Earlier this month I wrote about the ups and downs of peanut allergy diagnosis in our family. On one medical visit for my son Dexter's lingering cough, the doctor used a term I had not heard before, but have since come to know well, "The Allergic March".
The Allergic March refers to a cluster of allergy-related diseases that occur in childhood. These often occur in a typical sequence, appearing early in life, continuing for many years, but often disappearing or lessening with age.
Here is an example of a typical sequence of Allergic March conditions and symptoms. My son's Allergic March followed this typical pattern:
- Infant eczema
- Food allergy
- Environmental allergy and associated stuffy nose
- Childhood asthma
In our case, the infant eczema was not severe. It appeared simply as very dry, chapped skin. Now, at age 7, he still gets very dry wrists and hands in the winter, but my home remedy of olive oil and aloe seems to help.
I have already
written about the food allergy and while we had been cautious about introducing nuts early because of a familial predisposition to food allergies, I am sure we did not expect that he would actually have an allergy.
The asthma was a surprise and took several months to diagnose at the age of 5.
Dex never had what I would characterize as an asthma attack. It was simply a lingering dry cough for several months that bothered him at night and upon any, and I mean ANY, physical exertion. For instance, a 10 minute walk to school would set off a cough every 10 seconds for a good hour.
On a vacation to Mexico, I finally clued in to the cough's duration and implications when I kept asking him to sit down for a minute until he stopped coughing. At one point in my life I suffered from exercise-induced asthma, and genius that I am, I had never made the connection between my post-exercise coughing asthma fits and his.
Treatment with inhaled-corticosteroids (flovent in the orange puffer), was effective within 2 weeks and he stayed on the medication until the end of that winter.
Since then, the asthma seems to only show up after he has a cold. That annoying cough comes back. We have explored various treatments with both our family doctor and our allergist. We were given the following therapies to consider:
1) Singulair - a once daily pill
2) Flovent (fluticasone: orange puffer) - an inhaled corticosteroid taken once-daily
3) Ventolin (salbutamol: blue puffer) - taken as needed up to 4 times per week, sometimes more during a cold.
We looked at the various options. Singulair, while not a steroid and good prevention, has some rare mood-altering side effects. Our son is moody on his best days and this slight risk was a strong deterrent for us.
Inhaled corticosteroids were effective for us, but studies have shown that long-term use of Flovent can cause statistically significant differences in height. My husband wants my son to play in the NBA (or at least the NBL), so growing to his full potential is important to us.
We have chosen option number 3. Dex uses his blue puffer (Ventolin) during a cold to prevent coughing and bronchial irritation. He uses it no more than four times a week before hockey games or practices where the cold plus the exercise is likely to set him off coughing. So far this year, we are happy with this course of action.
So, asthma under control for now, we now march on to the next issues: the anxiety associated with the food allergy and the recommended influenza immunization (flu shot) which will bring on an anxiety of its own. Stay tuned.
While this describes our family's account of asthma diagnosis, treatment, and management, every individual is different. Please consult with your family physician for any asthma or allergy-related concerns.
References:
- A Liu. The Allergic March of Childhood. Medical Scientific Update: The National Jewish Medical and Research Center. 2006; 23(1):1-7.
- The Canadian Lung Association
- BR Gordon. The allergic march: can we prevent allergies and asthma? Otolaryngol Clin North Am. 2011;44(3):765-77.
