Stuffiness, Pink Eye, Peanut Allergy – PediaCast 063

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Topics

  • Evening Stuffiness (Nasal Congestion)
  • Pink Eye
  • Kawasaki Disease
  • Molluscum Contagiosum
  • Peanut Allergy

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Transcription

Announcer: This is PediaCast.

[Music]

Welcome to PediaCast, a pediatric podcast for parents, the Listener Edition. And now direct from BirdHouse Studios, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone, and welcome to PediaCast. It's Episode 63 for Wednesday, October 17, 2007.

Pinkeye, Kawasaki disease and molluscum. We're also going to talk about peanut allergies briefly and evening stuffiness or nasal congestion.

It's our Listener Episode so all of these topics basically come from you. Questions that you had and I will attempt to answer.

Before we get started, I want to say, [Sigh] it was busy day in the office today.

0:01:00

The virus season is upon us. We're seeing a lot of croup, which is caused parainfluenza virus. And because it's a virus, antibiotics don't help it.

But even though fall means things get busier and we see croup in the office and some vomiting, and diarrhea, viruses as well, I have to say I really like fall in Ohio, or autumn.

We're just in California, and of course, the weather is great. We go to Florida a couple of times a year. I have a family that lived there. And the weather there is, of course, always great, except for the summer. [Laughter] OK. So quarters of the year the weather is great.

Ohio , you get in the middle of winter. It's cold. It's great. There's thick clouds and we have a lot of thick clouds today. But fall weather in Ohio is nice. It's usually in the 60s or 70s. And I tell you. I love when the trees are turning and the leaves are getting crispy; and they have that autumn smell to them.

0:02:05

Your neighbors are burning leaves and you get that smell. I really like it a lot.

College football in full swing. We get the baseball playoffs. The World Series is coming up. Since this is sort of a gathering of friends, I just wanted to share with you that I love autumn in Ohio. And actually I think autumn in the New England state is probably pretty cool, too.

All right. I already went through the line up we're going to talk about today. If there is a topic that you would like us to discuss, all you have to do is go to pediacast.org and click on the Contact link.

You can also go to pediacast@gmail.com or call the voice line at 347-404-KIDS. That's 347-404-K-I-D-S.

Don't forget the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you've a concern about your child's health, call your doctor and arrange a face-to-face interview and hands-on physical examination.

0:03:04

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.

And with that in mind, we'll be back to answer your questions right after this short break.

[Short Break Music]

All right, up first in our Listener's Segment, we have Brenda from Indiana and Brenda says, "I have a Listener question for you. My seven-year old suffers from evening stuffiness to the point it inhibits a good night sleep for him."

0:04:03

"My pediatrician suggested looking for mold in his bedroom. None found. He also suggested giving him Claritin at night only, but this hasn't helped and may make him even more restless. We are a non-smoking, no-pet household.

Could this be seasonal allergies that manifest only as evening stuffiness? If so, should I seek the advice of an allergist or an EENT physician? Any suggestions would be greatly appreciated.

We'll thanks for the question, Brenda.

I'm going to go through this very quickly how I would approach this in my office. And, of course, for liability reasons, I can't say, "Hey, Brenda this is what you need to do. This is what I think it is" because, again, that's practicing medicine and not what we want to do in this program.

But a stuffy nose every evening definitely makes you think about allergies ,not so much seasonal allergies. Probably seasonal allergy would mean that there is something that's seasonal outside, such as pollens, ragweed–those kind of things–that are seasonal.

0:05:05

[Laughter] That's why you call it seasonal.

And if it's just in the evening, that makes that less likely. Now I'm assuming, by evening, that you mean when he goes to bed. Because you talked to your pediatrician about this , it's inhibiting a good night sleep , they suggest to looking for a mold in the bedroom.

So I'm going on the assumption that this is stuffiness that begins after he goes to bed, and it's there every evening. Now, in terms of my approach with this the first thing you want to do, if you're thinking that its allergies is, of course, try to eliminate the source of the allergen.

And remember the way allergies work. There's a foreign substance that enters your body , we call it "the allergen" , and your body recognizes it as foreign , makes antibodies against it. So that when it is re-introduced, then the antibodies do their thing.

0:05:59

They tried to attack the allergen because it thinks it's going to hurt you. Then by-product of the immune system doing this is what causes the symptoms that we see, such as the runny nose, sneezing and then cough. And as it gets worse, they can then lead to wheezing or skin manifestations like eczema.

