Allergies and Asthma in Young Children: A Parent's Guide

Allergic rhinitis / Asthma

My daughter (2 years old) has always been in good health, rarely experiencing fever.
When she does have a fever, it usually subsides quickly, often without the need for medication; just giving her some warm water is enough to help reduce the fever.
However, she has had issues with eczema since she was little, though it is not severe and mainly occurs during weather changes, particularly around the joints of her hands and feet, accompanied by constant scratching.
As for colds and coughs, they occurred occasionally until 22 months ago, primarily presenting as a productive cough, which would resolve with a few days of medication.
She has always been prone to vomiting, especially when coughing.
Since August of this year (now 23 months old), she has been experiencing persistent coughing that does not improve with cough suppressants, expectorants, or antihistamines.
She has a lot of clear, watery nasal discharge, mostly coughing at night or in the early morning, with less coughing during the day.
Recently, her nasal discharge has turned green.
Notably, she has been having low-grade fevers (around 37.2–38 degrees Celsius) every two months, similar to before, which resolve with increased fluid intake.
Last night, she had the following experience: she did not cough the night before or during the day.
After having a snack at daycare around 4 PM, she started a persistent dry cough around 5 PM, which continued every few minutes.
By 7:30 PM, she began to vomit profusely, resembling a faucet.
We took her to a hospital in Macau, where the doctor noted that her throat was not swollen, but there were wheezing sounds in her lungs, and her breathing was labored.
They recommended a chest X-ray and steam inhalation.
After the steam treatment, her dry cough finally stopped, and the X-ray results were normal.
However, the doctor mentioned that if she has two or three more episodes, she may be diagnosed with asthma.
Last night, she took medication to help her sleep, including cough suppressants, expectorants, and antihistamines.
She continued to cough severely during the night and early morning.
Generally, we ensure she stays warm, but I’ve noticed that when she has a runny nose, the discharge can feel cold.
I immediately give her warm water, hot soup, or porridge, which seems to help reduce the nasal discharge.
I would like to understand if her situation could be related to post-nasal drip causing the persistent cough.
I have read that if parents have allergies, it can be inherited by their children, starting with eczema and later developing into allergic rhinitis.
How can I help my daughter? Given her experience last night, I suspect she may have had an allergic reaction to something she ate at daycare, leading to the continuous coughing.
Is this a possibility? Is it true that the doctor’s mention of asthma could be a concern?

Liang Tai Tai, 30~39 year old female. Ask Date: 2009/11/25

Dr. Pei Rensheng reply Pediatrics

Dear Mrs.
Liang,
Hello.
Allergic diseases are related to two factors: one is the allergic constitution, and the second is the allergens.
The allergic constitution can be hereditary; numerous studies have shown that if one parent has an allergic constitution, the child has a one in four to one in three chance of also having an allergic constitution.
If both parents have an allergic constitution, the likelihood increases to as high as one in two, or even two in three.
Despite advancements in medical science, genetic factors cannot be easily altered.
However, we can take preventive measures against allergens to reduce the occurrence of allergic diseases.
Allergens include contact allergens, such as metals like nickel and cadmium, which can cause skin reactions like redness and itching in some individuals.
Additionally, common food allergens include fish, shrimp, crab, peanuts, soy, and eggs, which can trigger symptoms like urticaria and atopic dermatitis in those with an allergic constitution.
Lastly, common inhalant allergens include dust mites, dust, cockroaches, pollen, animal dander, and mold, which can lead to allergic rhinitis, allergic conjunctivitis, and asthma in susceptible individuals.
Prolonged exposure to these allergic diseases can easily result in dark circles under children's eyes.
It is fortunate to identify the allergens; however, some individuals undergo blood and skin tests and still cannot find the culprit behind their allergic diseases.
One possibility is that the allergen causing the disease is rare and not within the detection range of the testing reagents.
Another possibility is that non-allergic factors may also trigger excessive respiratory reactions, leading to allergic diseases, which we refer to as intrinsic allergies.
Factors causing intrinsic allergies include upper respiratory infections (such as influenza viruses), climate changes (temperature and humidity), air pollution (cleaning during the New Year, clearing bedding, emissions from factories or vehicles), irritating odors (such as incense burning, secondhand smoke, perfumes, insecticides, and paints), psychological factors, and intense physical activity.
If the aforementioned factors correlate temporally with the onset of allergic diseases, it can strongly suggest they are the culprits.
Allergic diseases in children manifest like a march; not only do different ages present different diseases, but even the same disease can change as the child grows.
Take atopic dermatitis, for example.
In infants under one year old, atopic dermatitis typically presents as red, eczema-like changes or yellowish scaling on the forehead, cheeks, and neck.
If there is severe itching and scratching, it can lead to crusting.
During early childhood, rashes are primarily distributed on the extensor surfaces of the limbs.
After puberty, if atopic dermatitis persists, it tends to affect the flexural surfaces of the limbs, becoming itchy and dry, with severe cases showing lichenification.
Most allergic rhinitis begins to appear in toddlers around two to three years old, characterized by itchy noses, sneezing, runny noses, or nasal congestion upon waking in the morning, with clear, watery nasal discharge.
Symptoms are usually milder in the afternoon or evening unless there is post-nasal drip or concurrent asthma, as simple allergic rhinitis typically does not cause coughing.
This differs from a common cold, where nasal discharge and coughing occur throughout the day and night, with nasal mucus becoming thicker during recovery.
Asthma is characterized by nighttime and early morning coughing, which can persist and is more easily diagnosed after the age of two.
Wheezing may be heard during breathing, and lung function may decline, impacting daily life.
Based on your description, your daughter likely has atopic dermatitis, allergic rhinitis, and asthma.
Please consult a pediatrician for diagnosis and treatment.
Wishing you health and happiness!
Sincerely,
Dr.
Pei Ren-Sheng
Director, Pediatrics Department, Taoyuan Hospital, Department of Health

