Dr. Annie Coates (Guest): Absolutely. Thank you so much, Melanie, for having me back on the show. I’m delighted to be here today, and especially since May is Asthma Awareness Month and allergies and other airway irritants can so commonly exacerbate underlying asthma symptoms. This is a really important topic to really try and understand and help our patients understand that they may be affected by these various types of things that can irritate our airways. In addition to a number of other common allergens on the home front that we’ll talk about, certainly, environmental pollutants like bus fumes, car exhaust pollution as well are things that can otherwise bother the airways or contribute to inflammation, mucus that can result in those symptoms we talked about last week, like coughing, like wheezing, like feeling of tightness and shortness of breath.
Melanie: We’ve even got things like the ozone, and they have ozone action days in the summer. What do we do about those kinds of days? Do we just keep our children that may already have some kind of an asthma issue? Do we keep them inside on those days?
Dr. Coates: You know, I think it’s a great question, Melanie, and it’s something that I think is important to be aware of as contributing to underlying difficulty of breathing. But I think also, trying to bring your child outside—and although it’s important to minimize and trying to avoid anything that can irritate the airways, although I want you to be aware of what those things may be—there are a number of benefits from being outside. And so, I think that you can kind of play it by ear, and as long as there’s an awareness -- like you don't want to be standing by buses, for instance, and the exhaust that they put out or careful about any exposure to car exhaust but just being aware of the different types of things that can irritate the airways and listen and watch for those responses of your child and then decide accordingly about whether or not it’s safe to bring them out or if it’s better to stay inside.
Melanie: So those are irritants outside. When we look at some of the substances inside and indoor irritants—dust mites, pollens, molds, pet dander, even cockroach droppings or mouse or any of these things that go on inside—tell us what some of the most common triggers are and what we should do about them.
Dr. Coates: Well, you nailed the majority of them. And so, dust mites are high on the list. These are microscopic organisms that are found in bedding, upholstered furniture, carpet, as well as in other places. They can't be seen by the naked eye, but they’re a very common irritant. Furred animals—dogs, cats, guinea pigs, gerbils, rabbits—are among some of the most common animals that people have in their home, but they can also cause allergy symptoms. Pests like cockroaches, mice, rats, the urine, in particular, of rodents can be very irritating to the airways. Pollen in general—so that can be from trees, grasses, weeds—particularly in the spring and then again in the fall. Molds and fungi, those include mold. That again, just similar to a dust mite, would be too small to be seen by the naked eye but sometimes certainly are large enough, particularly in moist areas, to keep out. So at places like bathrooms, for instance, basements, particularly here in Maine, where they tend to be very moist. And then even foods. Common foods that can be irritating are cow’s milk, eggs, peanut, tree nuts, soy, wheat, fish, and shellfish are certainly all common possible triggers that can result in allergy symptoms that most commonly are itchy eyes, runny nose, cough as well.
Melanie: What do we do about those? If we start to see our kids with those itchy eyes and the running nose, and they do that thing with their hand, they rub up their nose until it’s raw, do we start with over-the-counter antihistamines? Do we try and clear out the house? What about air filters? People always want to know if those things work.
Dr. Coates: You bet. There are a number of things. I think, again, similar to what we talked about last week, the most powerful defense is understanding what is going on and what’s possibly causing it, trying to avoid it, and also, being aware of what medicines can help. So first, recognizing that your child may have allergy symptoms is important, and so those are the symptoms that we just mentioned a few minutes ago, like the runny nose, the itchy eyes, the coughing. It may not be a cold. This may be related to allergies, particularly with the change in seasons and particularly in the spring and the fall. And then once you recognize, gosh, maybe this is from allergies, knowing what is it caused by—we talked about common allergies in the home front as well as in the environment. So, different types of things like carbon dioxide, methane, cyanide, carbon monoxide that are all really potential irritants to the airway and important household cleaners that have ammonia or bleach are other things to be aware of. And so, trying to avoid them even if that means staying inside that day. If they’re allergies from dust mites or pests, like cockroaches or furred animals, doing your best to avoid exposure. So when it comes to dust mites, there are different types of covers that you can place on mattresses and box springs, for instance, that are allergy-proof and really block out the possible exposure to dust mites. Air filters are fine to use. I think that they are hit or miss. Some people find them particularly helpful. Others don't. I think they’re certainly reasonable to try. I just caution when it comes to humidifiers in the room to just be aware that they can be a source of mold collection. So just be on the lookout for that. It’s important if you prefer to wash your linens and supposed to put covers on them to just know that they need to be washed at least once a week in hot water. And the minimal temperature to kill mites 130 degrees Fahrenheit, whereas in most homes, we don't recommend going higher than 120 because they can cause burns, so just being aware of that but trying to balance minimizing the risk of burns versus also being able to kill the mites. And then if there are still symptoms that are ongoing, even after taking various types of precautions, like removing dust mites in the home, possibly removing animals in the home, there are different types of medications that you can use. So you touched on one of the most important ones, which is antihistamines. These are medicines that are largely over-the-counter and can be taken by mouth. And they help really try and control those underlying symptoms of itchy, watery eyes and runny nose. Sneezing is another common symptom. Another common medication to use in addition or instead of antihistamines are nasal steroids. That’s actually taking a steroid and applying it directly on the tissue on the nose to help control some of the symptoms that I mentioned. There are other types of medications, but those are two of the most common that we usually recommend after going through allergy avoidance recommendations.
Melanie: Do you recommend trying nasal lavage with our children?
Dr. Coates: I never think that that’s a bad idea, to be quite honest, because what’s involved with that—and this can be done in a variety of ways, one in the shower by just hot steamy water. So, bending over so that water can get into the nose and get up into the sinuses -- sinuses typically start developing about the age of three. Or there are actually sinus rinses. And I am not affiliated with any of these sinus rinses, but one that we use is something called Neil rinses, which we’ve had a lot of positive feedback from our patients, which is basically just a saltwater solution that you can place up the nose and through the sinuses. The whole point and benefit of that is that it just helps rinse out that mucus, rinse out any irritant that’s in the nasal passages or the sinuses. That is always a good idea. But if you do, I just recommend doing it before taking the medicine so that after you rinse out that mucus and irritant, like pollens, for instance, there,that you then can apply the medication like a nasal steroid directly.
Melanie: It’s kind of like a shower or bath for your sinuses. In just the last minute, Dr. Coates, if you would, please give your best advice on dealing with allergies and asthma and these airway irritants that we find outside and inside.
Dr. Coates: Absolutely. I think that it always comes back to education and understanding what may be affecting your child. And so, if you recognize that there’s a particularly time of year where they tend to struggle more—for instance, most commonly in the spring and the fall—trying to understand what may be causing the symptoms of allergies. And then, when that is understood either by parent’s recognition, a child’s recognition, bringing that to the attention of the medical care team, whether that’s your primary care provider and/or a member of my team at the Pediatric Specialty Care at Maine Medical Partners here in Portland, we are here to help understand how we can keep your child as happy and thriving as possible. We look forward to working with you together to be able to achieve that.
Melanie: Thank you so much, Dr. Coates. It’s really great information. You’re listening to MMC Radio. And for more information, you can go to mainemedicalcenter.org. That’s mainemedicalcenter.org, mmc.org. This is Melanie Cole. Thanks so much for listening.