Managing asthma and hay fever in kids

Written by: Dr Kishor Tewary
Edited by: Laura Burgess

Asthma symptoms occur due to inflammation of the upper airways, causing a partial obstruction during exhalation and presents with a typical musical sound called a 'wheeze' and difficulty in breathing. Hay fever symptoms are produced due to the inflammation of nasal mucosa and usually presents with nasal stuffiness, sneezing, and a runny and blocked nose. The eyes can also be affected causing itchiness with occasional redness, watery discharge and swelling around the eyes. Both hay fever and asthma are on the spectrum of atopic conditions and are usually caused by the release of intrinsic enzymes such as histamine or cytokines. 

Leading paediatrician Dr Kishor Tewary offers his advice on managing asthma and hay fever symptoms, how the two conditions intertwine and how to differentiate between them both.

If a youngster suffers from asthma are they also likely to suffer from hay fever?

It’s usually the other way round. A person suffering from hay fever may have a predisposition to asthma. However, not everyone with hay fever suffers from asthmatic symptoms.

How important is it that my child follows their inhaler regime?

Once diagnosed with asthma, it is important to continue with the inhalers as prescribed. There are usually two types: the blue and brown. The blue is a reliever and used when a child feels wheezy or breathless. The brown inhaler is a preventer and once started should be continued every day, as per prescription, unless the doctor has reviewed the condition and decided to stop it.

It is quite common for people suffering from asthma to have seasonal triggers, such as pollens that worsens their symptoms. Once diagnosed, doctors are supposed to provide an ‘asthma treatment plan' to address this exacerbation and the ways to titrate the dose of inhalers. If provided with a treatment plan, people can titrate their inhalers themselves as per prescribed. However, if the symptoms are not settling, getting worse, or if they have not been provided with a treatment plan, they should seek an opinion from their doctor.

Are some parents actually missing the signs of asthma thinking their child is simply suffering from hay fever or an allergy?

Asthma is often present with a unique noise while breathing, which is known as wheezing. This is a musical sound heard during the exhalation. The child may have breathlessness also. Asthma should be checked out if parents think that their child is wheezy or having difficulty in breathing.

What precautions can we take to protect our child from the effects of hay fever?

Avoidance of triggering factors, such as exposure to grass and pollen, often help. However, it can be extremely difficult and damaging to a child's day-to-day life to implement this. The general precautions recommended are to:

  • Avoid high pollen count areas/weather
  • Shake and wash clothes after coming back from outdoors
  • Keep windows closed
  • Dry the clothes inside or in the dryer
  • Regularly shower
  • Avoid histamine producing food - smoked and cooked meat, fish, cheese and nuts
  • Take more of omega 3 fatty acid though green vegetables, carrots, beans and fish oil
  • Avoid any environment filled with smoke, including cigarettes.

Once onset occurs, it is usually treated symptomatically. Many children respond to steroid nasal sprays which reduce the inflammation within the nose. Antihistaminics such as Cetirizine or other non-sedating/sedating also helps by blocking histamine and can be taken after discussing with a pharmacist or a doctor. There are also antihistamine nasal sprays as well as non-medicated nasal sprays. Any medication should not be used without advice from a pharmacist or a doctor. If my child has hay fever and I know they are not asthmatic, is there any point taking them to their GP if symptoms appear more severe than usual? It is always advisable to see a doctor if symptoms are more severe than usual. 

Are there any lifestyle changes that could ease the problem?

A good and active lifestyle often boosts the immunity. Avoidance of histamine-releasing food and taking more of carotene and omega 3 fatty acid has been shown to provide some relief, although the evidence is variable.

By Dr Kishor Tewary

Dr Kishor Tewary is an experienced consultant paediatrician, with a special interest in paediatric urology and nephrology, treating conditions such as bedwetting, urinary incontinence, urinary tract infections and hydronephrosis. He also treats a wide range of general paediatric conditions including abdominal pain, gastric reflux and asthma. Dr Kishor Tewary is based across the Midlands, in both Birmingham and Solihull.

Dr Tewary qualified in 1987. After working for several years as a paediatric consultant in India, he went on to gain further paediatric training with the NHS, becoming a consultant and Fellow of the Royal College of Paediatrics and Child Health in 2007. He continues to further his clinical knowledge, and attends many conferences internationally, most recently presenting at the International Congress of Paediatrics in Athens. He has had many years of experience as a paediatrician, and as a result, he understands children and their parents very well, ensuring that the whole family is involved in the process.

Dr Tewary is regularly involved in educational activities, and has also recently featured on ITV speaking on the issue of 'Children and sleep disorders'. He has recently been awarded the 'Lifetime Achievement Award' from the 10th International conference of Scientists, Engineering and Medicine in 2020, and 'Certificate of Excellence' from Top Doctors. 

Dr Tewary's publications include a recent book chapter on 'PFAPA and its association with facial swelling' in 'The Recent Developments in Medicine and Medical Sciences, volume 7'.

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