Now it sounds like you've already embarked down that road. You talked about there not being any smoke in the house; there are no pets in the house and you looked for molds. Although, yes, I think molds are less of an issue in the bedroom, unless you're running a humidifier every night and the room was just dripping in moisture then molds in the bedroom might be a problem.

But molds are more going to be a problem in basements and the bathrooms and places that have a pretty humid and moist environment, less so in the bedroom.

The big thing that you're going to worry about, in terms of allergens, in the bedroom is going to be dust mites. And then there's all kind of critters that can live in mattresses and pillows.

0:07:01

You get a new mattress. You get a new pillow. You're going to have these microorganisms in the material pretty quickly. So just because they're there it doesn't mean that the mattress or the pillow are bad, or too old.

They're in everybody's house. They're in your house. They're in my house. And whether we have a reaction to those microorganisms, it's usually , as much as you hate to think about it , a lot of times, it's not even the microorganism that you're allergic to.

It's the feces of the microorganism. They're eating. They're excreting. [Laughter] And I know you don't want to think about these things. But look, folks, it happens and that oftentimes is what causes some allergies that are associated with nighttime and sleeping.

Now one thing that you can do is to make a barrier between yourself and the pillow and the mattress. One way to do that is with a plastic pillow inserts so just take the pillow. You use one of those plastic inserts. They usually zip and then put the pillowcase on top of that.

0:08:02

So there's a layer of plastic between your pillowcase and the actual pillow material itself.

There's also mattress pads that you can get that are made out of plastic. And again, you just put this plastic mattress pad over the mattress and then put the top sheet on top of that.

You can use a mattress pad on top. This padding material , it could get the microorganisms in it as well. So it's going make some funny noises if you put the flat sheet right on top of the plastic but that maybe what you need to do.

Now another source of allergen exposure at night time is in the sheets and pillowcases themselves. So you want to make sure that you're using a hypoallergenic detergent, such as Dreft, or they have no dye and no perfume additive like Tide for sensitive skin.

Just use a really small amount of detergent and do the bed sheets and pillowcases by themselves and then double rinse it.

0:09:04

Don't use any fabric softener in the washer and no dryer sheets in the dryer because you're just trying to decrease the amount of chemicals that are on the pillowcase and on the sheet. All these things will just help to eliminate the source of any possible allergens during the night.

Also if you haven't thought about it, make sure you're changing your furnace filter on a regular basis and they do make special furnace filters if you have forced air heat that can also trap allergens and just make the house in general have less allergic tendency.

So that's what I would do first, is to eliminate the source. Now if you've done everything you can to eliminate the source and the kids still having allergy symptoms, the next thing that I do in the office would be to start some medicine to help control those symptoms.

Now Claritin is certainly a good start and it's a non-drowsy, for most, in a histamine medicine.

0:10:03

The generic is loratadine. It is available "over the counter". Zyrtec is another one. It will be going "over the counter" in just a few months. Allegra is another one. And all of these are basically one-a-day, non-drowsy antihistamine medicines.

Now one thing that I usually do is still even if it's nighttime allergies, I still would just take that Claritin every morning. And the reason is because Claritin, this once-a-day antihistamine medicines aren't the kind of medicine where you take it and it peaks in the blood in a couple of hours and then slowly your body metabolizes it and gets rid of it, so that then in a few hours later it's gone.

Now what happens with these kind of medicines if you do it every day and about the same of the day is, after a few days you reach what we call a" steady state" and this is where you're putting the same amount of medicine into the body in about the same rate, give or take, that the body is eliminating it.

0:10:59

So you really should not have a peak in the amount of the medicine that's in the blood over a few hours and then it peaks down. ADHD medicines are like that. You take it in the morning; it slowly rises and plateaus during the day; and it falls down in the evening.

Antibiotics do that. That's why you have to do them a lot of times, two or three times a day because they rise. They're there then they fall back down.

But with Claritin these ones that the body gets rid off very slowly, eventually reach what we call a steady state. So what's more important is not the time of day that you're doing it but that you're doing it at about the same time each day.

In the morning it's just the kind of good time to remember to take your medicines. So we generally do that one in the morning. And then with the Claritin, the other thing to keep in mind though is, it's going to take a few days to take effect.

So again people say "But it' stuffy in the morning, why at night, why do we do it in the morning?" You just remember you're doing it at a time that you can remember to do it. And you want to do it about the same time each day to keep the blood level of that medicine steady.

