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Triggers for Asthma and Allergies

Spring is almost here, which means that your child may be experiencing more allergies and asthma attacks. But what do you do if there is something triggering the allergies and asthma in the home? Dr. John Prpich, pediatric pulmonologist from St. Joseph’s Children’s Hospital took time to answer our burning question: what are triggers in the home and how do we fix them?

Are asthma and allergies related? Is something that is an asthma trigger also an allergy trigger?

Patients can have allergies which means that their body responds to something in the environment or something that they are exposed to so that might be pollen or dog dander or dust mites, or it might be a food that they ingest. But in order to be allergic your body has a response to something in the environment that your body is exposed to.

You can only have allergies meaning that you have nasal congestion or itchy or watery eyes or if its a food allergy you might have GI upset like nausea, or you might even have anaphylaxis which is a severe response– but you still may not have asthma.

Unfortunately, the people who do also have asthma will have further symptoms which include wheezing, coughing, more lower airway symptom. So in a sense, you can think about asthma as an extension of that allergy. But, some people have asthma and their triggers are not allergic. So they might be triggered by a viral infection or by exercise or cold air, so you don’t have to have allergies in order to have asthma, and you don’t have to have asthma in order to have allergies, but they’re very closely connected and very often an individual will have both and their asthma will be triggered by their allergies.

Are there any common household triggers that parents should look out for if their child has frequent asthma attacks in the home?

Absolutely. Our two most common triggers for asthma — specifically allergic triggers– are going to be dust mites or cockroaches. Its a little bit tricky though because when people hear dust mites the first thing they think of is just dust, so they think its an allergy to dirt or something that blows in through the window, but it is actually that you are allergic to a very small mite that is eating the dead skin that we slough. When we clean, a lot of what we are dusting up is the dead skin that has fallen off of our bodies, so it is kind of a creepy thing but what you are often allergic to are those dust mites. And dust mites can live in your pillows, stuffed animals, your bedding, and carpeting. So often kids might have chronic problems that are worse at night because a lot of the dust mites are located in an area like a bedroom, so that’s why you might wake up first thing in the morning with a lot of runny nose, itchy or watery eyes, and coughing and asthma. Dust mites are very very common and there is a very big correlation between dust mites and asthma.

With cockroaches it is not so much that you are allergic to the bug that might be running around and its not that you are interacting with the bug, it is droppings or parts of the cockroach that cause problems. So it is those small bits that you might not even know you are touching when you do have cockroaches– and you probably do because we live in Florida and they are everywhere– that are causing the reaction.

If you’re noticing chronic symptoms that are worse in the morning and at night, the first thing we think of is that you have a dust mite or cockroach allergy.

Other things in the home that can trigger symptoms are things like a dog or a cat. You don’t always have to get rid of the animal but you do need to practice some kind of limited exposure. Remove the animal from the bedroom, try to provide a safe zone. Some people do have to get rid of the animal though, depending on the level of the allergy.

Other common things that people may not think about would be if there’s something that might be inhaled like cleaning material, like sprays can trigger symptoms. People are always concerned about mold in the home as a reason for the symptoms as well. We live in Florida which means we have a chronic, low-level mold exposure, but if there is any increase or water damage in a wall, or an AC unit that is a window AC unit you may see a black mold or a sort of slime, so if there is anywhere that you see mold or water damage that can certainly trigger asthma and allergies.

Colognes, purfumes, cleaning materials, paint, those are on the non-allergic side but can be triggers. Dust mites and cockroaches are the most common triggers, though.

Is there anything parents can do to minimize the triggers? Should parents be using any special filters or anything? 

The world of environmental control measures, meaning what you can do in the home to limit exposure, is pretty big and you can spend quite a bit of money. But unfortunately except in a few certain areas, you can spend a lot of money with relatively limited impact. While air filters are nice and someone will sell you very expensive, very elaborate air filtration systems with different HEPA filters that tell you the size of the particles they filter out– those tend to be relatively over priced for the amount of benefit. It’s very very hard for large systems to truly filter all of these allergens out of the amount of air that is circulating through a general home. Of course if you have a very sensitive child with a lot of asthma you want to keep your AC unit clean and change your filters on a regular basis, but you really don’t need an elaborate expensive filtration system.

The most beneficial thing is knowing the patient’s triggers are, which is why we do skin testing. If the patient is dust mite or cockroach allergic, you can do pillow case covers and mattress covers which are going to be very effective at limiting exposure. You can wash stuffed animals at a higher temperature to kill dust mites on a regular basis and you can vacuum and clean the carpeting on a regular basis to eliminate dust mites there. But those tend to be more effective when they are in tandem with identifying the allergens. So I always tell families: “Lets identify allergens first, and then we can talk about control measures so that you’re not wasting a lot of time and a lot of effort when maybe they don’t have any allergies to those items at all.” Maybe it is outdoor allergens, and there is no way you are going to clean the oak trees in your yard.

I see commonly that parents have taken a lot of effort to tear up their carpet or spend money on elaborate expensive things, got rid of the dog and sent the cat away, and then they come in and it is an allergy to oak. So it is wasted time and then you don’t have your pet anymore. So knowing what the triggers are is the most important before you embark on any big changes.

If a child is having a lot of reactions in a short time should they see their pediatrician first?

It depends. In Florida its hard because we have at least some degree of year-round allergy. Of course dust mites and cockroaches are not seasonal, dogs and cats are here year round, but other allergens are seasonal and unfortunately in Florida we have a blur of seasons so there is a bit of a cross-over. So right now, if we have a bit of a cold and flu season but we can also have pollen allergies. So sometimes trying to tell the difference between a runny nose RSV, or a runny nose virus, compared to the runny nose of allergies can be hard. So it is safest to start by talking to your pediatrician to determine if the the symptoms are allergic or infectious. Then, based upon the severity and frequency, coming to see us is helpful to identify exactly what the trigger is an to come up with a treatment plan.

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