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.

Liisa is mom to 2 boys, ages 5 and 7. She is a medical writer and a book lover. She blogs at FitforKid.net andLittleBookLovers.Wordpress.com.

by an Ottawa mom I am a mom who has been dealing with multiple severe food allergies now for two years (the anaphylactic-Epipen-ambulance rides to CHEO kind). These two years have been the most stressful period of our lives. It has turned me into a total Mama Grizzly on the topic of food allergies and awareness. I am always protecting my little cub at home and outside – constantly on the lookout for crumbs, suspicious food labels and food wrappers left in the park (and more).

The tricky thing with food allergies is that once you’re outside of your safe zone, you rely on your friends and the people around you to be sympathetic to your needs and demonstrate compassion by taking your child’s medical needs seriously.

Here’s a recent (bad) example. One day last month there was a birthday in my son’s daycare and the children had a surprise treat of ice cream (it was a surprise to me too as we have an agreement about giving notice for birthday treats). Because of my son’s egg, milk and nut allergies, he cannot participate in these special activities. When I collected him at the end of the day shortly after the ice cream had been gobbled up by his classmates, I found my little boy in a high chair eating one of his homemade muffins. He looked miserable. His emotions were on his sleeve and he reached up for a big hug and slung his head on my shoulder. I felt horrible for him. And guilt. Then rage. A birthday party shouldn’t be the worst part of your week.

You might not think it’s a big deal, but it is when it happens repeatedly. This is just an example from last month. Month. Typing this story out is making me cry at my computer screen. Food allergies comes with a lot of emotional baggage.

You can show your respect towards a child with food allergies (and their parents) by creating safe situations for them when you invite them to playdates or birthday parties. Hosting an inclusive get together doesn’t have to be complicated.

Here are some tips :

Ask your guests if there are any food or environmental allergies in advance.
Understand the severity of the allergies. Is it sniffles and red eyes? Or is it “911 epipen hives and can’t breathe ambulance ride to the CHEO” allergies? Does the latter scare you? It should.
Before the party:
- Talk to the allergy parent about your menu plan. This allows the allergy parent to decide if they can allow their child to eat the same food or whether they will pack similar food to bring along. If you are the “allergy parent” offer to send recipes or even bake/cook something to bring for everyone.
- Ask is there are any food items that should not be offered at all.
- Let all of your guests know about any special considerations. Some parents may ask that children not have peanut butter or nuts before arriving or ask that they brush their teeth and wash their hands beforehand. You may also want to ask guests not to bring any food to avoid any awkwardness if their offering is not safe.
Make the party venue allergy-friendly. Give the place a good clean sweep. Wipe down surfaces such as play tables, kitchen tables and countertops with a clean cloth. Inspect any toys that will be shared for food residue and wash them if necessary.
Avoid cross contamination when preparing foods. If you are cooking a separate item for an allergy child, always use clean bowls, utensils and ingredients. Cover any baking sheets with tinfoil if you’ve baked with the allergen on them before.
Confirm any ingredients and food with the “allergy parent”. Allergens can be lurking even in products that don’t have the allergen on the ingredient list. Have you ever seen warnings that read, “This product has been manufactured in a facility the processes peanuts? ” To many (including our family), that warning is THE SAME as having the allergen included in the ingredient list. And here’s the tricky thing, that warning is OPTIONAL. Processed foods, even things like cereal, may not be safe.
Condiments. If you think there is a chance that a knife may have dipped into peanut butter and then into the jelly jar or onto the stick of butter, open a new package or jar. Play it safe.
Hosting a BBQ? Have you ever made a peanut sauce marinade for your meat and cooked it on the grill? Shrimp skewers? Maybe? Then your BBQ may still have that food protein residue on the grill. Cook any food for the allergy sufferer on a piece of tin foil and use separate tongs.