Understanding the intersection of asthma and environmental allergies

Mengdi Lu, MD and Bethany Bartley, MD, pediatric pulmonary fellows at Mass General for Children, discuss the connection between asthma and environmental allergies and the steps you can take to manage these two conditions. 

 

What’s the connection between asthma and allergies?
Asthma and allergies often go hand in hand, but are not the same thing.  Allergens are substances which trigger allergic symptoms such as stuffy or runny nose, scratchy throat or itchy eyes.  In some people who have asthma, breathing in certain allergens can trigger asthma symptoms.  These people are sometimes said to have “allergic asthma.”  The most common allergens that trigger asthma are indoor allergens such as cats, dogs, dust mites, mold spores, rodents, cockroaches; as well as outdoor allergens, such as pollens from trees, grass and weeds. 

How do I recognize symptoms of asthma?
Common symptoms for asthma include frequent coughing, difficulty breathing and wheezing.  Wheezing is a whistling sound you hear when your child exhales.  However, not all children with asthma will wheeze and sometimes wheezing can only be heard with a stethoscope.  Coughing at night or during exercise may be a sign of asthma.  Your child’s doctor can help provide more information on asthma and examine your child if he or she has these symptoms.

How do I recognize symptoms of allergic rhinitis?
Rhinitis means inflammation of the nose.  Allergic rhinitis, also known as hay fever, occurs when contact with allergens cause symptoms including runny, itchy nose and eyes, nasal congestion and sneezing.  Remember, some children are allergic to things that are mainly indoors, while others have trouble when playing outside.  Some children are only affected in the spring or fall while others may be symptomatic year-round.

Could allergens be triggering my child’s asthma?
Allergens entering the lungs can trigger the immune system and lead to lung inflammation in children with asthma.  Asthma attacks may be directly tied to increased exposure to a child’s allergen, and result in wheezing and increased work of breathing.  More commonly, allergen exposure from indoor or outdoor allergens can be associated with chronic airway inflammation and airway reactivity.  For many children, this inflammation may go unnoticed until another trigger for their asthma presents, such as a respiratory virus.

What can I do to prevent and manage asthma symptoms during peak allergy season?
First, work with your child’s doctor to determine if environmental allergies may be playing a role in your child’s asthma.  He or she may ask you about when and where you’ve noticed symptoms or ask you to keep a log.  Create an asthma action plan and allergy plan with your doctor with instructions on how to prevent and manage symptoms.  Your doctor may prescribe medications for your child to take. 

Can my child be tested for allergic triggers for their asthma?
If we find that your child has a history of allergy symptoms around certain exposures or seasons, or if their asthma is difficult to control with standard therapies, we may consider doing a blood test or a skin test to look for specific allergies.

What if my child is allergic to our family pet?
Asthma treatments minimize symptoms; however, they are not curative.  Allergen avoidance can be of benefit in allergic asthma.  If we find that your child has an allergic response to a family pet, we can help to mitigate their exposure to pet allergens.  The first step is keeping the pet out of the child’s bedroom.  Only in severe cases where a child’s asthma is difficult to control, would we consider advising you to find another home for your beloved pet.

What if my child is allergic to pollen?
There are several steps you can take to help reduce exposure to pollen.  Check the pollen count in your area before your child goes outside, especially on dry, windy days.  On days with high pollen count, keep the windows closed and use air conditioning to keep comfortable.  When your child goes back inside the house, have him or her change his or her clothes and shower or bathe daily to wash away pollen on the skin.

What if my child is allergic to dust mites?
Though dust mites to do not bite, some people may have allergies to dust mites.  Dust mites commonly live in bedding, including pillows, blankets, and mattresses; and in carpets, rugs and stuffed animals.  Special protective covers for pillows, mattresses, comforters and box springs are widely available to protect those items from dust mites settling in.  Wash your bedding in hot water with laundry detergent or drying on high heat for 20 minutes to get rid of dust mites.  Keep stuffed animals off your child’s bed and try to avoid carpeting and rugs in your child’s bedroom.  Since dust mites like warm, humid environments, dehumidifiers and air conditioners may be used to keep your home cool and dry.  It’s important to stay away from humidifiers as they cause dust mites to replicate.

Does second hand smoke exposure trigger asthma?
When present, second hand smoke exposure can be considered a child’s number one trigger for asthma.  Exposure to second hand smoke increases a child’s risk of developing asthma, and increases their severity of asthma symptoms.

Third hand smoke exposure, which is the residue left on surfaces like clothes from tobacco smoke, may also affect children with asthma and allergies.

Bottom line, tobacco smoke exposure is unhealthy for everyone, especially children with asthma.  To prevent asthma symptoms, it is important to avoid second hand smoke exposure for your child as much as possible, especially in your home or car.  For third hand smoke exposure, a good rule of thumb to follow is, if you can smell tobacco on your clothes, you should change your clothes to prevent potentially triggering asthma symptoms in your child.

Where can I get more information?
For additional information on asthma, call the MGfC Pediatric Pulmonary Clinic at 617-726-8707.