Seasonal allergies or asthma?

[eggallergymom]

My 7 year old daughter is miserable right now. She's always had seasonal allergies, but this spring has been a nightmare for her. We've upped her Zyrtec dose to help with the itchy eyes and nasal stuff, and she takes Zaditor eye drops, too. But she's now developed a chronic cough and says her chest hurts (when she coughs). The allergist suggested Delsym, which helps a bit at night, but makes her really sleepy so I'm reluctant to dose her in the morning before school. I'm worried that this is asthma, albeit a milder case. She isn't wheezing, but she is coughing quite a bit and says her chest hurts in a specific spot. She's also prone to lung infections, having had pneumonia twice and bronchitis once in the past calendar year. The allergist's nurse said that seasonal allergies can manifest in a cough, too, and wasn't concerned about asthma because DD has always done well on the lung capacity tests at her regular exams. But is that a reliable litmus test for asthma, given the other stuff? Ultimately, I don't want her to have asthma, but if she does, we need to know that, given the LTFA. I'm wondering if we need to get her in to see a pulmonologist? Get a second opinion from another allergist? Or do some of your kids experience this with seasonal allergies? This just doesn't feel right to me.

[Mookie86]

Is the cough caused by postnasal drip?  I'd rule that out before considering an asthma diagnosis.

If there is postnasal drip, perhaps adding a nasal spray like Nasonex would help?

What about adding Singulair?  That would help whether it's asthma or seasonal allergies.

[MandCmama]

I have mild asthma that sounds similar to what you're describing.  My DH has allergy induced asthma.

[MandCmama]

Oops! Hit post too soon. I'd see the dr. Won't hurt anything if it's not and you'll feel better!

[eggallergymom]

Thanks, everybody. Mookie--I do think postnasal drip could be part of it. She's been really congested for a few months now. She's been on antibiotics for 10 days for an ear infection, so I can't imagine she's developed a new infection. I think I will get her in to see the allergist, though, just to double-check. Thanks again!

[Janelle205]

Like Mookie, I would seriously consider a steroid nasal spray.  They're targeted, so they don't have the nasty side effects of something like pred, and for me, Flonase makes a WAY bigger difference than my daily antihistamine. 

[Carefulmom]

Singular is used to treat asthma or allergic rhinitis (seasonal allergies), so using it won`t help you decide if your dd has asthma.  A good way to tell would be to try an albuterol inhaler (with a spacer---ask your ped or allergist for a script for this).  That will help you decide if it is asthma or not.  If she responds to albuterol, she has at the very least reactive airway disease, which usually means asthma.  If she has had three lung  infections (three in the past year, right?), that is a pretty big red flag for asthma.  Have you actually discussed this with the allergist?  Or only the nurse?  I am surprised based on this history that he would not cut to the chase and prescribe albuterol.  If it doesn`t help, you could stop it after a day or two, and if it does help with the cough, it will make all the difference in the world.  And yes, if she has it, you really need to know.

Also, no one in the home is smoking, right?  That could also explain it.

[eggallergymom]

Nooooo, no smokers here. I haven't discussed this with the allergist yet, just the nurse. I'll see what he says.  Thanks for the advice!

[eggallergymom]

My DD saw the allergist this morning, and he thinks she does have asthma. He said that with the egg allergy, eczema and seasonal allergies, it was likely she would develop asthma at some point. He's prescribed the albuterol inhaler. I now have to revise the 504 plan for next year to reflect the asthma and that she'll have an inhaler at school. We talked quite a bit about her egg allergy, too. We're going to repeat her RAST testing next month but her numbers (from last year) are still just so high he doesn't think she'll outgrow it. Intellectually we knew this (at least, I did), but it's hard to hear. 

[Carefulmom]

Sorry to hear that she has asthma, but glad she got a dx.  He prescribed a spacer, too, right?  It is almost impossible for a child that young to use an inhaler correctly without a spacer.  Even dd uses a spacer still at 17.  If she doesn`t use the inhaler correctly, it doesn`t work, so that is why dd still uses a spacer.

One word of caution on the asthma.  It is a difficult decision how much you want to tell the school about the asthma.  I never said much to the school about it.  Several people (Sabrina Shannon, Nathan Walters) died because they had ana food reactions, but used the inhaler instead of the epi, because they thought it was asthma.  In Sabrina`s case, she was about 13 and she said it was only an asthma attack.  However, Nathan was in 3rd grade, and the school decided it was only an asthma attack.  They did not actually use the epi until 1 -2 hours into the reaction.  He died.  So you will want to think carefully what to tell the school, so that they don`t use an albuterol inhaler as an excuse to wait and see when it could be an anaphylactic reaction to egg.  This is even more important with your dd`s history (the pudding incident).  My dd almost never wheezed and only really had the albuterol inhaler for cough when she had a cold or viral illness, so I totally played down the asthma.  I lived in fear of the school using albuterol instead of epi.  I never gave the albuterol inhaler to the school, and had dd self carry it (with forms filled out for school, legal in our state).  I only had dd carry it on days when she was coughing, just a few times a year.

