JUST BREATHE
Your child will be happier and healthier if her allergies are treated — and if she avoids allergens whenever possible

By Nadyne Lee, CPNP

*First published in Spring/Summer 2008

Take a deep breath. Now let it out. For most of us, this exercise brings a feeling of well-being, relaxation and peace. But for children who suffer from allergies — or even worse, from asthma — practicing catch in the park, playing fetch with the dog and just taking a breath of fresh air can mean big trouble.

Causes of Allergies
Air is filled with many types of impurities: dust, pollen, chemical fumes and animal dander. Most people are unaffected by these common contaminants. But these airborne particles, as well as some foods, can wreak havoc in the life of an allergic child. The immune system of the allergic child overreacts to substances most of us find harmless, producing antibodies to attack the foreign substances. These antibodies trigger an allergic response.

Allergies and asthma are related, but differ in some ways. An allergy is the body’s reaction to a specific allergen (dust or pollen, for example). Allergic asthma, like other allergies, is caused by allergens, but the reaction inflammation occurs only in the lungs and bronchial passages. Asthma may also be nonallergic, including exercise-induced asthma or asthma that occurs in response to stress, cold air or a recent respiratory infection.

Allergy Symptoms
Allergic kids react to allergens with sneezing, a runny nose, red, itchy eyes, coughing, wheezing and rashes. Some children have dark circles under their eyes (allergic shiners) or creases near the tips of their noses (the allergic crease). Because many children can’t sleep when they can’t breathe well, they may be lethargic.

Allergies can lead to ear infections, hearing loss and speech delay. Environmental allergens cause inflammation in the ear and fluid retention behind the eardrum, which can cause chronic ear infections. A child with frequent ear infections, delayed speech or hearing loss should be tested for allergies.

Minimizing Allergens
The best way to treat allergic children is to decrease their exposure to environmental allergens such as cigarette smoke, dust, animal dander, pollens and inhalants. And if children are food allergic, it’s important to eliminate the offending allergy-causing foods from their diet.

Cigarette Smoke. For the allergic child, cigarette smoke is Public Enemy Number One. Second-hand smoke irritates the airways, which puts the child at risk for ear infections, bronchitis and severe allergic reactions. Your car and your home must become smoke-free environments if they’re not already. Smoking in another room isn’t a solution because the smoke still circulates throughout the house. Family members and friends who smoke should go outside and wear a smoking jacket that they can remove to keep the irritation away from the child. Quitting smoking is hard. But parents make many sacrifices for their children. If you decide to kick the habit, your health care provider can help.

Dust. We can’t do anything to stop dust particles from finding their way into our homes, but there are many ways to reduce dust, along with the thousands of mites that live in it.

■ Strip the bed and thoroughly clean the mattress with a vacuum cleaner. Cover the mattress with a mite-proof mattress cover (it looks like a huge pillowcase with a zipper). Wash sheets, blankets and curtains with hot water (at least 140°) once a week.
■ Remove dust collectors like trophies, model cars and stuffed animals from the bedroom. Your child may have a favorite stuffed animal that she just can’t live without. Giving up a teddy bear or bunny may not be an option, but these stuffed animals can take a trip to the freezer or a spin in the dryer for 20 minutes once a week. Both heat and cold are effective at killing dust mites without harming toys.
■ Change furnace filters monthly, and dust vents regularly.
■ If you cannot avoid having carpeting, vacuum daily using a HEPA filter bag and use a damp mop on wood or tile floors. Dust furniture daily with a dusting spray. Sounds like a lot of work, but the reward of a healthy, happy, well-rested child is worth it.

Animal Dander. Children who are allergic to animals react to pet dander (dead skin), urine and saliva. All mammals have pet dander. When dander becomes airborne and it finds its way to the airway of an allergic child, the child’s immune system goes on the offensive. The result is itchy eyes, a runny nose, coughing, wheezing and sneezing.

