Protecting children from winter allergies, asthma

Dr Karambir Singh Gill, Assistant Professor, Paediatrics at Dayanand Medical College & Hospital, is the first certified paediatric allergy and asthma specialist in Ludhiana city. He talks to Manav Mander about the common allergens and how to treat and overcome them.

Q What are the common respiratory allergies in children?

Allergic rhinitis (running nose or sneezing), atopic dermatitis (eczema) and asthma are the major respiratory allergic conditions observed in children. Allergic rhinitis affects 10-30 per cent of all adults and 40 per cent of children. In India, estimated prevalence of asthma is around 7-15 per cent among children with higher incidence among boys and in urban areas. Nowadays even rural areas are witnessing a rise in allergic cases.

Q Why are allergic conditions increasing in current times?

There is increase in air pollution in all major cities of India. The majority of cities in Punjab have AQI of over 100, which is unhealthy. Fall in temperature in winters with deteriorated AQI poses serious health concerns to children in form of allergies and asthma. Air pollution and asthma have synergistic effect. It causes irritation and inflammation of airways. PM 2.5 penetrates deeper into the respiratory system and causes higher inflammation.

Q How is asthma diagnosed in children below 5 years of age?

In younger children the diagnosis of asthma is challenging and needs detailed history and examination. Recurrent episodes of cough and wheezing, each lasting for more than 10-15 days is a strong predictor. If first degree relatives have a history of allergy and asthma, it favours early diagnosis. Nowadays, we perform lung function tests (PEFR, spirometry and oscillometry) to diagnose asthma and skin prick test to identify allergens.

Q What are the common allergens that trigger reaction?

Mattresses, carpets, pillows and heavy curtains can get infested with house dust mite. It is the faecal particles of the mite which tend to be the major allergen causing sensitivity and then asthma. Mold (fungus) on damp walls releases millions of spores in the air. Cigarette smoking, use of agarbati, mosquito coils, fresh paint, furniture polish, floor cleaners, air fresheners, perfumes, and use of talcum powder can act as triggers. Pollen, cold air and air pollution are the common outdoor allergens. Pollen calendar helps identifying seasonal change in pollen exposure.

Q Are nebulisers safe for kids?

Nebulisers were originally designed for use by adult patients. International guidelines (GINA) advises against home nebulisation for control of symptoms. Bronchodilator drugs used for nebulisation can cause tachycardia and tremors in higher doses. This augments the risk of airborne infections increases. Widespread use also has ocular side effects as these drugs get deposited all over face. Ideally nebulisation in children should be done in a hospital setting while monitoring oxygen saturation.

Q What is right way to administer inhalation drugs to kids?

The safest and most effective way to give bronchodilators to a child is with inhalers through a spacer device. Spacers allow the aerosol (drug particle) delivery directly to lower airways (lungs) and avoids deposition in upper tracts. The main advantage is that a small dose of drug required, and there is rapid action with less side effects.

Q Do allergies run in families?

Allergic disorders have a genetic predisposition. Asthma runs in families and children of asthmatic parents are at increased risk. One asthmatic parent increases the chances of allergies in children by up to 25 per cent, while both parents increase risk it to 50 per cent.

Q Myth or fact: Kids with cough should not consume milk?

It is a myth that milk increases chances of cough and asthma. In case a child has an immediate reaction within 2 hours of milk intake in the form of skin rashes (urticaria) and fall in blood pressure, IgE mediated cow milk protein allergy is suspected. Blindly stopping milk in a child who has cough and wheezing is a wrong practice and should be discouraged.

Q What are the general measures advised for long-term control of asthma in children?

Acceptance of diagnosis and early treatment is the key. We should not be afraid of using inhalers. Most children do well within 3-6 months of starting treatment. Adequate physical activity, yoga and breathing exercises promote cardiopulmonary fitness and improves lung function. Obesity is known to increase chances of asthma, hence weight control is crucial. Further, a diet rich in proteins, fruits and vegetables enhances our fighting capacity against illnesses. Fast food rich in trans fats, sugary drinks and preservative-rich foods all trigger allergies and should be avoided.