Tuesday, October 02, 2012

Back to School Wheezing and Sneezing

Guest Post by Paul Ehrlich, MD

When school starts each year, pediatric allergists brace ourselves for the rush. When kindergartners and first graders pull out their mats and rugs at quiet time, the dust comes out, too, bringing with it asthma, runny noses and sneezing. Guinea pigs and white mice may be nice classroom mascots, and educational in many ways, but they also exude the things that provoke allergies, called allergens. Turtles and frogs aren’t as cuddly, but they don’t make you sneeze.

When leaves are falling, mold spores begin to increase both indoors and out. At this time of year, air-temperature inversions -- warm air on top of cold -- occur both inside the classroom and out in the fresh air. Contaminants like dust and pollens build up at ground level because there’s less vertical air circulation, indoors and outside, bombarding little noses and lungs.

The start of heating season is always busy in our offices. This is when custodians fire up the furnaces, sweeping accumulated dust and mouse droppings from the heating ducts into the classroom. Windows are shut, to keep out cold air, but they trap allergens.

On top of these seasonal events, schools remain an allergen super- market: Chalk, pollens, pesticides, laboratory chemicals, sanitation supplies, perfumes, rodents, and cockroaches all make schools a 7- to 10-hour-a-day, year-round threat.

Even the most careful custodian can’t make a school allergen free for every child. For example, kids who are allergic to cats probably don’t have one at home, but cat dander will stick to the clothes of kids who do and rub off on those of their allergic classmates. It’s often a good idea for these children to change into fresh clothes as soon as they get home.

Asthma is complicated by the fact that there are many different “triggers” for an attack. Some are environmental, but there’s also something called “exercise-induced asthma” which can be triggered by activity in gym class. Any child who complains that exercise makes him cough and wheeze should take precautions. Likewise a child who has trouble when going from a warm school building to play outside in cooler air.

Then there are the issues with food allergies, but they are too complex to discuss here. You can find some very helpful ideas at asthmaallergieschildren.com, in particular this conversation between two experienced school nurses, at http://www.asthmaallergieschildren.com/2012/08/22/food-allergies-elementary-school-tips-for-parents-from-a-couple-of-veterans/.

All in all, allergies and asthma are taking an immense toll. They affect sleep, play, school performance, and the ability to hear spoken language and speak clearly. Asthma alone accounts for over 10 million missed school days per year, making it the leading cause of school absenteeism from chronic illness, yet only around ten percent of cases ever make it past the pediatrician’s office for treatment by a specialist, and half at most who are prescribed the proper medication take it as directed. We must do better.

Dr. Paul Ehrlich has been named New York City’s top pediatric allergist for more than a decade by Castle/Connolly. He was educated at Columbia University, NYU Medical School, and Walter Reed Army Hospital, where he studied allergy and immunology. He is Assistant Clinical Professor of Pediatrics at NYU, and President of the New York Allergy and Asthma Society, in addition to running a private practice, Allergy & Asthma Associates of Murray Hill. He is also co-author of Asthma Allergies Children: a parent’s guide (available in paperback from Amazon.com and Barnes & Noble.com as well as an eBook from all major platforms), and co-founder and contributor to asthmaallergieschildren.com. An anthology of readings from the website will be published as an eBook later this fall.


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