Allergies and Childhood Asthma
An attack of asthma can usually be summed up by one word – distress! It may come on slowly or with shocking suddenness. It may be preceded by such signs as sneezing, coughing, a runny or stuffy nose, yawning – all followed by shortness of breath, choking and wheezing.
These symptoms increase until the child’s neck and chest muscles strain, not only to breathe air in but to exhale it. The pulse often races. The child’s face may be pale and the lips turn blue from lack of oxygen. Both face and body may become covered with sweat. There is a frightening feeling of suffocation and the child’s terror may serve to increase the harshness of the attack.
Strangely enough, however, infants commonly display little of this anxiety. They may lie peacefully on their backs, wheezing and struggling for breath, yet smile and even play with a toy during an attack. This is probably accounted for by the abdominal breathing pattern of infancy, which changes as the child grows older to thoracic breathing.
Asthma may appear at any stage of childhood, although it is less common during the first two years. When asthma does make its unwelcome appearance in infancy, food allergy is the most likely cause, especially sensitivity to milk (cow’s).
When the child begins to crawl and walk, his exposure to dust and other inhalants is greatly increased and he becomes vulnerable to respiratory allergens as well as to a variety of foods added to his diet. Thus, the age of onset can be a valuable clue for the doctor.
Heredity is a first-class predisposing factor in allergy and this we can understand.
But that so potent a respiratory disease can also be caused by something the child eats seems strange to most of us. It seems far more natural that a child might suffer an asthmatic attack after inhaling dust or pollen than after drinking a glass of milk!
Yet, it is often his sensitivity to food in his first years of life that starts the whole unfortunate business, and it is usually the child who suffers eczema as a baby who tends to have the severest problem later with asthma. Thus, it would be wise to look at allergenic foods that are most likely to cause asthma.
These are milk and milk products (cheese, ice cream), with the exception of cream cheese and cottage cheese; all beans except string beans; broccoli, Brussel sprouts, cabbage, cauliflower, celery, cucumbers, green peas, green peppers, lentils, mustard, onions, parsley, radishes and horseradish, both white and sweet potatoes, and turnips; raw apples, avocados, cantaloupes, honeydew melons, raisins, berries, watermelons, citrus fruits; nuts and peanut butter; tea, chocolate, and cocoa; carbonated drinks (colas, ginger ale); spices; salad oils using vegetable oils; food fried in vegetable oils; wheat; eggs; shellfish.
In infants, the most common foods that cause asthma are orange juice, wheat, milk, eggs, chocolate.
Unfortunately, pets and asthma do not mix. Strangely, it normally takes a dog in person to trigger the attack, whereas cats have an uncanny way of bringing on asthma by doing little more than passing by. Birds are especially poor risks as pets for the asthmatic child, for feathers are highly allergenic. Even cute little guinea-pigs must be forsworn.
Animal danders (skin flakes, scale, etc.) are such potent allergens that a highly sensitive youngster could react to their presence in the manure in a neighbor’s garden or on his sister’s riding jodhpurs.
Let us imagine that your family physician has just referred you to an allergy specialist because your child has recently suffered several bouts with asthma. As with other allergic manifestations such as skin or gastrointestinal symptoms, the allergist will require a full history of the child’s present illness, past illnesses, immunizations, and a family history of allergy, if there is one.
In discussing the child’s present problem, he may ask when it began and at what time of day or night it seems most prevalent and what time of the year. He may ask if there are any other allergy symptoms that appear at the same time (or at other times) such as eczema, cold symptoms, gastrointestinal discomforts.
He will inquire as to the child’s diet, paying particular attention to allergenic foods – how often and in what quantities? And there will be that standard question – are there any pets in the home? Or even in the close neighborhood? Have the parents noted that physical factors such as cold, heat, wind, and sun make a difference in the child’s asthma? What sort of furnishings are in the child’s bedroom? The rest of the house?
What sort of toys does he have? Play with most frequently? Where is he most bothered by wheezing – in the home, at school, outdoors, in the homes of playmates? What kind of cosmetics does mother use – including soaps, hair sprays, perfumes, etc.? What kind of insecticides are used around the house, and how often? Is there much in the way of painting, varnishing, waxing, etc. going on? Does the child cut the grass during the summer? Rake leaves in the autumn? Has he taken any drugs? What kind?
When he turns his attention to the family’s history of allergy, he may ask whether any member has asthma, hay fever, skin allergy, and what was their relationship to the child. The more members of the family who had an allergy, and especially if in the families of both parents, the greater the chances are, of course, that your child is also allergic.
The next step will be a thorough physical examination with careful attention to teeth, sinuses, tonsils, and adenoids as foci of infection and with special attention being given to the condition of the child’s chest. X-rays of the chest, and perhaps of the sinuses and adenoids, will usually be taken to determine both their condition and to rule out such possibilities as pneumonia, tuberculosis, growths, etc.
