All About Children’s Allergies – PediaCast 120
We are joined by Dr Eric Schenkel, an allergy specialist and clinical investigator. He has lectured widely to fellow doctors, has appeared on CNN and in the Wall Street Journal, and has conducted hundreds of clinical trials studying the latest allergy medications. Today, Dr Schenkel joins us on PediaCast to answer everything you ever wanted to know about your child's allergies!
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Announcer: Welcome to PediaCast, a pediatric podcast for parents. And now direct from Birdhouse Studios, here's your host, Dr. Mike.
Dr. Mike Patrick: Hello everyone and welcome to PediaCast, a pediatric podcast for parents. It is episode 120 for Friday April 18th, 2008. And we are joined today by Dr. Eric Schenkel. We're going to talk about everything you ever wanted to know about allergies but never had the opportunity to ask. So that's right, we're going to take a little bit of a deviation from our regular News Parents Can Use and answers to listener questions and we're going to have an interview show.
Before we get to the interview though, spring is walkathon season. I don't know if you've ever done that before or not. The March of Dimes is the big wig I guess you would say in the walkathon category. And the Walk America walkathon has had been called for many, many years is now called the March for Babies. And it's an appropriate name change because the March of Dimes, they use their resource to help babies. They support research and provide assistance to babies suffering from birth defects, premature birth, low birth weight, a genetic conditions, blood disorders, brain disorders – I mean really the list goes on and on. So if you want to help babies across the globe, and who doesn't want to do that? Please consider participating in the March for Babies through the March of Dimes in your local community. If you can't participate yourself, consider supporting someone you know who is marching, they're not really marching but you know what I'm talking about.
I guess marching – March of Dimes. I don't know… walkathon, I like that name better, the Walk for Babies. ‘Cause you're not really marching. Anyway if you don't know anyone, you know my tangents I'm sorry, it's my ADHD acting up. If you don't know anyone who is marching, we'll make it really easy for you to still help out. If you go to the Pediascribe blog and look for the post Babies Win and You May Too.
There'll be a link in the show notes for this episode at PediaCast.org if you have trouble finding it. So if you go Pediascribe click on that blog post Babies Win and You May Too or go to the show notes and click on the link there. And then if you click on the Donate Now button that's in that post, you'll be able to help out March of Dimes in their quest to help babies. And as it turns out we're actually going to run a contest along with it as well. Every $10 that you donate through our link, we'll give you 1 entry into a drawing.
So if you donate $50 to the March of Dimes that will equal 50. No that will equal 5 entries so one entry for every $10. $50 gives you 5 entries. $100 gets you 10 entries. OK you get the picture. One entry for every $10 you donate. And then we're going to have a random drawing and the winner gets $50 cash. If your donation's as a group through that link reached $300 we'll have a second $50 dollar winner and if your donations reached $700 then we'll have a third $50 winner drawn totally at random out of all of those entries in the drawing.
Don't forget your donation is tax deductable and hey you may win some cash. So stop by the Pediascribe blog some time before May 11th, that's when the contest ends, and look for the post Babies Winn and You May Too and help out a baby who needs you. OK so what are we talking about today? Again we have a guest on the show joining us after the break. Dr. Eric Schenkel is an allergy specialist and clinical investigator from the Valley Allergy and Asthma Treatment Center in Pennsylvania.
And he'll be here to talk about childhood allergies. And you don't want to miss this one folks. Dr. Schenkel is a dynamic speaker. He has appeared on CNN. He has been featured in the Wall Street journal and he excels at answering allergy questions in a way parents can easily understand. But before we get to the interview, I have a reminder for you. If you have a topic you would like us to discuss on PediaCast, it's really easy to get a hold of me. Just go to PediaCast.org and click on the Contact link.
You can also e-mail email@example.com or call the voice line at 347-404-KIDS or 5437 if you don't have letters on your phone. If you use the voice line or you e-mail, make sure you'll let us know where you're from. That's always interesting.
And with that in mind we will be back with Dr. Eric Schenkel right after this short break.
