'Tis the Season: Allergies and Asthma

Since we’ve talked about autism recently, I thought it would be worthwhile to note that the American Academy of Pediatrics (AAP) is offering a new resource on CD called Caring for Children with Autism Spectrum Disorders: A Resource Toolkit for Clinicians. If you haven’t already, check it out.

Shortly after relocating to Atlanta in 1988, I met a pediatric allergist who had formed a rather large practice, opening up multiple offices in and around the city. He joked that between the poor air quality and the naturally occurring allergens, Atlanta was the perfect place for his specialty. He also warned me that anyone who comes to Atlanta without allergies will develop them, provided they stay long enough.

Bless his prophetic heart - eighteen years later, I found that I had begun sneezing without necessarily having a cold. Last year, my eyes began to water and swell while helping my 6 year-old retrieve and play with her pet rabbit from its pen. And this past winter, I began to wheeze and cough uncontrollably after walking across the university campus in the cold night air. Embarrassed, I went to the doctor and got an albuterol inhaler, which helped to control the coughing fits just a little bit better than zip. The warmer spring weather has helped abate the symptoms to some degree, but I predict I’ll need a different prescription before long.

I don’t think my daughter will be as lucky as her mother in avoiding allergies into middle age. Like me, she also began to wheeze this past winter, especially when she had a respiratory virus. And although she mercifully has not developed coughing fits to date, I’m watching closely. Smoking is forbidden in our house, but we have just about every other known allergen around us— dander and feathers from pets, dust, an incredible amount of pollen, and, clean as I might, mold will occasionally turn up in a bathroom that was flooded when my daughter went to clean her shoe in the sink, got distracted, and left the room with the water running.

Interestingly, a study recently presented at the American Academy of Allergy, Asthma and Immunology (AAAAI) annual conference found that a majority of children who wheezed with colds by age 3 developed asthma by age 6. Allergen exposure was also a predictor of asthma development, but not to the same extent. This data is preliminary, but it does suggest that wheezing in young children who have rhinovirus infections should alert the pediatrician to a strong possibility of asthma down the road.

Considering that asthma is the most common chronic illness in childhood and the third leading cause of hospitalization in kids, it may be beneficial for clinicians to follow these children more closely. It also may be helpful to alert parents of children who wheeze with colds to the possibility of asthma so that they are cognizant of other warning signs.

Do you do this already, or will this new information cause you to modify the way that you approach patient care in your practice? Share your ideas and experiences here.