0:12:05

The next thing I would do, if the non-drowsy antihistamines aren't helping, is either Singulair or a nasal steroid, such as Nasonex, Rhinocort, Flonase. There's lots of different ones out there.

I don't know. Everybody's got their own opinion on this. I want to do Singulair first just because, I think for most kids, it's easier to get them to do a pill that you chew, or the other kid just swallow it, and then the little kids we do have some granule packs that you can use.

I think it's easier to use than have them spray something up their nose. But your mileage may differ and different doctors have different opinions on that.

So Singulair is a good one. We do that one at night. I don't really know why. I probably should know that. I've looked it up briefly before. These things come into your mind and you'd try to look it up and I wasn't successful in figuring that one out.

I think it's just because the studies that were done originally, it was used at night time.

0:13:03

Again it's a steady-state kind of medicine. You're going to use it daily at the same time to get the blood levels up and keep them at a steady state, just like the Claritin.

And I guess there's several reasons that I could think of why and I don't know. This is just me guessing or hypothesizing. But I wonder if it works better on an empty stomach. Maybe it gets absorbed better, and so if you have it being absorbed overnight, that's better.

I don't think it really has much of a drowsiness issue with this so that wouldn't probably be it. But if anyone out there is a Singulair expert, you can tell me why we do it at night time. That'd be great. I'd love to know.

But the standard is to do it at night that what they recommend and so you do Claritin in the morning, Singulair at night. Even if the stuffiness is just in the evening I would still do it that way and then the nasal steroids.

0:13:57

Now if I have a kid who you've eliminated the sources, you're doing the Claritin, you're doing Singulair, you're doing a nasal nose spray and still, they're having these symptoms, then, for me, it's time to refer to a pediatric allergist, especially if they're not getting a good night sleep.

If they're a little stuffy and they're able to sleep through it and they're living with it then , do you have to get skin testing and do allergy shots? No, no, I mean, if you can live with a little stuffy nose and you're doing better with that, then go on and get the weekly shot. I'm sure the kids "Hey, let me have my stuffy. I'll blow."

But if it's so stuffy, it's to the point where they're not getting any good night sleep, then pediatric allergy referral will be my next choice.

Also if it's not getting better then you have to think "Do we have the right diagnosis?" And with it just be an evening like this, I think we do have the right diagnosis. But you know you still have to consider viruses.

If you have a kid who's stuffy, usually it's going to be all day long. But prolong stuffiness can be back-to-back viruses, especially when school starts.

0:15:03

You think, if each virus is lasting a week to two weeks, and you get two or three of them in a row because you get 20 to 30 kids in a class, they're all three to four feet from each other all day long, and they're going pass things back and forth, you can definitely get a kid who has three or four virus back-to-back.

And it seems like they just have the stuffiness for six weeks and it's viral. And treating it like allergies, it might help a little bit because of the antihistamine effect, but not completely. And doing like a nasal steroid may actually, sort of, prolong it because steroids decrease the immune system. That's why they help allergies because it's the immune system going haywire.

But if it's caused from a virus and your immune system is all you've got to fight that virus then the steroid may make it prolong a little bit.

Also sinus infections, yes, those aren't nearly as common in kids, as we call it. But sometimes they can't get that. It's your older kids who have developed sinuses where that's going to be an issue , not in the younger kids who do not have very well developed sinuses.

0:16:08

Also, green, if it's a green nasal discharge, this does not mean it's a sinus infection. That's like in my grandma's day.

A retained foreign body is something to think about especially with young kids, if they put something up their nose, a little bead or toy, piece of plastic that can cause chronic irritation and a runny nose that's lasting for a long time.

So that would all be in the differential. Although again with those things, it's probably going to be more 24/7 they have the symptoms, not just at night time.

So again, I hope that helps you Brenda. Really what I did there is just go through my thought process and how I would approach this sort of thing in my own office practice.

OK, let's move on. Listener number two is , and I'm sorry if I get your names bashed here. There's a couple of them this week I may have trouble with. But this one, it looks like Marivic and this is from San Francisco.

0:17:01

And she says, "Dr. Mike, have you done an episode about eye infection/pinkeye? My son Matthew age seven now seems to be getting them frequently, six to be exact since September of last year.

Is there an underlying cause for this? What steps should I take to prevent another break out? And is it normal to have so much occurrence in a year?

Another great question. Let's do a little definition first.

Pinkeye is an inflammation of the conjunctiva. And the conjunctiva is a fancy medical name for the transparent layer that covers the outer most portion of the eye. And it's full of blood vessels because it's nourishing that portion of the eye. It's protecting, nourishing. So it's full of blood vessels.