Alright welcome back to the program. For over 20 years Dr. Eric Schenkel has been a respected authority on allergy and asthma care. He's the director of the Valley Allergy and Asthma Treatment Center in Bethlehem Township Pennsylvania. He has lectured globally to doctors, patients and parents and he has appeared on CNN and featured in the wall street journal and other prestigious publications. He has conducted hundreds of clinical trials studying the latest medications and he has helped thousands of kids cope with allergy symptoms.
Today Dr. Schenkel joins us on PediaCast to answer everything you ever wanted to know about allergies but never had the opportunity to ask.
So welcome to PediaCast Dr. Schenkel!
Dr. Schenkel: Thank you. It's a pleasure to be on with you.
Dr. Mike Patrick: I appreciate you stopping by. I think we should probably start out with some definitions because in the course of our discussion they're going to be some terms that some parents have probably heard but may not be familiar with their exact meanings. So what is meant exactly by the term allergic rhinitis?
Dr. Schenkel: Allergic rhinitis is a disease that affects the nasal passages and the membranes of the sinuses due to an allergic sensitivity. And we often call it all seasonal allergic rhinitis or perennial allergic rhinitis to distinguish problems that may develop during a pollen season or year around problems that may develop to a cat or a dog or other type of dust mite problems that's in the home.
Dr. Mike Patrick: OK so allergic rhinitis then is sort of the body's response to an allergen, so that's another term that we want to definitely define. So what's an allergen?
Dr. Schenkel: That's right. An allergen is a noxious substance something that irritates somebody but the very important distinction here is it irritates the body by interacting with the immune system. You know a lot of us when you get around some pepper or cigar smoke or some cigarette smoke, we might sneeze. That's not an allergen, that's an irritant. It just bothers you. It's like eating spicy foods can bother you. And allergen is usually a protein substance that interacts with the body's defense system. And the defense system is there to protect us. But with allergies the defense system starts overreacting.
These otherwise harmless substances like pollen, dust mites, cat dander, molds etcetera.
Dr. Mike Patrick: OK and then the third term that I wanted to define before you really get started with the discussion is sensitization. That's something that's going to come up. What exactly is that?
Dr. Schenkel: Well there are several books it says sensitization with an allergy it's the immune system. So you're exposed to something, your immune system starts acting in a very, very abnormal fashion and it's a genetic programmed to that. To have allergies you have to have the certain genes that produce certain ways in which your body reacts abnormally.
This sensitization exposes you to this otherwise harmless substance not to pick on cat's dander. So that when you react to it and then react to it again, you have an exaggeration of responding your body releases chemicals like histamine and inflammation chemicals that causes the sneezing, runny nose, and congestion, etcetera.
Dr. Mike Patrick: OK and you mention a couple other terms perennial allergic rhinitis and seasonal allergic rhinitis, what are the difference between those two?
Dr. Schenkel: Well perennial a year around and seasonal is just during a season. And right now we're in the middle of tree seasons, tree-pollen seasons. The more up to date terminology is actually persistent which means a year around… "all-the-time rhinitis… or intermittent which is just every now and then. And that's the term that everyone else in world has used. And in the United States we still use seasonal and year around or seasonal and perennial.
Now, seasonal allergies… Hay Fever for example is often thought about as in ragweed season.
And in the Northeast middle of August and until first frost. It's not caused by hay and doesn't cause fever but it certainly causes misery for that person that have them.
Dr. Mike Patrick: Yes I can vouch for that, personally.
Dr. Schenkel: There you go.
Dr. Mike Patrick: In addition to tree pollens, what are some other common outdoor allergens that people are sensitive to?
Dr. Schenkel: Well I take you to the season say in the Northeast where I live and practice, tree pollens start usually in March – April and continues until the early mid quarter May. Grass pollens start in early part of May and goes until early July. Molds pores are out from April until the first hard snow fall or hard freeze and ragweed& it's the middle of August until the first frost.
But there are many ways in which you can access information about what's available in terms of what outdoor allergens are in your community. There are couple of websites that will helps you understand where the pollens are coming from. Pollen.com I think can do that. We measure our own pollens right now so we know what's in the year.
