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TRIGGER AVOIDANCE
Allergies: Your child may be tested for allergies to help identify triggers. The following is a list of common allergens and ways to help control, reduce, and eliminate those triggers.
Pets: Almost all pets can cause allergies, including dogs, cats, birds, hamsters, and guinea pigs. People who have allergic reactions to animals are actually allergic to the animal's "dandruff" (referred to as "dander"). Any animal with skin produces dander. There are no "hypo-allergenic" dogs or cats. All pets should be removed from the home, if possible. Pet dander may stay in the home for months after the pet is gone; thus it may take a while for the asthma symptoms to improve. If removing the pet is impossible, keep it out of your child's room. Bathe the pet weekly to cut down on the amount of dander in the home. Fish or snakes are good alternative pets.
Dust mites: Dust mites are microscopic mites that live in bedding, carpet, and stuffed animals. Dust mite allergy is very common in people with asthma.
- Encase mattresses, box springs, and pillows with allergen-impermeable covers.
- Wash bedding weekly in hot water and dry in dryer on hot setting.
- If possible, remove stuffed animals from room or wash frequently with bedding.
- Remove carpet from bedroom if possible. Otherwise special powder is available to clean carpet that kills the dust mites. This typically needs to be done 3-4 times a year.
Molds: Try to reduce indoor humidity to less than 50%. Use a dehumidifier if necessary. Provide good air circulation in high humidity rooms such as bathrooms, kitchens, basements. Carpet and pad should not be laid on concrete basement floors. Vinyl flooring is best. Use paint with mold inhibiter. Avoid live Christmas trees. Molds also form in house plants, so keep live plants out of the child's bedroom. Have your child avoid sources of outdoor mold such as wet leaves and garden debris.
Pollens: Any time air pollution and pollen levels are high, it is a good idea to stay indoors and use air conditioning. Keep windows closed when the pollen and mold counts are high (many TV weather channels report the pollen and mold counts). If your child is allergic to grass pollen, he or she should not mow the lawn. Keep in mind that other chores, such as doing the dishes or washing the laundry are acceptable.
Cockroaches: A major cause of asthma in urban areas is cockroach allergen which comes from dead roaches and roach droppings. Roach motels may be helpful. Careful cleaning of the home will also help.
OTHER TRIGGERS:
Exercise: All and any activity is encouraged. Give any medication prior to activity/exercise as prescribed by your healthcare provider. Intense exercise in cold air is more likely to trigger asthma.
Tobacco smoke: Smoking should not be allowed in the home of someone with asthma. Ask family members and friends to smoke outdoors. Suggest that they quit smoking. A person with asthma should try to avoid wood stoves and fireplaces. Glass doors on fireplaces may be sufficient to reduce the potential harm.
Aerosol sprays: Perfumes, hairsprays, room deodorizers, cleaning chemicals, paint, and talcum powder should be avoided or kept to low levels.
Cold, dry air: Have your child wear a scarf or pull a turtleneck over his or her mouth and nose in cold weather.
Weather changes or hot air: Have your child take medicines as directed. In extremely hot and humid weather, have your child stay indoors with the air conditioner on.
Respiratory infections (colds): As much as possible, have your child avoid people with colds or the flu. Practice principles of good health in the family, including getting plenty of rest, eating a balanced diet, and exercising regularly. Teach your child good hand washing. The influenza (flu) vaccine is recommended every year in the fall.
Laughing hard, crying, and yelling: Teach your child how to calm down, using slow breathing and relaxation.
Gastroesophageal Reflux (GER): When both GER and asthma are present, the GER may make the asthma more difficult to control. When a child spits-up the food/formula contains a small amount of acid from the stomach. The acid can get into the lungs and cause asthma symptoms (cough, wheeze). Acid into the food pipe can trigger bronchospasm. Medications may be prescribed to treat the reflux (Prevacid, Nexium, Zantac, or Pepcid). Other measures to help reflux symptoms include:
- Thicken formula/breast milk with rice cereal
- If breast feeding, feed rice cereal by spoon halfway between nursing
- Keep infant upright for 30 minutes after feeding
- Use the car seat only when infant will be riding in the car, otherwise a bouncer seat is better
- Avoid tight diapers/waistbands
Foods: It is rare for foods to trigger asthma. Unless your child wheezes or has other asthma symptoms shortly after eating a particular food, it probably isn't a problem. Unfortunately, allergy to peanuts (though still relatively rare) is becoming increasingly common in children. Recent studies have shown that children who have asthma and severe, life-threatening reactions to peanuts are more likely to suffer fatal reactions after eating peanuts, than are children who have severe, life-threatening reactions to peanuts alone. If your child is allergic to peanuts, ask your doctor about getting a "Medic-Alert" bracelet or necklace and also about having an adrenaline syringe (Epi-pen) with your child at all times. You should, of course, be instructed how to administer the adrenaline injection and to call 911 in case your child ever accidentally ingests a peanut product. Teachers, school nurses, and any other supervising-adult should all know of the child's peanut allergy and be instructed in the administration of the adrenaline injection, and to call 911.
The great difficulty with peanut allergy is that peanuts are hidden ingredients in many foods (such as food which cooked in peanut oil). Additionally, some children are so sensitive to peanuts that they may have a reaction by just inhaling peanut vapors or by coming in contact with foods that have just been prepared in the same kitchen as peanut-based foods. This requires constant vigilance to ensure that the peanut-allergic child never eats a peanut product. Reading food labels and asking specific questions about food preparation when eating outside your home is mandatory.
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