December is that time of year which excites children and adults alike, not just because it gets a bit colder (yes to sweater weather!), but also because it brings us closer to celebrating Christmas. But for those parents with children who have asthma and allergic rhinitis, this season also heralds the onset of more frequent stuffy, runny noses and asthma attacks. The cold, dry weather can trigger airway narrowing (bronchoconstriction). This is especially true if your child has exercise-induced bronchoconstriction a.k.a. exercise-induced asthma. Your child would usually inhale through his/her mouth, causing the air to be dryer and cooler as compared to breathing through the nose. Also, the dry season would allow more dust and pollen to circulate in the air, hence the more frequent occurrence of allergic rhinitis.
Allergic rhinitis, also known as hay fever, is a common and chronic immunoglobulin E-mediated respiratory illness that can adversely affect the quality of life. This means that your child’s body overreacts to things that usually do not cause problems for most people, which are called allergens. The body’s reaction to these allergens is what causes symptoms. Asthma, on the other hand, is a chronic inflammatory condition of the lung airways resulting in episodic airflow obstruction. The chronic inflammation increases the twitchiness of the airways – termed airway hyperresponsiveness (AHR) – to common provocative exposures. As one would notice, these two conditions have some similarities which would allow some overlap concerning their management.
As a parent, you would want to be able to help your child as much as possible with his or her symptoms. Fortunately, many things that can be done to alleviate these conditions.
According to Nelson’s Pediatrics, the goals of therapy for allergic rhinitis is safe-effective prevention and relief of symptoms. For asthma, the key components of management are:
1. Assessment and monitoring of disease activity
2. Education to enhance patient and family knowledge and skills for self-management
3. Identification and management of precipitating factors and comorbid conditions that worsen asthma
4. Appropriate selection of medications to address the patient’s needs
These objectives, although they may seem intimidating, are very achievable through a combination of non-pharmacologic (avoidance of triggers, environment modifications, etc.) and pharmacologic interventions (medications). That is why the cooperation between the parents, physician, and patient is very important in addressing these conditions.
Allergic rhinitis is firstly managed by avoiding the allergens that trigger the symptoms. According to the American College of Allergy, Asthma, and Immunology, both outdoor and indoor exposures should be regulated. Here are some suggestions:
A. Outdoor Exposure
Ø Stay indoors as much as possible when pollen counts are at their peak (depending on where you stay and the type of pollen), and when the wind is blowing pollen around.
Ø Avoid using window fans that can draw pollens and molds into the house.
Ø Use eye protection (glasses or sunglasses) when outdoors to minimize the amount of pollen getting into the eyes.
Ø Avoid eye rubbing; doing so will irritate them and may make your child’s symptoms worse.
B. Indoor Exposure
Ø Keep windows closed and keep air conditioning units clean.
Ø Reduce exposure to dust mites, especially in the bedroom. If possible, use “mite-proof” covers for pillows, comforters and duvets, and mattresses and box springs. Wash your child’s bedding frequently using hot water (around 54?C).
Ø Clean floors with a damp rag or mop rather than dry-dusting or sweeping.
C. Pet Exposure
Ø Wash your child’s hands immediately after petting any animals and wash their clothes after visiting friends with pets.
Ø If your child is allergic to a household pet, keep the animal out of your home as much as possible. If the pet must be kept inside, keep it out of your child’s bedroom so that he/she is not exposed to animal allergens while sleeping.
You should also avoid exposing your child to aerosol sprays, air pollution, irritating fumes, and tobacco smoke as these may make symptoms worse.
Most children with asthma have an allergic component to their disease. Hence, avoidance of triggers similar to the ones listed for allergic rhinitis may help prevent attacks. Allergic testing should also be considered for at least those with persistent asthma. It should be kept in mind that acute exacerbation of asthma – an asthma attack – must be managed with appropriate medication and prevention can only do so much.
Also, other conditions such as rhinitis, sinusitis, and gastroesophageal reflux (if present) should be treated to control asthma attacks.
Try as you might, you may never be able to truly eliminate exposure to the offending allergens and especially for asthma, random attacks are possible. There are several medications available for the treatment of allergic rhinitis and asthma. You should pay a visit to your pediatrician so that your child would receive a treatment regimen that is tailored especially for him/her.
For allergic rhinitis, some medicines that can reduce nasal congestion, sneezing, and itchy and runny nose. They are also available in different forms – oral tablets, liquids, nasal sprays, and eye drops. Some of these medications are also used in the management of asthma and will also be briefly discussed in the corresponding section.
1. Intranasal corticosteroids – These are the mainstay of treatment for allergic rhinitis. They reduce the reaction of the nasal tissues to inhaled allergens and helps relieve the swelling in your child’s nose.
2. Antihistamines –This helps reduce sneezing, runny nose, and itchiness of allergies.
3. Decongestants – These provide temporary relief to the stuffy nose of allergies; they are best used only for a short time because prolonged use may lead to rebound rhinitis, also known as rhinitis medicamentosa.
4. Cromolyn Sodium – This drug comes as a nasal spray but requires frequent administration (every 4 hours).
5. Immunotherapy – This type of treatment is usually considered for children whose symptoms cannot be adequately controlled by avoidance and medication. With asthma, immunotherapy for allergic rhinitis prevents the onset of asthma.
For asthma, your doctor may prescribe two types of medications, relievers and controllers.
1. Relievers are given to treat an asthma attack – sudden onset of coughing, wheezing, and shortness of breath. This usually comes as an inhaler and should always be with your child for use at the first sign of symptoms. Some examples are short-acting beta 2 agonists, anticholinergic agents, and systemic corticosteroids.
2. Controllers are given to treat the inflammation of the airways to prevent asthma symptoms and attacks. Some examples are inhaled corticosteroids (low-dose ICS is the preferred treatment for all patients with persistent asthma, given alone or in conjunction with other medications), leukotriene modifiers, long-acting beta 2 agonists, and methylxanthines.
Depending on the severity of your child’s asthma, your doctor may prescribe only one controller and reliever or provide a combination of the options.
With all the intricacies of managing allergic rhinitis and asthma during the dry season, the key takeaway points are: prevent exposure to allergens and be vigilant in taking the medications prescribed by your doctor. If you keep those two things in mind, then you can breathe easy knowing that your child can breathe easy too.