But any allergist can help you understand what's in the air right at this moment.
Dr. Mike Patrick: So Pollen.com, I'll be sure to put that in the show notes too so people can find the link. And then, so really there's no break is there except in the dead of winter at least in your neck of the woods?
Dr. Schenkel: You know also I designed a website called Nasal-allergies.com, that can also help people with the checking out pollen counts, at least remember that one as well.
Dr. Mike Patrick: Great.
Dr. Schenkel: There really is no break. And a lot of our patients with perennial or persistent rhinitis have outdoor allergy problems. But that's on top of having the indoor allergy pollens due to dust mites or indoor molds or a feather pillows or some other sensitizing items in their house.
Dr. Mike Patrick: Right. Or the cats that you like to pick on.
Dr. Schenkel: Well the cat, I'm not picking on the cat. Yes.
Dr. Mike Patrick: Yeah it seems like that's definitely a common one. So whether it's an indoor allergy or an outdoor allergy, how exactly does all this happen sort of on the cellular level? I mean what exactly is happening inside the body to make kids have these symptoms?
Dr. Schenkel: Well you have to have this genetic programming to have an allergy and usually there's a family history. So you have the genes that produce certain antibodies and the antibody is called IgE.
Now remember the antibodies are what we use to fight off germs and infections but with allergies this IgE reacts abnormally. So you have this IGE that then recognizes pollen, or mold, or dust mite, or cat dander or whatever you're allergic to. And then it causes a release of chemicals from a special cell antibody called the mast cell.
And those chemicals histamine, leukotriene, and other kinds of chemical mediators then cause all the allergy symptoms. But it's more to just a little sneeze and a runny nose; the biggest problem is the congestion. And that comes from inflammation. So our new concept of allergy is that it's the inflammation of the sinuses in the nose more than just a runny nose and sneezing.
Dr. Mike Patrick: Right. Now those sound like the same kind of symptoms that kids would have with a viral upper respiratory infections. So how can you tell the difference or how can parents know whether its allergies, that's the problem or just one cold after another?
Dr. Schenkel: That's a really good question and there's often a overlap between the two. And in fact a lot of kids I see with recurring ear infections or recurring problems with rhinosinusitis or infection of the sinuses often have allergies. But a common upper respiratory infection is very, very self limited. And kids feel stick. And they last only three to five days, the mucus is clear and may not be aches in pain or maybe a low grade fever. On the other hand allergy symptoms are usually associated with itching, clear mucus and more chronic symptoms and just something that happens for a few days.
But there's certainly is a blending of the two and the other problem that I see is commonly kids do have upper respiratory s on top of allergies. And then develop a sinus infections and sinusitis is real tough to diagnose in kids.
Dr. Mike Patrick: Right. I guess if parents are having trouble with these kind of symptoms, at what point should an allergist get involved? I mean they talk to their regular doctor first and then with you being an allergy specialist, how do they come to see you?
Dr. Schenkel: Well a lot of patients come to see me on their own because they either know what we do or they've got other people know what we do. But when a parent sees her child's suffering, when the allergies get in the way of life, if the sinus problems are causing other complications like ear infections, sinus infections, or if it's dropped into the lungs and someone' developing& bronchial asthma. A lot of kids with allergies suffer. They may not focus well in school; so if they're having more… what I would call systemic effects or just quality of life issue that's when I would certainly consider seeing a specialist.
Dr. Mike Patrick: Alright. In my own practice I know a lot of times parents will have an idea that their kids have allergies because they suffer from allergies themselves and they're seeing the same sort of symptoms in their kids. And they come in and say we want an allergy test. I mean do all kids with allergic rhinitis need to have an allergy test done? Is that something that should be done in all kids that you suspect an allergy?
Dr. Schenkel: Well first of all I wanted to clear that there's allergy test and there's allergy test. Some of the newer that we test that don't even involve needle it's called the multi-test which is like the old tine test. So kids don't react fussy to it. It doesn't involve needles and yeah I mean it's not comfortable because you're at doctor's office and kids may not like it but it's not terribly difficult to the patients. It's not an obnoxious test.