Laboratory studies that the allergist may order might include throat cultures; gamma globulin determination tests, which indicate whether or not the child can produce adequate antibody protection against infection; and sweat tests, which are employed to rule out the possibility of cystic fibrosis. Other studies he may wish made could be nasal smears and blood-cell counts to determine if the number of eosinophil cells are increased, which would then substantiate other findings of allergy.
One study that is of considerable importance in asthma is the Pulmonary Function Test, which evaluates the degree of lung function by determining how much air is being inhaled and exhaled, especially the latter, during the child’s respiration and how much remains trapped in the lungs. It may not be possible to perform this test on a very young child, since it requires a measure of co-operation on the child’s part.
Let us assume that the physical examination and laboratory tests, combined with the history of your child and your family, all point to allergy as being the cause of your child’s asthmatic attacks. The next step then is to pinpoint the specific allergen or allergens.
Skin tests can be very effective in many cases in hunting down the allergenic agents. Elimination diets and reintroduction of foods may have the same result when food allergens are at fault. Once the allergy-producing factor is discovered, there are several routes to take.
Avoidance, of course, is number one. Together, parents and children learn to manage the environment so as to eliminate allergenic factors of the child’s asthma.
Desensitization is effective in many cases and is called for when possible and when allergens cannot be avoided.
Medication that will relieve the child’s symptoms and make his lifeless uncomfortable and his asthma less debilitating. Medicine, however, does not affect a cure; it only relieves.
Perhaps we should briefly recapitulate avoidance measures:
- No pets in the house. If asthma is severe, no pets anywhere in the child’s environment.
- Dust-free bedroom.
- Parents should not smoke in the house or the presence of an asthmatic child.
- Save house painting, etc. for the summer months, when all the windows can be open.
- Be careful of insecticides, furniture polishes, and all sprays, including hair spray. There have been reports of increased asthma cases due to aerosol cans of all kinds, including deodorants.
- Infection in an asthmatic child should be treated early in the game.
- Chilling and overheating should both be avoided.
- Glues from animal sources may have to be avoided, but the child who likes to make models may do so undisturbed, for plastic glue (and white paste and rubber cement) do not seem to present a great problem.
- The child’s home chores will have to be chosen with care to avoid pollens, molds, dust, etc. As we have seen, grass-mowing and leaf-raking are not for the asthmatic child.
- Plants and flowers, whether potted or cut, should remain outdoors.
- Air conditioning helps cut down on pollen and mold in the home. Humidity should be kept at about 40 percent.
- Extreme temperature changes should be avoided when possible.
- Thus the house should be kept at as even temperature throughout as possible.
What is a mother to do? One of her most important contributions is to keep the child’s general health level high with plenty of sleep and a healthy diet (one that avoids, of course, any food allergen the child does not tolerate) and preventive measures against colds and other infections which could bring asthmatic attacks.
She should be certain that the older asthmatic child drinks a goodly quantity of fluid each day, at least ten glasses of water. Why? Because fluids thin the mucus that causes so much of the child’s problem and makes it easier for him to cough it up.
Clothes dampened by sweat should be changed at once. An electric blanket is excellent for such a child, not only to keep temperatures constant but to relieve tension and joint aches.
She should see to it that the asthmatic child eats his meals slowly and that he does not stuff himself, for even if he is not allergic to a specific food, overwhelming his digestive system can bring on an attack of asthma.
Fatigue must be avoided, for it predisposes to asthmatic attacks.
The mother of an asthmatic child should help him as best she can to avoid emotional stress. This may be a large order. An impossible order, for life is full of stress from unexpected quarters – home, school, playmates. But in so far as possible the asthmatic child should be encouraged, for instance, to lead a normal life; he should not be made to feel different, and if he cannot keep up with his peers in one area because of his disability, he should be encouraged to excel in another.
It is very likely that the doctor will recommend breathing exercises. Depending on the age of the child, the mother will have to help and supervise these, at least in the beginning.
The mother of a child with asthma must be on the lookout for the first signs of any infection. At the first symptom of a cold or other infection she should: keep the child indoors; even better, keep him in bed to protect against chilling, over-exertion and stress; be sure, of course, that his room is as allergen-free as is humanly possible; force fluids; keep a record of his temperature morning and night.
If the doctor has prescribed medications for just such occasions, start them quickly as per his instructions, for the earlier infection is caught, the less likelihood asthma will develop.
Finally, the mother of an asthmatic child must make a mighty effort to be matter-of-fact and calm about his wheezing attacks when they cannot be prevented, for the difficulty in breathing is a frightening thing, and the fear itself further upsets the child, making his efforts to breathe even more torturous.
Reference: Asthma – Journal Med Sci