They're usually too small to be seen. But if there's inflammation, you have increased blood flow and then the conjunctiva becomes what we call "injected" because the blood vessels are now injected with more blood and so the eyes starts to have a red appearance. And this is where we get the term "pinkeye".

0:18:03

Now causes of this , You can divide them into three main groups. There's going to be allergy, which again, because it's immune-mediated, you're going to have mild injection and usually a clear drainage or you can get a yellowish look to the drainage, kind of sleepy.

If you're making a lot of tears and the tear part, the hydrate, you're left with some sediment which has sort of the yellow appearance and that's just kind of sleepy, you can see that with allergy , allergic conjunctivitis.

Also it can be bacterial and bacterial usually is more mild injection, mild redness. But you do get more of the green "goopy" discharge that sort of strings between the two eyelids. And they're just real sticky and goopy.

And then you have the viral forms of pinkeye or conjunctivitis, and this is sort of what we call "classic pinkeye," which is really a viral conjunctivitis. With this, you get anywhere from mild to very severe injection, so they can be really, really, really red.

0:19:03

The discharge with it is usually clear to yellowish to sort of a green discharge, not nearly as goopy and thick green as you see with bacterial infections.

Now you can also have a combination of these things. So you can have a kid who has underlying an allergic conjunctivitis. Their eyes are itchy and watering a little bit so they rub their eyes a lot. Next thing you know you have some hand bacteria that are growing in the eyes. So you have an underlying allergic conjunctivitis with bacterial overgrowth on top of it.

And the same happens with virus, too. If you have viral conjunctivitis then you can start to grow some bacteria overlying that, so you get a mixture.

So how do we treat this? It depends on the cause. And really it takes a doctor looking to tell you what they think the cause is, taking into account the history, how long it's been there, is it recurrent, how often¡K? And then looking at what the physical exam is like.

0:20:02

So I think in your case, since it's recurrent, allergic conjunctivitis certainly comes to mind. And it could be that there's an allergic conjunctivitis undertone and then your child is rubbing their eyes a lot and that's why they keep getting conjunctivitis, you know, with the viral, or bacterial , so all things to think about.

With allergic conjunctivitis, just like with the nighttime nasal congestion, you want to try to avoid the triggers, if you know what they are.

Cats are particularly bad for this. And we did an episode not too long ago. No, I think it's been a little while, a few months ago. If you searched the archives on "Cat Dander Allergies," and that's a classic one for causing lots of runny eyes.

But there's other things , hay fever and ragweed , that can do it and other things, too. There are antihistamine-type eye drops so Claritin or Zyrtec for the eyes. Panthenol is one of them. And you can even use oral antihistamine medicines to help with those symptoms, too.

0:21:01

So Claritin, Zyrtec, Allegra , those may help allergic conjunctivitis, too. For bacterial conjunctivitis, we usually use the antibiotic eye drops.

And for viral conjunctivitis, really because it's a virus, antibiotics are not going to help. We tend just treat the symptoms–warm compress to the eye, trying to keep the kids hands away from their eyes as much as possible.

But with the classic viral pinkeye, you just have to let the body do its thing and fight off the virus. Now especially in young kids, even if we think it's a viral conjunctivitis, a lot of times we go ahead and prescribe antibiotic eye drops for them. And it's really to prevent bacterial overgrowth because how do you keep a three-year-old from rubbing their eyes when it's itchy and watery?

Really bad with the viral conjunctivitis, nearly impossible, so you sort of just assume that they're going to get a bacterial infection on top of the virus.

0:22:00

So a lot of times we go ahead and use the antibiotic eye drops even if when we think it's viral. Now some special considerations with conjunctivitis or with pinkeye that we need to talk about.

One is that steroid eye drops can greatly reduce inflammation and severe conjunctivitis. But you have got to have what we call a slit-lamp exam of your eye before you do that, to make sure that there's no herpes infection in the eye.

And really the best person I have to do that is an ophthalmologist. So if you really have bad pinkeye or really bad conjunctivitis, and your doctor thinks about putting you on a steroid eye drop, I personally would say "No, No, No, No, No, No, No."

Don't do that without letting an ophthalmologist take a look at the eye with a slit-lamp exam to make sure there's no herpes. Because if you give someone with active herpes infection in the eye, which I know is again it's not something I'd like to think about, but it can happen, then you don't want to do the steroid because that can cause the herpes infection to get worse, which can cause scarring and eventual blindness.