Also you can test kids down to age six months,& eight months. I see a lot of kids who are told not to come to see an allergist because they say, "Oh you can't be tested until you're 10 years old or 5 years old. And that's nonsense. But not everybody who has sinus or allergy problems needs testing. But if it's not to the point where it's interfering with your life or there are other complications… then I think allergy test would be appropriate. Now the best way from an allergist standpoint is the allergy skin test an alternative or a screen test could be a blood test for allergy but it's often fall with false negative and false positives.
Dr. Mike Patrick: Right. Now this is more of a doctor question and we do have a lot of physicians in the audience as well. So this may go a little bit above what the parents need to know. But I've always wondered with the skin testing when you're talking about respiratory allergies and you talk about IgE, does IgE really react to things that you inject into the skin, the same way that it does if you're exposed to it from a respiratory standpoint?
Am I making sense with the question?
Dr. Schenkel: Yeah you are. Yeah and it goes back to history with the laboratory blood test and this case skin test supporting the history. You don't like to do it in a vacuum so you get a good history and then you also support it with the skin test. It becomes more complicated with food allergies where you can get false positive or false negative skin test. But there's good data that at the skin test then they're done right then it does correlate with what goes on in the nasal passages and the lungs.
Dr. Mike Patrick: Good. So let's say that you do establish that a child has allergic rhinitis, what sort of treatment options are available for them?
Dr. Schenkel: Well the first thing that I always tell parents is avoid what you're allergic to. People look at me and they say, "Well that mean my kid has to live in a bubble…. I say, "No…. But using air-conditioning can help staying indoors in the morning hours – can help.
If you have a pet and you're allergic to it then the best thing is to get rid of it but nobody ever does that.
Dr. Mike Patrick: Right.
Dr. Schenkel: And by the way, I'd like the audience, please don't get rid of your cat or dog just because you have asthma or allergies because until you have proper testing you may not be allergic to the cat or dog.
Dr. Mike Patrick: Right.
Dr. Schenkel: But the test has to be done properly. So avoidance measures are the first measure and there're dust mite avoiding measures, there's mold measurement that you can get in the house and you can avoid mold and so on and so forth.
Now you have medications. Now I have to tell you this by far and away, the best medication for both preventing and treating nasal allergies is a nasal steroid.& When I mention the word steroid to parents, everyone freak. They think they're going to turn into a baseball player who we shouldn't name or somebody who's grown hair or somebody like in the wrestling federation or something.
Dr. Mike Patrick: Right.
Dr. Schenkel: So I have to make it clear to them that steroids for the noses are different. Now antihistamines are very commonly used. But here we have to be careful because they can cause central nervous system defects. You know some popular ones over the counter, Benadryl, Dimetapp and even Zyrtec can make you drowsy. So I'd urged parents to use non-sedating& antihistamines like Loratadine or Fexofenadine rather than the sedating antihistamines.
But nasal steroids really are the best. Now there are lot of different steroids out there. My preference would be Nasonex which is approved down to age twp and is very, very safe in both kids and adults. It's been studied extensively here and all over the world and not only helps to treat allergies but can also prevent allergies. So Nasonex probably is one of the best medicines for controlling nasal allergies in both kids and adults.
Dr. Mike Patrick: Is that something that once kids start a nasal steroid, is it something that they have to do then the rest of their life, is this sort of what's the long term outlook with this?
Dr. Schenkel: Well many kids with allergies get better as they get older. No one outgrows the allergies. I mean a lot of kids who get better when they're teenagers that comes back in their 20's and 30's. Been around that long I guess. And so no one ever outgrows it but there's a tendency to gets better as you get older.
It's not definitely that you need the medication forever. But one of the most important mistakes I see is when a nasal steroid is prescribed that is not used either two of the season or continuously to prevent this symptoms just use sort of "as needed…. That's the big mistake.
