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

Allergic asthma in children?

Dear Doctor,
I would like to inquire about my child's allergies and asthma issues.
I am currently abroad and have a two-and-a-half-year-old child who has been experiencing cold symptoms since the beginning of the year.
Initially, he had a persistent cough for two weeks, and the doctor prescribed antibiotics and an inhaled bronchodilator, but there was no improvement.
Aside from the cough, my child was otherwise normal.
In the second month, he started having nighttime coughs, and the doctor suspected post-nasal drip as the cause, so another antibiotic was prescribed, but again, there was no significant improvement in the cough.
By the third month, the cough persisted without fever or other symptoms, and the doctor suspected a middle ear infection, reverting to the first antibiotic.
Not only did the cough remain unresolved, but after ten days of antibiotics, he developed hives all over his body.

A different doctor diagnosed him and mentioned that the skin issue was closely related to the antibiotics and directly attributed the cough to asthma.
In addition to antihistamines to address the hives, treatment for asthma was initiated, including five days of Millipred and the use of Combivent, which has effectively controlled the cough.
Although his skin remains sensitive, there is no severe redness or swelling.
Due to my lack of knowledge and the inconvenience of seeking medical care abroad, I feel that the initial misdiagnosis led to the inappropriate use of antibiotics, which negatively affected my child’s health.

Although switching doctors has significantly improved my child's cough, I am still concerned about potential side effects from the medications used.
The doctor mentioned that Combivent is primarily for adults, but prescribed it to us to control the current cough, with instructions to use it three times a day.
I would like to know if this medication is appropriate for a two-and-a-half-year-old child in Taiwan, or if there are other suggestions I can discuss with the doctor during my next visit.
I previously inquired about Singulair, but the overseas doctor indicated that it is more preventive in nature.
Additionally, I would like to understand if the inappropriate use of antibiotics can be metabolized and eliminated from the body over time.
I am very concerned about my child's health being affected.
Thank you for your response, and I will definitely seek a thorough examination when I return to Taiwan next month.

Thank you once again!
Sincerely,
Joy

Joi, 30~39 year old female. Ask Date: 2011/05/05

Dr. Xiao Kaiwen reply Pediatrics

Persistent cough in children that lasts a long time and is difficult to resolve is most commonly caused by respiratory allergies.
The key to using allergy medications is that they should only be prescribed by an "experienced" and "specialized" pediatric allergist or immunologist to ensure safety and avoid harm to the body.
In fact, excessive concern and not collaborating with a professional physician can worsen allergic conditions.
Children's bodies can change, but if they reach puberty, their allergic constitution may remain for a lifetime.
Regarding the use of antibiotics, as long as the dosage is within a reasonable range, they can be metabolized without harming the body.

Reply Date: 2011/05/05

More Info

Understanding allergies and asthma in young children is crucial for parents, especially when faced with persistent symptoms like coughing, which can be distressing for both the child and the caregivers. Your experience with your two-and-a-half-year-old child highlights several important aspects of managing allergies and asthma in young children.

Firstly, it’s essential to recognize that allergies and asthma can often present with overlapping symptoms, such as coughing, wheezing, and difficulty breathing. In your case, the initial treatment with antibiotics and bronchodilators did not yield the desired results, which is not uncommon. Antibiotics are effective against bacterial infections but are ineffective against viral infections, which are often the cause of respiratory symptoms in young children. The fact that your child developed hives after antibiotic treatment suggests a possible allergic reaction, which can complicate the clinical picture.

The diagnosis of asthma, particularly in very young children, can be challenging. Asthma is characterized by inflammation and narrowing of the airways, leading to symptoms such as coughing, wheezing, and shortness of breath. In young children, asthma can often be triggered by allergens (like dust mites, pet dander, or pollen), respiratory infections, or environmental factors (like smoke or pollution). The nighttime cough you mentioned could indeed be a sign of asthma, especially if it is associated with nasal congestion or post-nasal drip.

The treatment approach you received after switching doctors seems to be more aligned with managing asthma. The use of corticosteroids like Millipred (a form of prednisolone) can help reduce inflammation in the airways, while bronchodilators like Combivent (which contains albuterol and ipratropium) can help open the airways and relieve coughing. While Combivent is typically prescribed for adults, it can be used in children under certain circumstances, especially when the benefits outweigh the risks. However, it’s crucial to monitor your child for any side effects, such as increased heart rate or nervousness, which can occur with bronchodilator use.

Regarding the use of Singulair (montelukast), it is indeed often used as a preventive treatment for asthma and allergic rhinitis. It works by blocking leukotrienes, which are substances in the body that can cause asthma symptoms. If your child’s symptoms are well-controlled with the current regimen, it may not be necessary to add Singulair immediately, but it could be a consideration for long-term management, especially if symptoms recur.

As for your concern about the potential long-term effects of antibiotic misuse, it’s important to note that while antibiotics can disrupt the natural balance of bacteria in the body, most children metabolize and eliminate these medications relatively quickly. However, repeated or unnecessary use of antibiotics can lead to antibiotic resistance and other complications, so it’s always best to use them judiciously.

In summary, it’s vital to maintain open communication with your healthcare provider about your child’s symptoms and treatment plan. If you have concerns about the medications prescribed, including their appropriateness for your child’s age, don’t hesitate to discuss these with your doctor. Additionally, when you return to Taiwan, seeking a pediatric allergist or pulmonologist may provide further insights and tailored management strategies for your child’s allergies and asthma. Regular follow-ups and monitoring are key to ensuring your child’s health and well-being.

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