If you have an allergic child, you probably should not buy a pet. But many families have the pet before they have the child. This doesn’t always mean that your family pet needs to find a new zip code. Someone other than your allergic child should be the one to brush your dog — and to do so outdoors. Ask your veterinarian to recommend a supplement to reduce dander production. Since frequent bathing results in dry skin, bathe your pet only when the animal is dirty. Adding a small amount of cooking oil on the pet food can moisten the skin and help reduce the production of dander.

Cat saliva is also an allergen. Most cats are very neat creatures and spend a lot of time cleaning themselves with their tongues and paws. Cats mark their territory (or their humans) by rubbing their saliva-scented fur upon the object of their affection. Your allergic child is likely to get a big dose of cat saliva every time the family kitty curls around him.

The allergen on the fur of guinea pigs and hamsters is urine. Remind children that they must wash their hands after handling cats, guinea pigs and hamsters.

The good news is that you don’t have to replace your furry family friends with slippery, scale-covered creatures, as long as you take the proper precautions and limit your child’s contact with the pet.

Pollens. Airborne particles from trees, plants and grasses float through the air during the spring and throughout the fall. Keep your windows closed when possible.

Inhalants. You should avoid the use of perfume, aftershave, hairspray, mothballs and fresh paint. Room fresheners, fresh flowers and Christmas trees are also triggers for the allergic child.

Banishing Bad-News Foods
Many children are allergic to certain foods. The most common culprits are milk, wheat, eggs, nuts and chocolate. You should eliminate any food that your child is allergic to from his diet. This may not be as easy as it sounds. If your child is allergic to wheat gluten, for example, you will have to read labels at the grocery store and avoid cookies, cakes and pies, as well as some processed foods.

This does not mean that your child will forever be the only one at the birthday party not having cake and ice cream. Under the guidance of your health care provider or pediatric allergist, you may be able to re-challenge your child with the allergy-causing food after a six-month elimination period.

Classroom Comfort
Some children with allergies have difficulty performing well in school. Because of their chronic runny nose, itchy eyes or difficulty breathing, allergic children may be irritable, tired or inattentive. When the child’s allergies are treated, school performance may improve.

Here are tips to make your child’s time at school more comfortable and, therefore, more productive:

■ To avoid chalk dust, allergic children should not sit by the blackboard.
■ If the classroom has a pet, allergic children may react to the pet’s dander.
■ If the classroom is not air-conditioned, the allergic child may have difficulty breathing.
■ Children with asthma and other allergies are not contagious.
■ Children with asthma and other allergies should participate in school activities
and sports, as long as they follow their health care provider’s advice.

Treating Allergies
It is helpful to know which allergens are triggers for your child. Your pediatrician,
pediatric nurse practitioner or pediatric allergist can conduct a skin test or a
RAST blood test to determine the specific allergens troubling your child. After they
have been identified, the provider may prescribe weekly allergy shots to gradually
desensitize your child to her allergens.

Although avoiding allergens is best, the symptoms of allergies can be partially
treated with the use of antihistamines and decongestants. Your health care provider might recommend other medications like nasal steroids or a leukotriene inhibitor to help prevent allergies.

Allergies can be as minor as sneezing and itching; however, in some children,
they can be serious or even life-threatening. If you suspect that your child has a problem with allergies, consult your pediatric nurse practitioner or other health care provider.

FOOD-ALLERGY FACTS
■ Common food allergens are eggs, cow’s milk, wheat, soybeans (and soy formula), nuts, peas and shellfish.
■ Food allergies can cause hives, eczema, vomiting and diarrhea, breathing difficulties, shock and death.
■ Food allergies are treated by avoiding the offending foods. Hives can be treated with diphenhydramine.
■ Children who have suffered a severe reaction or anaphylactic shock should carry an epinephrine auto injector.

Nadyne Lee, CPNP, has been a PNP
for 30 years. She and her husband, Joe Lee,
M.D., a pediatrician, have a clinic in rural Kentucky.