Dr. Mike Patrick: I think I see this lot too in my own practice where kids are doing well on their nasal steroid and their parent starts to think, "Oh they don't need this anymore because they're doing well…. And so they stop it and they don't get bad immediately after stopping it and then you know they're back in to see us in couple months later.
Dr. Schenkel: It reminds me of the inflammation of the body in general. It's like OK let's prevent it and let's make sure it stays under control and yet may flare it up but it certainly works better to keep it under control.
Dr. Mike Patrick: Right. Right. Well what about you talked about histamines being one of the chemicals and then Leukotrienes is another one. Singulair is anti-leukotriene, does it have a place in allergy treatment or is it just in the realm of asthma?
Dr. Schenkel: It does have a place. It's not a real strong medication that works on allergies but it is a medication that we use. It's not really strong. It's something that I use a lot with kids with nasal polyps ‘cause it may have a special role on that and though it's not approved for that.
Certainly if there's an upper and lower airway link as in asthma and allergy, it may be more beneficial. If the child's allergic to aspirin, it may be more beneficial. But as an anti-allergy medicine it's not as a strong or as good as anti-histamine or nasal steroid.
Dr. Mike Patrick: So you would look at nasal steroids as being first line and then if you need to add something to that think about the non-drowsy anti histamines second?
Dr. Schenkel: Yeah that's for the persistent rhinitis. I mean for intermittent rhinitis, you can use an anti histamine but if it's gone to the point where it's severe, where there's more nasal congestion then I'd rather use a nasal steroid along with an antihistamine.
Dr. Mike Patrick: OK now where do allergy shots fit in to the picture?
Dr. Schenkel: Oh allergy shots are a marvelous way to really impact the immune system. It's allergy vaccine desensitization immunotherapy… they've been around for 75, 80 years or longer and they're very effective but not everybody. People who have significant symptoms where there's a lot of medicines being used, where their comorbid conditions, complications like asthma, sinusitis, ear infections or the medicine's simply not working that allergy shots certainly would be strongly be indicating. And there may be either for 3 to 5 years and some kids do willing to a more permanent remission.
Dr. Mike Patrick: Have you noticed like over the last let's say 5 to 10 years, a lot fewer kids are getting allergy shots than before? I guess it's because of the newer non-drowsy antihistamines and nasal steroids and I mean is that a fair…
Dr. Schenkel: Not my practice, actually what happens with me is I see a lot of people now self medicating, will go to the store they'll take an antihistamine, they'll get hooked on a nasal spray like Afrin and Neo-Synephrine. They'll& be treated a little bit here and a little bit there and then I see more trained rhinitis patients now than before because of the delay by the parents or delay by the physician. So it's still a mess for a lot of people.
Dr. Mike Patrick: Sure. What about young babies? You talked about Nasonex being approved down to age two. Can babies have allergies? Or does it take longer for the sensitization process to occur?
Dr. Schenkel: I've seen at 9-month old, 10-month old who had food allergies and recurrent RSV yielding asthma and I've seen allergic rhinitis in six month old, we diagnosed it with both skin testing and blood test. And Nasonex is approved down under age two and it's a real challenged to get a baby to take it. One of the things I used more and I'm sure you do is in babies using a bulb syringe to help drain out the nose that way.
Dr. Mike Patrick: Sure. And a humidifier and saline nose drops and those kind of things.
Dr. Schenkel: Nasal saline is like chicken soup to the nose for all ages. I'm a huge fan of it.
Dr. Mike Patrick: Great. You talked a little bit about prevention and keeping kids' exposure to the allergens down. What are some things specifically in the homes that parents can do you know for kids who have dust mite allergies or molds and that sort of thing?
Dr. Schenkel: Well keep the humidity of low because that keeps the dust mite average down and keeps the mold down. If there's obvious molds smell somewhere there is mold looking under the kitchen sink and the bathroom, the shower stool, in the basement, all that area can have a mold growing into it as well. Dust mites cover the mattress with in box springs special mite avoidance devices or sheets rather and use HEPA filters. You don't have to go out and get a fancy electrostatic or air purifier – HEPA filter – High Efficiency Particulate Air filters are wonderful in the bedroom. Clean air-conditioning filters frequently and get rid of feather pillows because they can harbour dust mite and get rid of carpeting – that's all part of the plan for dust might avoidance.
