The curse of chronic childhood diseases – Dr Greg Clugston
You’re not imagining things if it seems more kids these days are suffering from eczema, asthma and hay fever.
In developed countries, the incidence of these childhood atopic diseases has skyrocketed over the past few decades. Today, one in four Australian children are affected by at least one atopic disease1. It’s common for a sick child to exhibit symptoms of more than one of these conditions.
The physical symptoms of these conditions can range from mildly annoying skin rashes through to life-threatening asthma attacks.
Simply put, an atopic disease is a condition that results from being hypersensitive to allergens. An atopic child produces antibodies (known as immunoglobulin-E) when exposed to allergens. These antibodies trigger a cascade of cellular responses that ultimately result in symptoms. This is known as a type 1 hypersensitivity reaction and is the underlying mechanism for all atopic disorders.
Though we still don’t completely understand the reasons for the increase in the prevalence of childhood atopic diseases, we do know it’s linked to many factors. These include genetics, lifestyle changes, environmental irritants and our diets.
Below I’ll explore the three most common of these diseases* and offer parents and carers tips for treating affected kids.
The most common form of eczema is atopic dermatitis. It presents as dry, itchy and irritated skin.
In small children, it typically starts on the face, elbows and knees. Older kids might get eczema in the folds of their elbows, hands and knees, as well their scalp and behind their ears.
It can be pretty nasty stuff. Unfortunately there’s no known cure.
Eczema is aggravated by numerous factors including:
- chemical irritations (chlorine, detergents and soaps – bubble baths are a definite no-no)
Food sensitivities can also be a culprit. Some of my younger patients avoid substances like artificial colours and preservatives, egg, peanuts, seafood and soy. However, it’s worth discussing with your doctor before you start excluding foods from your child’s diet.
We do know that early introduction of ‘allergenic’ foods is important. It’s counter intuitive, but the very foods we sometimes seek to avoid can be introduced before a child is six months old as a prevention tactic. Please consult your GP before heading down this path.
Eczema treatment tips
Try these simple techniques to manage your little one’s eczema at home:
- Keep them cool, especially on hot days.
- Moisturise their skin daily, or more often if needed, especially after playing outside or bathing.
- Use antihistamines and cold flannels to reduce itching and scratching.
- Observe and note foods that make eczema worse.
You can also apply topical creams prescribed by your GP such as cortisone-based treatments. Some parents are overly cautious about using this steroid, yet I assure you it’s perfectly safe – and very effective.
For more detailed information, check out this fact sheet on eczema from The Royal Children’s Hospital Melbourne.
Asthma is a cruel disease characterised by the constriction of inflamed and swollen airways. Added to the symptoms is increased mucus production, making it even harder for kids to get a lungful of air.
Acute asthma attacks, also known as asthma episodes, can occur when things get really bad. Such attacks are a leading reason for emergency department visits – often contributed to by sub-optimal management at home.
Unsurprisingly, these attacks can be terrifying for kids and parents alike.
It’s vital that you’re prepared and have an asthma action plan in place for your child. These should be created in consultation with your GP. These potentially lifesaving plans give parents and carers a way to recognise symptoms and include instructions for when symptoms present. Asthma action plans should be reviewed annually with your GP.
There’s a lot that can irritate your child’s airways and trigger asthma symptoms. Some of the critical factors include:
- air pollution and smoke
- colds and respiratory infections
- animals and pets
- household dust and mites
- cold air.
As with the other childhood atopic diseases, there isn’t a cure. Luckily, many children simply grow out of their asthma.
Asthma treatment tips
Above all else, call 000 immediately if your child has a severe asthma attack. Don’t try to fix the problem with inhalers or other medications.
Aside from this, you can help manage their asthma by:
- making sure they carry their blue reliever puffer everywhere
- teaching them how to use medication
- learning asthma first aid
- ensuring preventers are taken every day (if prescribed by a GP)
- using spacers
- giving them annual flu shots
- staying calm in the event of an asthma attack.
For more information check out this helpful website for children with asthma from Asthma Australia.
Allergic rhinitis, commonly known as hay fever, results from an allergic reaction to airborne allergen particles getting trapped in the small hairs in the nose. Though most of us make little fuss of this, prone children can suffer a great deal.
Uncontrolled sneezing, itchy ears, nose and throat, red eyes and headaches are common symptoms. Often it won’t go away on its own. Untreated hay fever can lead to all kinds of problems including sleeplessness, acute eye infections and poor concentration at school.
Many kids with asthma unfortunately also suffer from hay fever. The trigger factors are pretty much the same for both childhood atopic diseases. High pollen-count days are a nightmare!
Limiting irritation factors is your best weapon in reducing symptoms of flare ups:
- Get pets out of the house.
- Avoid smoking around kids.
- Close windows and doors.
- Don’t mow the lawn.
Hay fever treatment tips
You’ll probably hear of many possible ways to treat your child’s hay fever symptoms. My advice is to stick with methods that have some scientific evidence of their effectiveness. Some of these include:
- looking for obvious hay fever aggravators and eliminate the source
- nasal sprays
- non-sedating antihistamines
- washing your child’s hands and bathing their eyes throughout the day
- using eye drops to relieve itchy eyes
- smearing Vaseline around the nose to help trap allergens
- giving your child spoonful of locally produced honey each day may help in some instances.
In severe cases, your GP may suggest allergen immunotherapy as an option to explore. It involves gradual repeated exposure to specific allergens over time, usually years. The theory is that your child will produce less immunoglobulin-E in response to the allergens and this will reduce the atopic symptoms.
For more detailed information, check out this fact sheet from the Australasian Society of Clinical Immunology and Allergy.
1 Gold M.S., Kemp A.S. Atopic disease in childhood. Med J Aust. 2005; 182 (6):298-304.
* Food allergy is a fourth childhood atopic disease for which we’ll do a separate blog post for in the near future.