0:23:11

So really we sort of "reserve" the steroid eye drops for the ophthalmologists to use so it's one of those things that's drilled into you in medical school, at least where I went.

You have the second year medical student. I remember the ophthalmologist coming in and saying, "Don't use steroids in the eye. It's just for us." [Laughter] OK. Fine, OK. Yes, 10 years later, more than that, 14 years later. I remember.

OK, so when can kids go back to school who have pinkeye? Well, that depends on the cause, if it's allergic, right away. They're just having an allergic reaction. They're not contagious.

If it's a bacterial conjunctivitis, then most of those once you start the eye drops, the next day, they're usually fine to go back to school. But the most common cause of pinkeye in a school setting is going to be the viral conjunctivitis.

0:24:02

And the viral conjunctivitis is contagious until the "pink" is gone, till the eye symptoms are pretty much gone, even if you're doing the drops, because remember the antibiotic eye drops only treat bacteria, not viral.

So even if your doctor gives you eye drops for a viral pinkeye to prevent bacteria growth the viral portion that's really causing the symptoms that's still contagious even on the drops, and will be contagious till the eye symptoms are gone.

Now, in terms of prevention of pinkeye, of course, if it's allergic conjunctivitis, the main prevention is going to be to try to avoid whatever that causes it. But when you're in a school setting, the way that pinkeye is so easily transmitted, especially the viral type is, basically from when kid rubbing their eyes who has it, they touch a door knob.

Your child comes along a few minutes later, touches the same door knob, or it could be a shopping cart.

0:25:01

It could be any object. Most of the viruses that caused conjunctivitis can live on any animal or objects for quite some time so frequent hand washing in the winter time and use of antibacterial gels and of course, keeping your hands away from your face and your eyes, will also help to prevent it.

There is a link in the Show Notes for some pinkeye information. That's from the Mayor Clinic. And you can look for that in the Show Notes at pediacast.org.

OK. Next stop we have, and this another one where I'm going to, hopefully, not bash up the name too much.

I think it is Eilan. It could be "Aileen" E-I-L-A-N from Vancouver, British Colombia. And Eilan says, "Hello, Dr. Mike. Thanks again for the wonderful podcast I really enjoy the new format."

"A rare childhood disease that you may want to share with your listeners is the Kawasaki disease. It's a common disease in Asia, specifically in Japan and Korea but considered rare in the Americas."

0:26:01

"My husband and I are neither Japanese nor Korean but our daughter developed this disease at age two. The cause of Kawasaki is still unknown and those who are affected are diagnosed based on their symptoms."

"These symptoms include a high-spiking fever for five days in the 39 to 40 degrees Celsius range" ,which 102 to 104 degrees for the metric-impaired members of our audience.

"You can also see redness in the eyes, which we just talked about , conjunctivitis , a rash swollen tongue, sore throat, red lips, swollen lymph nodes and swollen palms and soles of the feet."

And I'll add to this, a lot of times these kids are just extremely irritable, too. That's not one of the diagnostic criteria just to my personal experience. A lot of kids with Kawasaki disease just typically are very irritable.

"But I guess if you had all the symptoms, you probably would be. If the child is not treated within 10 days of when the first symptoms began, it leads to serious heart complications."

0:27:04

"Luckily my daughter was treated on the fifth day."

"We brought her to the hospital on the fourth day when her only symptoms were fever, swollen tongue and body rash. And we're sent back home because they thought it was viral. The next day, she had red in her eyes."

"And you might chuckle at this. But I Googled her symptoms and found out what she had. We rushed her back to the hospital and she was finally admitted and treated."

I love that story. Did you print out your Google, your search results and showed it to your doctor? "I think my child has this."

You've got to be an advocate for your child and with the information on the Internet, as long as you're using good reliable resources, there's nothing wrong with doing that.

All right. Eilan continues, "I could go on with all the information that I collected on Kawasaki disease, but I believe you are aware of them already and will tell your listeners all about them. Thanks again. I look forward to your next episode."

Well, actually, Eilan, I think, [Laughter] I think I'm saying Eilan one sense, Aileen the next. I apologize. I think it is Eilan.

0:28:06

There's not a lot left to say. You did a very good job describing this disease. Again, it's called "Kawasaki disease". The etiology or the cause of it is really unknown. It's likely an overreaction of the immune system to some antigen stimulation.

It's typically seen in young children, and as you said, the diagnosis is based on the history and physical. There are no real good tests, lab tests. There are some lab tests that suggest the diagnosis but really this is one of those that you diagnose it based on the history and physical.