Reply Date: 2009/11/25

More Info

Understanding allergies and asthma in young children can be quite challenging for parents, especially when symptoms are not straightforward. Your daughter’s history of eczema and recent respiratory issues, including persistent coughing and nasal congestion, raises valid concerns about potential allergic reactions and asthma.

Firstly, it’s important to recognize that allergies can manifest in various ways in children. Eczema, or atopic dermatitis, is often one of the first signs of an allergic predisposition. Children with eczema are at a higher risk of developing other allergic conditions, such as asthma and allergic rhinitis (hay fever). The fact that your daughter has experienced eczema since infancy suggests that she may have an underlying allergic tendency.

The symptoms you describe—persistent coughing, especially at night, along with nasal congestion and the production of clear or greenish nasal discharge—are indicative of possible allergic rhinitis or asthma. The cough, particularly if it worsens at night or after physical activity, can be a sign of asthma. The presence of clear nasal discharge can indicate a viral infection or allergies, while greenish discharge may suggest a bacterial infection.

The phenomenon of post-nasal drip, where mucus from the nasal passages drips down the throat, can indeed lead to a chronic cough. This is particularly common in children with allergies, as they may have increased mucus production in response to allergens. If your daughter is experiencing nasal congestion, it could lead to mucus accumulation, which may trigger coughing, especially when lying down.

Regarding your concerns about potential triggers, it is possible that certain foods or environmental factors in her daycare could exacerbate her symptoms. Allergic reactions can be triggered by various allergens, including dust mites, pollen, pet dander, and certain foods. If you suspect that a specific food item may have caused her reaction, it would be wise to discuss this with her pediatrician or an allergist. They may recommend allergy testing to identify specific triggers.

As for the possibility of asthma, it is indeed a concern, especially given her symptoms and the doctor's comments. Asthma is a chronic condition characterized by inflammation and narrowing of the airways, leading to difficulty breathing, wheezing, and coughing. Early diagnosis and management are crucial to prevent complications and improve quality of life. If your daughter continues to experience these symptoms, it would be advisable to follow up with a pediatrician or a pediatric pulmonologist for further evaluation.

In terms of management, here are some strategies you can consider:
1. Environmental Control: Minimize exposure to known allergens. This includes keeping her living space clean, using air purifiers, and avoiding smoking around her. If dust mites are a concern, consider using hypoallergenic bedding and washing her sheets in hot water regularly.

2. Monitor Symptoms: Keep a diary of her symptoms, noting when they occur and any potential triggers. This can help identify patterns and inform her healthcare provider.

3. Medication: If her symptoms are persistent, her doctor may recommend antihistamines for allergy symptoms or bronchodilators for asthma symptoms. Always consult with her healthcare provider before starting any new medication.

4. Hydration: Keeping her well-hydrated can help thin mucus and may alleviate some coughing.

5. Follow-Up: Regular follow-ups with her healthcare provider are essential to monitor her condition and adjust treatment as necessary.

In conclusion, your daughter’s symptoms warrant careful observation and possibly further evaluation for allergies and asthma. Early intervention can significantly improve her quality of life and help manage her symptoms effectively. Don’t hesitate to reach out to her healthcare provider with your concerns, as they can provide tailored advice and support for your daughter’s specific needs.

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