Southern Peninsula Paediatric Allergy strives to provide education and understanding to parents and children to enable them to better manage their medical problems.
Asthma is a common condition which is due to a sensitivity of the small tubes leading down to the lungs. These tubes become inflamed and the inflammation leads to changes in the tubes which result in the symptoms of coughing, wheezing, shortness of breath, "rattliness" and "chestiness".
Asthma can be an inherited sensitivity and is related to a number of other sensitivities which includes rhinitis or hayfever, eczema, sinus problems and food allergy.
There are other multiple triggers for asthma which can include virus or colds, climate factors such as temperature variations, exercise, atmospheric irritants such as smoke, dust and fumes as well as allergy factors due to sensitivities to airborne allergens (aeroallergens) such as house dust mite, pollens, animal fur and moulds. Other factors such as stress and emotion can be important for some individuals.
The treatment for asthma can be divided into three parts:
The first is the accurate diagnosis of asthma and potential triggers that might be avoidable e.g: smoke, aeroallergens.
The second part is a plan to treat symptoms when they occur. The most effective medications are called relievers or bronchodilators such as salbutamol (Ventolin) or terbutaline (Bricanyl). These need to be used appropriately to achieve maximum benefit. There used to be a concern about using large doses but it is now recognized that larger doses e.g: 6 puffs instead of 2 or 3 puffs (which was previously recommended) will be more effective at opening up the airways. For older children and adults, 6-12 puffs every 3-4 hours is often now recommended. It has also been shown that using the aerosol (puffer) through a spacer will increase the deposition in the airways significantly so again it is recommended that a spacer be always used in conjunction with an aerosol (puffer).
The third part of the asthma treatment often involves the assessment of and the need for daily maintenance treatment to control asthma symptoms. The decision for maintenance or preventative treatment is based on principally the history of the asthma symptoms such as the frequency, severity, symptoms in between obvious episodes and the disruption to normal daily activities.
There are two types of preventative preparations available. One is a chewable tablet called Singulair(R) which is useful for the children with frequent episodic asthma. This is usually taken daily on a long term basis (months and sometimes years).
The alternative is an aerosol spray (puffer) containing a steroid preparation (e.g: Flixotide) which comes in various strengths and is usually twice a day administration, again best used with a spacer.
If the steroid preparation alone is not satisfactory to control the symptoms, there is a compound aerosol spray which contains a steroid (e.g: Flixotide) and a long acting Ventolin (Salmeterol). This combination is often effective in preference to increasing the dosage of the steroid alone. The steroid sprays used for prevention do not work immediately. They take several days to work to reduce the inflammation in the airways and therefore are not recommended for occasional use such as to treat symptoms but are designed to be used longer term (months to years).
Once control has been established for some time, it is possible to reduce the dosage (back-titrate) and still maintain good control. The current inhaled steroids have low levels of absorption into the body and can be safely used in the recommended doses for long periods of time without concern for side-effects.
It is also known that under treated chronic asthma has a significant impact on the health and growth of children as well as make them more susceptible to picking up other illnesses and affecting their involvement with sport and schooling. For this reason, the diagnossis and proper treatment of asthma should be an important goal for any family who have children with asthma symptoms.
Steriod Phobia is a common concern for parents of children with eczema.
There are many myths and incorrect beliefs about steriods.
This article by two British Consultant Dermatologists provides answers to many of the concerns and questions regarding steriod usage.
Mosquito bites are common, annoying and often difficult to avoid given Australians love of outdoor living especially in Summer.
In Southern Victoria, fortunately, we do not have mosquito's that carry nasty diseases such as Malaria, Ross River fever and Murray Valley Encephalitis.
Most mosquito bites will result in a small itchy papule (swelling) which disappears within a day or two. It can become infected if the temptation to scratch it is not controlled otherwise it is nothing more than irritating.
Some people however (adults and children) do develop much larger reactions than usual at the site of the bite which can be alarming and distressing. Often there is a family history of similar large reactions. Sometimes the swelling will appear to become bigger with subsequent bites and concern is raised about the possibility of potentially very severe reactions such as generalized (system c) reactions that could involve breathing difficulties (called anaphylaxis)
Fortunately anaphlaxis to mosquito bites is very, very rare. A survey was carried out over the whole of Europe and North America and out of millions of people exposed to mosquitos, they were able to identify 14 individuals who had definite evidence of a systemic reaction (eg hives, swellings, breathing problems) and allergy antibodies (IgE) to mosquito were detected from blood tests.
So, local reactions are common but more severe reactions are incredibly rare.
For those people who do develop large local reactions to mosquito bites, apart from trying to avoid mosquito's (appropriate clothing especially at dusk, staying indoors at night, insect repellant), other strategies helpful in reducing the swellings include: immediate icing of the bite area, large dose non-sedating antihistamines (eg: Zyrtec, Claratyne or Telfast) and topical corticosteroid cream or ointment (eg: Elocon, Novosone, Advantan) or a single dose of oral prednisolone as soon as possible after the bite.
Some children (and adults) seem to "attract" insects and are bitten far more often than others. Insects hone in on chemicals our body emits and people producing certain chemicals called pheromes seem to be particularly pleasing to mosquitos.
For these individuals, avoidance of being bitten is virtually impossible and taking daily non-sedative antihistamines over the summer period when mosquitos are more prevalent and active can often reduce the local swelling.