And basically five days of high spiking fever and you have to have four of these five things also present–erythema or redness of the lips, cracking lips; or strawberry tongue , it's swollen. It's got dots on it. It looks like a strawberry. Non-specific rash on the trunk.

0:29:01

Number three would be swelling and/or peeling, or redness of the hands and feet. Number four is a conjunctival injection and hey, you know what that means now, right? And number five is a swollen lymph node in the neck of at least 15 millimeters, so you get a big, big lymph node.

Now the significance of this disease is that, in 10% to 20% of these kids, they would develop a coronary artery aneurysm. That's some serious stuff so one of the blood vessels that give blood and oxygen to the heart itself can get an aneurysm in it, with this disease.

So obviously, as a doctor, if you see a kid who you think has Kawasaki disease, you refer them immediately to a children's hospital. And they need to be seen by the infectious disease people and the cardiology people.

The cardiology people they'll do the echocardiogram and EKG.

0:30:02

Do things to evaluate their heart and to look at their coronary vessels. The treatment of it , interestingly, this is an interesting treatment scheme. Because we think that it's the immune system going crazy, a blood product called IVIG is used. And basically, what this is , is you've seen plasma donation centers.

They take blood plasma, which is just the liquid portion of the blood without the red blood cells and white blood cells, and they extract antibodies out of the plasma. And they do this for hundreds of donors so that you, basically, have a product, that is a collection of antibodies from a bunch of different people.

And the idea here is, whatever antigen is causing this, it's probably other people have had exposure to this antigen and they have made antibodies against it, without necessarily getting the overreaction in Kawasaki disease.

0:31:00

So the hope is that in a bag of IVIG, there's going to be some antibodies there that will take care of whatever it is so that the child's body doesn't have to get over revved anymore.

And it is true that usually within 24 hours of starting the IVIG, they usually do get better pretty quickly with it because, again, you're using donor plasma or donor antibodies to help calm this down

It's not an antibody for any specific thing because we don't know what that thing is so that's why you use IVIG rather than some specific antibody, like you do with tetanus. You know with tetanus if they have that, you can't give someone medicine that is just antibody against tetanus.

I think we've talked about this before, too, with other illnesses as well. For instance, botulism, you know you can give them an antibody that just attacks botulism. Again in those cases, with tetanus, with botulism, and rabies is another one.

0:32:04

But you know what it is that you want to attack, whereas with this, you don't so that's why you use the whole IVIG.

Corticosteroids are less effective but they do help calm down the immune system. And then aspirin is also used. Now aspirin prevents clots from forming in any coronary aneurysm that the child may have. And it also serves to help calm down the immune response as well because aspirin is an anti-inflammatory drug.

Now I do want to point out that this is one of the few, few, few reasons why we give kids aspirin these days. We generally do not use aspirin in children anymore. We use Tylenol or Motrin. Acetaminophen is the generic for Tylenol. Ibuprofen is the generic for Motrin or Advil.

And the reason we don't use aspirin anymore is because, with certain viral infections, including chicken pox, there was an association with aspirin use and a disease called Reye's syndrome, which can in itself be deadly.

0:33:05

It goes beyond the scope of this program today to talk about Reye's syndrome. We should do that sometime though. So we don't use aspirin anymore in kids. But Kawasaki disease is one of the reasons that you would still use aspirin because the benefit would outweigh any risks associated with it.

So thanks for the question, Eilan. This is definitely an interesting disease. No question about it. I did see quite a few times actually during my residency. In private practice, I have not seen it in the last few years, very often, but we know when you're in a big children's hospital, you have a big referral area so you're much more likely to see things that aren't so common.

You can check up the Show Notes. I have a few links for you on Kawasaki disease , one from KidsHealth; another from the American Heart Association; and there is a support group called the Kawasaki Disease Foundation. And there's a link to that as well in the Show Notes.

0:34:00

OK, moving on to Barbara who is also in Vancouver, British Colombia and who has an easier name to say. [Laughter] Barbara says, "Hey, Dr. Mike. I've been enjoying your show and learning lots."

"Here is my question. My 10-month old has had molluscum since she was two months old. Our pediatrician said to leave it untreated. I'm a bit concerned because several spots look red and a bit infected. What is your philosophy in treating molluscum? Many thanks. I'm so grateful for the work you do putting out your excellent show."

