising on a routine basis improves lung capacity, reduces the amount of medications needed and overall improves asthma control.

 

 

Back to School Tips for Students with Allergies and Asthma

September signals the beginning of another school year for students of all ages from preschool through college. Parents and children with asthma and allergies often feel anxious at the thought of returning to school because of the potential for problems relating to their allergies/asthma as well as their ability to participate in school activities.

The start of the new school year also brings exposure to new environments, stress from new activities, the fall allergy season and viral infections. Often, children get viral illnesses at the beginning of the school year, but some of what looks initially like a virus might actually be allergies related to environmental exposures—indoor dust, animal dander or pollen.

Communication and cooperative care between parents, students, teachers, school nurses and your physician’s office will enable your child to attend school regularly and function at an optimal level.

  • Educate yourself regarding your school’s policy for medications that may be needed at school, sample questions to ask: what age are students allowed to carry their quick relief asthma inhaler, where will my child’s inhaler be stored, who will make sure my child takes his inhaler if needed?
  • Obtain necessary medical paper work from your child’s school, update and take to your child’s health care provider for validating and signing.
  • Visit your Allergist/health care provider before school starts to “tune up” your child’s allergies and asthma and to update your child’s asthma/allergy care plan. This plan should contain a maintenance plan as well as an emergency plan should allergies and asthma symptoms increase at school.
  • Update and refill all medications that will be required to be kept at school. This could include asthma inhalers, injectable epinephrine, Prednisone and antihistamines.
  • Discuss with all your child’s teachers, school administration and the school nurse/health aid, specific triggers and early warning signs and symptoms of deteriorating asthma and allergies.
  • If your child has been diagnosed with asthma or has difficulty with increased asthma symptoms during exercise inform teachers regarding your child’s care plan that may require premedication 15 – 20 minutes before exercise.
  • If your child has been diagnosed with severe food allergy, inform school if strict avoidance is needed and recognition of symptoms if food is accidentally eaten.  Provide EpiPen (emergency injectable epinephrine), Prednisone and antihistamines that your physician has prescribed to be used if needed should accidental ingestion occur. Provide detailed list of foods to be avoided (your allergist’s office can give you a list of foods that contain the allergic food).
  • If your child has been diagnosed with a severe reaction to stinging insects inform your child’s school of your physician’s emergency plan for treatment. Provide school with EpiPen (emergency injectable epinephrine and antihistamines as prescribed by your physician.
  • Provide your child’s school direction for seeking emergency treatment and adequate phone numbers to reach you the parent.

Parents should be encouraged to communicate with teachers regarding their child’s health issues. Many days, children spend more time face-to-face with their teachers than they do with their parents. Teachers can be on the lookout for symptoms such as repeated coughing or exercise-induced wheezing. Sometimes teachers notice these things before the parents. Effective communication will help your allergy and asthma student function in all phases of his/her school day.

Tips for Traveling with Allergies and Asthma

 

 

Summer has officially arrived; vacation, that special time of year is scheduled for many. This time away could be a family vacation traveling by car or by plane to visit relatives or friends within the U.S. or it could be that special trip abroad. Perhaps it is an exciting solo trip for your child to attend a camp away from home.  

 

 If you have allergies and asthma, advance preparation will help insure that you have a pleasant trip that includes controlled allergy and asthma symptoms and prevention of serious allergic reactions.

 

  • Anticipate your allergy needs; check the pollen counts for the geographic area that you will be visiting. The following website lists a U.S. map with pollen counts by date: www.aaaai.org/global/nab-pollen-counts.aspx

 

If you previously lived in a geographic area and had increased allergy symptoms during a specific time of year try to avoid visiting during those times. An example would be the person who grew up in the Midwest with a history of severe allergy symptoms every August and September during the ragweed season. Returning to the turf of your youth during August and September would likely cause you to remember why ragweed season was not an ideal visiting season for you.

 

  • Take adequate medications along even though you are not taking them daily now. Make sure your medications are in-date and in adequate supply if for some reason your trip home is delayed. Keep all medications with you; do not pack medications including your inhalers or emergency medications in your luggage that will be checked through with your baggage at the airport. 

 

  • If you are allergic to cats, dogs and other indoor animals, check to make sure the homes that you are visiting are pet free or that you will have a pet free sleeping room. This would also apply to hotels where animals are allowed in the sleeping rooms.

 

  • If exposure to mold causes you to have increased allergy and asthma symptoms, avoid basement sleeping rooms as they are often a source of mold, especially if carpet is installed over a concrete floor.

 

  • Travelers who are severely allergic to foods or insect stings should have 2 of their emergency epinephrine self-injectors available at all times.

 

  • Severe food allergies: carry safe snacks, create and carry a business-sized card to give to the waiter that lists your food allergies and state that your food must be cooked in a clean and safe area to avoid cross contamination. For a sample of cards in several languages visit www.faiusa.org  and enter in the search line “food allergy cards”.