[eggallergymom]

Thanks, Carefulmom. Yes, she has a spacer. The allergist thought that was a pretty important thing to have, too. I wish our insurance company had agreed with him! It's amazing how much I just shelled out at the pharmacy for two packages of albuterol and two plastic tubes. Grr.

Thank you very much for the advice about the asthma versus the LTFA, too. I asked the allergist to write out a detailed action plan, should she have another egg exposure at school. He said the correct order is Epi first, inhaler second. He's going to write it all out, though, and that will become part of her 504 plan. I also notified the 504 coordinator that we'll need to revise her plan again to reflect this diagnosis. Once I have the written plan in hand, I'm going to talk to the nurse at school in person, to make sure she understands that the Epi injection comes first. So far, my daughter's asthma symptoms have been pretty different from her ana symptoms (from the last big reaction, anyway) so I'm hoping she'd be able to differentiate the two. Though, if she were really sick, she wouldn't be able to articulate that, so they'd need to know to Epi her first. Because of what happened last year, her action plan (also written by the allergist) says that she's to have an Epi injection after any known or suspected exposure to eggs, whether she's having any symptoms or not. So their threshold for giving her the Epi should already be pretty low. Hopefully. I feel like I need to put a giant asterisk after everything, given last year. 

[Carefulmom]

One more thing to think about is what to do if she is coughing and wheezing and does not have a known exposure to egg?  All of dd`s food reactions have been after no known exposure.  Later I called companies and we figured out what it was.  One even triggered a national recall.  It was an item that had milk as an actual ingredient, but they inadvertently left it off of the ingredient list.  Therefore, the item appeared safe, but dd (allergic to milk) had a reaction that was only respiratory.  I sent the leftover food for testing and it tested positive for milk.  The company had made a mistake. So I think you have to give them instructions for if your dd does not have a known exposure, but has respiratory symptoms.  Use epi first or albuterol?  We are lucky, because dd only has asthma symptoms if she has a cold or if she is having an allergic reaction.  But for kids with chronic asthma, it becomes less clear cut when to epi and when to use albuterol inhaler.  Anyhow, I think you really do need to spell out for the school if no known egg exposure how to decide whether to treat it as asthma with inhaler or to treat as food allergic reaction with epi.  The food allergic reactions that don`t give skin symptoms and only give respiratory symptoms are more likely to lead to a fatality, because the person or caregiver thinks it is asthma and uses albuterol when they should epi.

[eggallergymom]

Good questions, Carefulmom. So far, she's known right away that she was in anaphylaxis--and that's been every time, even when she little. The last reaction was different in that she didn't throw up at all or have any hives, as she had before, but she did have the bad taste in her mouth, then the tickly throat, then nausea, then the hoarseness (when her throat was swelling shut at the hospital--before the next round of Epi). She was also very "altered" about ten minutes into it, for lack of a better word. By the time we got to the hospital she wasn't coherent at all, which scared the hell out of me.
 The asthma symptoms she's experienced so far have been pretty mild--no wheezing at all (even after running a few miles with me on Saturday!), just a little bit of a tight feeling in her chest, and that dry cough during the day, particularly if she's been outside. I think those sensations/symptoms are different enough that she wouldn't confuse them. And knowing the school nurse as I do (she was the only one who took my daughter's reaction seriously last year, and Epi'd her), she'd Epi her if she had ANY question. After what happened, I get a call if my daughter has a hangnail or scrapes her knee. No joke.

I'm hoping that a lot of this is because the part of the country we live in is having the worst spring pollen season in 15 years. I'm pretty miserable, too, and seasonal allergies are usually just annoying for me.

My daughter has had one mystery reaction that we finally chalked up to cross-contamination from a deli slicer (last time we got anything from a deli.) But she knew right away, after just a few bites of her sandwich. I Epi'd her that time.  I hope it continues to be this clear-cut for her. But we will make sure her plan spells out the procedure clearly, particularly since she's changing schools  (and school nurses) next year.

[Carefulmom]

Yes, you just want to make sure that the school does not use the fact that she has asthma as an excuse to give albuterol and then wait to see if she improves, resulting in delayed epi.

[Mfamom]

I think the school should know she has asthma though.  In gym, they start doing a mile run early on (here anyway) and the teacher needs to have that information so if she has an asthma attack during class, she is able to get help. 
I also worried about school mistaking asthma for anaphylaxis.  On the asthma action plan, the box is checked to give epi pen if symptoms dont improve after albuteral. 
I have also told my son that if he is ever having an asthma attack and it doesn't improve with his inhaler to use the epi pen.