Molluscum is a cousin of warts. It's a skin lesion that's caused by a virus. And in this case, the virus causes these dome-shaped small flesh-colored papules, if you remember from our talk with Dr. Michelle.

Papules are bump. So it's a dome-shaped smooth flesh-colored papule that ends up being fairly small. It can be anywhere from really tiny to , and they can grow to be , you know what I want to say , a few millimeters big.

0:35:04

They have a central umbilication or a tiny dimple. So they have just a little tiny dimple right in the middle of it, most of the time, often, they have that. And so that's one of the hallmarks to diagnosing it.

Now like warts, they can spread because it's a viral infection. But they do eventually go away because your immune fights the virus. But this can take several months to go away. And a simple observation is a fine course of treatment, especially if it's not a cosmetic issue.

But if it's a cosmetic issue, your child has a lot of them. They're picking at them all the time. It's a nuisance. They're worried about it. You're worried about it. Then there are some things that we can do for it.

But if it's under the clothing and there's a couple of them, and your kids leaving them alone, let them be there for a while. I should say even if there's more than a couple. I see some kids who have 20, 30 of them.

0:35:58

And again, as long as they're not bothering the child, the child is not bothering them, it's not too much of a cosmetic issue then you're probably best off just leaving them alone and let the immune system do its thing.

But if you need to do something about them, you can. Now they can become infected. Kids like to pick and so any skin infection associated with molluscum, obviously, needs to be treated appropriately by your doctor, with either a topical antibiotic or ointment. And sometimes even a cellulitis or an abscess can start to form and you need an antibiotic by mouth in that case.

Now sometimes these actually just sort of reddish on their own and the insides of them can come out, just some dead digested skin material. So to the person who doesn't see these a lot, sometimes they can look infected when they really aren't infected.

So if you have any concern about them, obviously, see your doctor and let them take a look. And we can freeze them off with liquid nitrogen, what we call "cryotherapy".

0:37:02

There are chemical agents that can be put on the outside of them. Again, this will all be done at the doctor's office. And there's a procedure called "enucleation" where you use a needle to poke it and remove the contents of the papule.

This, by the way, does not work for regular warts, but for molluscum it often does so that, basically, like I said, they can pop open and the stuff from the inside , this digested skin that the virus has damaged , can come out. And often times that will help, that will make it go away, too.

Now keep in mind though that these methods can lead to scarring. In some cases, they can lead to some pigment color changes of the skin and you have less risk of those things happening if you just watch them.

So a lot of times you have parents that say, "I don't like the way this looks on my kid." But if we get too aggressive with it, the results are also going to be unsightly and can last a little bit longer than if you just , I mean, if you could get a scar that can last for years and years.

0:38:03

So sometimes you do have to look at the whole picture and say, "Is this really bothering my child? Can they just stay for a while and let them go away on their own?" So that's definitely a choice.

Observation is definitely , I would say the treatment of choice , but sometimes you have to do other things, if the situation calls for it. More information on molluscum, I got this one from WebMD.

You notice I used mostly mainstream sites for information that I give to you because it's important to use trusted resources. So there's a link at WebMD to some information on molluscum for you.

OK. And we are definitely running over. I want to squeeze one more question in here. This one comes from Suzanna. And Suzanna says, "I'm sure a million people already wrote to say this," which actually they didn't. [Laughter]

You can't send peanut butter to school, she says. I haven't seen a school camp or current environment that allows nuts of any kind, even as a trace ingredient.

0:39:02

I wish the people who write this lunch box recommendations would catch up.

What Suzanna is talking about is, we talked about nutritious lunches in one of our news shows a couple of weeks ago. And one of the recommendations was for peanut butter , because it's a good source of protein and kids like it.

And basically, Suzanna is saying, "And don't put peanut butter in lunch boxes."

I'm going to disagree with you on this, Suzanna. First, let me talk a little bit about peanut allergies. It's kind of our allergy show. But just like with other allergies, the way peanut allergies work is that, you have a protein, one of the peanut proteins that enter the body, making antibodies against it and then you have a reaction with subsequent exposure to the peanut protein.

And with peanuts, this can be a particularly severe allergic reaction and can lead to what we call anaphylaxis, which is where you have wheezing and then you can stop breathing, have blood pressure problems.

So people who have peanut allergies you do have to take it pretty seriously.

0:40:01

And they probably ought to carry like an EpiPen or rescue medicine with them. And let people know that "I'm allergic to peanuts. Please keep them away from me."