 

  • Check with your Dr. when planning for your vacation, are your allergies and asthma in control, are you taking the appropriate medications to control and prevent your allergy and asthma symptoms? Should you start medications before you begin your trip that will help control your allergies and asthma? Do you have a written daily care plan and do you have an emergency plan?

 

Your preparation will assure that you and your family will have that special vacation that you deserve.

 

“Take Me Out to The Ball Game”

 

 Spring is here! Flowers are blooming, grass is green, trees once again have leaves, and the baseball diamonds and soccer fields are occupied with players of all ages. Many of these youthful athletes (nearly 40%) are allergic to airborne pollens such as grasses and trees.  For them, spring and the opening of a new season of baseball also means the beginning of increased sneezing, wheezing, hives, headaches or itchy swollen eyes. The wind that is often present during the springtime, increases exposure to grass and tree pollen and also stirs up higher doses of mold spores. Allergy sufferers often experience fatigue during the allergy season due to their increased sneezing, wheezing or eye itching.

 It’s difficult to enjoy the outdoors when your allergy symptoms cause you to feel miserable.

 Before you go out to the ball game arm yourself with some good allergy defense:

  • Take allergy and asthma medications that your physician has prescribed as a preventive before taking part in outdoor activity.
  • Avoid over the counter allergy medications that can cause drowsiness.
  • Shower and shampoo immediately after returning from the outdoors.
  • Keep pets outdoors and out of your bedroom as they often carry pollens indoors on their fur.
  • Consider an allergy treatment plan that includes allergy injections which can change the way your body reacts to pollen and other allergens
  • Keep bedroom windows closed during the pollen season.

 

 

Oral Allergy Syndrome

Oral Allergy Syndrome

Do you ever get an itchy mouth, tongue and lips when eating apple, celery, peach or watermelon?  If so, you could be included in the up to one-third of allergy sufferers who’s pollen allergy sets them up to react to particular foods.

If you suffer from hay fever and have experienced an itchy mouth or scratchy throat after eating certain raw fruits or vegetables and some tree nuts, you may have oral allergy syndrome (OAS).

Oral allergy syndrome, also known as pollen-food syndrome, occurs because the proteins found in some fruits and vegetables are very similar to those found in pollen. These proteins can confuse your immune system and cause an allergic reaction or worsening of existing allergy symptoms.

Individuals react to different foods based on the type of seasonal allergies they are affected by. Examples of this cross-reactivity;  if you are allergic to birch tree pollen, a primary airborne allergen responsible for allergy symptoms in the springtime, you may have oral allergy reactions triggered by almond, apple, carrot, cherry, cucumber, hazelnut, kiwi, parsley,  peach, pear and plum.

An allergic person who gets a runny nose or drippy, itchy eyes when exposed to ragweed pollen in the late summer and fall might develop an itchy, tingling mouth or lips when eating foods with similar proteins. Examples of food and ragweed pollen cross-reactivity are banana, cucumber, melon and zucchini.

Similarly, people with allergies to airborne grasses may have an oral allergy reaction when eating celery, peach, banana, melon, tomato, orange and kiwi.

Oral allergy syndrome symptoms appear soon after the food is eaten and symptoms are usually limited to the mouth, tongue, lips and pass away quickly. Research demonstrates up to 9% of patients with oral allergy syndrome can potentially develop a serious, severe allergic reaction called anaphylaxis that will require immediate emergency treatment.

Symptoms can seem quite random. Many people are only bothered during the pollen season; the rest of the year they can eat pollen-related foods with no problem. So if they are allergic to ragweed, eating a melon in February (when ragweed is dormant) may not bother them at all, while eating melon in September (when ragweed pollen counts are high) could set off symptoms with the first bite. Other patients report that they can eat cooked but not raw fruits and vegetables or can tolerate them if the peel is removed.

Children and adults can develop oral allergy syndrome even if they have eaten these foods previously without problems. Also, parents might not associate a child’s dislike of a vegetable or fruit with an allergic reaction.

Food-related symptoms can sometimes alert you to a more dangerous allergy such as latex. A board-certified allergist can give you an accurate diagnosis using a thorough history, skin testing, or oral food challenge advising you which foods to avoid and recommend treatments to relieve your symptoms. This treatment could include a prescription for an epinephrine auto-injector to treat potential severe reactions.

Childhood Asthma

Childhood asthma has become more widespread in recent decades. As the most common chronic illness in children, childhood asthma causes more missed school days and places more limits on activity than does any other disease in the United States. Childhood asthma and adult asthma have the same underlying cause – inflammation (swelling) of the airways. Approximately 75% of children with asthma have allergies that trigger this inflammation. This swelling causes the asthmatic patient’s airways to narrow, leading to signs and symptoms that range from minor coughing or wheezing to serious flare-ups that interfere with breathing.
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