Now talking about prevention, it's interesting because there's actually a theory now that if kids are exposed to more dust when they're very young and dirt when they're very young and animals when they were young, they may have less allergies when they get older. Now what very young means?& I don't know. It could be a year, could be two years but there's a fine line between exposure and causing problems and exposure and preventing it. But don't go out and get a dog or cat because you're thinking that will prevent things later on. But it's curious that kids who grow up on farms where it's dusty and dirty have fewer allergies.
Dr. Mike Patrick: So it's almost like allergy shots and I mean it's sort of the equivalent of an allergy shot?
Dr. Schenkel: Something like that yeah! Something like that.
Dr. Mike Patrick: And I probably don't want to get you started on indoor cigarette smoke.
Dr. Schenkel: Don't even get me started on that because it's in right there.
Dr. Mike Patrick: Yeah and I did see a study that even parents who… ‘cause now the thing now is, "Oh yeah but we smoke outside. Everybody smokes outside….
Dr. Schenkel: They could smell the smoke on the skin.
Dr. Mike Patrick: Yeah and I did see a study that if they wear another layer of clothes outside while they're smoking and then take that layer off, then that's even better. That parents who smoke outside and then came in and then you look for toxins in the urine of the kids that there was more toxin there if they smoked outside without putting an extra layer on.
Dr. Schenkel: Yeah well that's a nice theory but you know…
Dr. Mike Patrick: Please stop smoking. That's the better.
Dr. Schenkel:& Like the ad that's I think it's the health department in New York City or New York State and it shows a baby and it just shows smoke coming out into his mouth and the tag line is, "If you're smoking in the house and you have your kid, this is what happens to your kid…. Very effective.
Dr. Mike Patrick: Right. I guess very. What' the relationship then between allergic rhinitis and asthma and how does then eczema fit into the picture too? ‘Cause this all – really the same disease process isn't it?
Dr. Schenkel: Absolutely it's IgE and the anti-allergy antibody and it will be a whole one airway one disease the upper or lower airway link. And if you have allergic rhinitis then you have a higher risk in having asthma.
Getting asthma probably about 80% of kids have allergies and allergic rhinitis that is very important for parents and physicians both to know that you have to treat thenasal symptoms to control the lower airway and that's why clearing up the nasal problems with a good nasal steroid like Nasonex& and a good oral antihistamine. And even there Singulair for upper or lower is important to controlling the entire airway.
Dr. Mike Patrick: Right. And since these are long term problems and requiring long term treatment, many parents have concerns about the safety of giving their kids medicine over a long period of time. Can you speak a little bit to that?
Dr. Schenkel: Yeah. One of the things about nasal steroids is and again not to hop on pick on Nasonex because it's been studied extensively would come by to the nose and sinuses – very, very safe long term. The antihistamines has been around for years but again I'd stay away from& anything that causes drowsiness and that's why I've used the newer generation Loratadine, Clarinex, the Fexofenadine rather than the ones that cause fatigue. But again these medicines are very safe, they've been studied long term. So yes they're all generally safe.
Dr. Mike Patrick: Alright well we really appreciate you stopping by and talking about allergic rhinitis and we'll have to have you back some time talk asthma or skin problems too.
Dr. Schenkel: Anytime you want to contact me, feel free.
Dr. Mike Patrick: Alright before we go many thanks to Dr. Schenkel for stopping by and sharing his expertise. Also thanks to Nationwide Children's Hospital, Medical News Today, Vlad Studio and of course listeners like you.
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I know the show is a little late this week but never fear we will be back on Monday with an all new episode. I promise because I've already done major work on it. So this week was our special interview show. Next week we will be back with News Parents Can Use and answers to your questions on Monday.
And until then this is Dr. Mike saying, "Stay safe, stay healthy and stay involved with your kids….
So long everybody.