Now, of course, those who are allergic peanuts have to avoid eating them so to direct ingestion. They have to avoid cross contamination so you wouldn't want, if you have a bad peanut allergy, you don't want your food being cooked on a surface or prepared on a surface that previously had peanuts or peanut product, or peanut ingredient, because it can become contaminated and then you're exposed to the protein.

And also if the protein touches the skin, sometimes, that can cause a problem and if peanut dust is aerosolized so if a dust, there's a powder and a person with peanut allergies breeze in peanut dust that can be a potential problem as well.

Now the next thing you ask yourself, well, if that's the case, it it's so bad like that why in the world do they serve peanuts on airplanes?

0:41:00

I mean it's a small closed environment and the air is dry. It's re-circulating and we have this peanut powder that comes out of the packs.

Now my personal opinion on this is, the airlines cannot guarantee a peanut-free cabin because passengers could bring their own peanuts. And so, by banning peanuts on airlines, it would seem to imply that the cabin is peanut-free, which opens them up to liability if someone has a reaction.

So for them to say, "We're going to serve peanuts. Don't fly in our aircraft if you have a severe allergic reaction." You may get upset at that if you have a peanut allergy. And I am not saying this is the right thing. I'm just saying from the airlines point of view. It's easier to say, "Look, there's peanuts here. Come at your own risk."

But if they say, "We're not going to have any peanuts." Then there is an implied, sort of an implied agreement that we are peanut-free and they might not be. Then if you have a reaction, then you sue them and say, "I thought you didn't allow peanuts in your aircraft. You let the guy next to me open a bag of peanuts."

0:42:05

So from a liability standpoint, it's actually easier for them just to allow peanuts. Plus, I think peanuts are probably a pretty cheap option for him, don't you think? I don't know. Maybe there's even a big peanut lobby, the lobbyingforce.–I don't know. But I digress.

So do we ignore those with peanut allergies or do we ban peanuts everywhere? This is a heated debate that's out there. And it will be different if peanut allergies weren't potentially life threatening, and it would be different if peanuts weren't good nutrition for some kids.

So I think you have to take a middle approach here. Those with peanut allergies should be proactive and inform those around them and carry their rescue medicines. And those of us around people with peanut issue should be sensitive to their needs.

If you're in an airplane and someone next to you says they have a peanut problem, you probably don't want him having an anaphylactic attack and having to use their EpiPen next to you.

0:43:03

So I mean, it'd be wise to , or get crackers instead of peanuts on that flight.

But I do think that in the absence of a person who has extreme allergy, just a total beyond is overkill and in my opinion shows a lack of understanding on the part of those running the school programs that ultimately, completely, totally ban peanut products.

They think they're decreasing the risk for these kids, their own liability and the risk that these kids will have problems. But they actually might be increasing the risk because, if the schools say that they have a peanut-free lunch room, then the child or the parent can become lax because they're starting to trust that there's going to be a peanut-free environment.

They don't take the precautions that they should and then the child has a reaction when someone slips and brings a nut product to school. They're caught off guard and that can be a more dangerous situation than if you allow the peanuts but just take the precautions that need to be taken.

0:44:02

In any case, I don't really see as much of a problem with packed peanut butter, anyway, because it's a good source of protein. Kids like it. It's a low contact and aerosol-risk in the scheme of things. So unless there's a close contact with a known peanut allergy, I still think the benefit outweighs the risk, at least, in my opinion.

We do have a link to peanut allergy information from kidshealth.org in the Show Notes, and you can find that at pediacast.org.

All right, we will be back and wrap up the show because we've definitely gone over. [Laughter] There's no question about that. Sorry about that, folks. I tried to pack five questions in and maybe I shouldn't do that.

So we're going to take a break and we'll be back right after this.

[Music]

0:45:26

All right, thanks go out to all of you for joining us here today at PediaCast, also to Vlad over at vladstudio.com for providing the art work that we use at the website and in the feed as well. So thank you to Vlad. Please be sure to visit and support him at vladstudio.com.

Also thanks go out to my family for allowing me to do this project. And iTunes, if you have not left us a review on iTunes yet, if you could be so kind as to go to the Kids and Family Section of the iTunes directory, last time I looked we were in the featured page, front page, top right.

0:46:01

A review there will be most helpful. Tomorrow, we're going to have a news program, and then Friday, we're going to answer more of your questions. And I'll try to be a little quicker.

And so until then, this is Dr. Mike saying, stay safe, stay healthy and, of course, stay involved with your kids.

So long, everybody!

[End Music]
So long, everybody!

[End Music]

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