Being an Allergy & Asthma Mom
This is a summary of Episode 4: Interview with Emma Amascato: Her allergy journey & managing her son's asthma by Emma Mizrahi-Powel.
Emma Amoscato, the blogger behind The Free From Farmhouse and author of Living with Allergies: Practical Tips for All the Family, discusses her journey into becoming an allergy mom of two and her son's experiences with asthma. Emma also shares how her son copes with asthma and allergies. Plus, Dr G explains a little more about pediatric asthma and the treatments available. Read on for advice about how to help your children take ownership of their allergies and asthma.
Emma's journey into becoming an allergy and eczema mom
Emma Amoscato is very familiar with allergies and asthma. Both Emma and her husband had asthma, allergies, and hay fever as children. Now, their two children have multiple food allergies and environmental allergies, and their son has asthma as well.
Emma has a background in journalism; the way she deals with things is by writing, searching, investigating. In 2014, she set up her blog, Free From Farmhouse, to provide advice, recipes and inspiration for families living with allergies and asthma. When her kids were first diagnosed, she felt scared, overwhelmed, and isolated. Emma felt like nobody else was going through this, and she didn't know what to do. Her mind used to be preoccupied with questions such as, "How will they be able to go to a birthday party?" or "how will I send them to school?"
Through her blog and other activism efforts, Emma strives to make other parents both aware of allergies and more confident about their children's' allergies.
Her first step into managing food allergies
Her son, James, has an exceptionally long and complicated history with allergic conditions. Ever since he was a baby, James has had severe eczema. At six months old, Emma weaned him off of milk due to a suspicion that he had a milk allergy. Emma knew her child well, and after seeing so many signs and symptoms, she was sure that he was allergic to her milk. However, James's doctors insisted that wasn't the case, and that James was not likely allergic to dairy.
Despite initial pushback from doctors, James was finally tested and diagnosed with a milk allergy at nine months old. Managing the milk allergy was smooth sailing for a few months, but at 15 months old, James got a hold of someone's milk bottle, took a sip, and had an anaphylactic reaction.
Dr. Payel Gupta took an interest in the fact that James's journey started with eczema, noting that he should have been tested for food allergies once the doctors knew about his eczema. Children with eczema are predisposed to have food allergies. Dr. Gupta knows that if you have eczema, you need to get tested for food allergies, but that connection from A to B isn't always made with doctors.
Doctors, Coomunication & Diagnosis
Unfortunately, there is often a struggle between a dermatologist, a pediatrician, and an allergist's knowledge. The dermatologists who saw James were likely well trained in their fields, and they were practicing at exceptional hospitals. Doctors in different specialties receive different types of training, but too often those areas of knowledge haven't meshed. Dr. Gupta uses this type of dangerous oversight as an example of why there needs to be more cross teaching in medicine. If a dermatologist or a pediatrician sees a child with eczema, they need to be referred to an allergist.
James has since outgrown his milk allergy, but he is still allergic to eggs, peanuts, tree nuts, sesame, and garlic. He is also allergic to pollen, cats, and dogs. James's allergic conditions don't just start and end with eczema and allergies-- he also struggles with asthma. At ten months old, James had bronchiolitis and was admitted to the hospital. From there on, he was having episodes of viral wheeze.
The connection between asthma and allergies
Dr. Gupta emphasizes two main things that go on in people with asthma. The first is the muscles around the airways are more sensitive, so when asthmatics get exposed to things like viruses or environmental allergens, their muscles will tighten up more quickly, making it harder (or in some cases, impossible) to breathe. The second issue is that those same triggers can also lead to the release of inflammatory cells that can cause inflammation and irritation.
When James's doctors first described his asthmatic episodes as "viral wheeze," they managed to avoid diagnosing him with asthma. One of Dr. Gupta's pet peeves: "if we don't define what it is, it makes it harder for parents to take control if nobody is calling it asthma." Dr. Gupta starts talking about asthma early on with her patients when there is allergic predisposition in the family. She finds that if she informs the parents early on that the child likely has asthma, parents can get a hold of the condition better and be granted more certainty and information.
If it does turn out that the child did in fact just have transient wheezing, and if the child is totally fine after a year, then the physician can simply say, "never mind, it doesn't look like they have asthma-- they just had reactive airways that were sensitive in that time of life, but now they are fine."
Emma adds that it is also difficult for parents to communicate the condition to other people when doctors are vague about asthma terminology: "You want people to take it seriously. The label of 'viral wheeze plan' vs 'asthma plan' sounds different. Those two terms do not have the same resonance, and it becomes confusing."
Looking for asthma triggers
James's asthma symptoms are severe, so naturally, Emma would find it crucial that they are treated as such. His symptoms usually start with a cough, and it kicks off and progresses from there. Most of his asthma episodes occur during wintertime (when lots of viruses are going around) or pollen season. Emma can usually tell that James is having an asthma episode when he isn't being himself and can't carry on doing his normal activities. When it starts to progress further, Emma will see him starting to work harder to breathe. A sign to Emma that the asthma attack is getting particularly bad is when he can't talk anymore and is struggling to take a breath.
Looking for asthma symptoms
Dr. Gupta has a wealth of knowledge about specific signs that a parent should look out for if they feel their child might be experiencing asthma.
Viruses can cause coughs or difficulty breathing for all children. Parents can start to worry when the coughing is accompanied by wheezing, increased respiratory rate (rapid breathing), and shortness of breath. If it lingers, doesn't go away after a night or two, seems like it's getting worse instead of better, and only gets better after use of a nebulizer (given at a hospital or doctor's office), that's when doctors start to think that it looks like asthma.
In brief, if symptoms include coughing, wheezing, and shortness of breath (that seem abnormal for the common cold), and the symptoms don't get better without needing some extra intervention, it may be asthma. If the situation is not an emergency, Dr. Gupta recommends that the first stop is to the child's pediatrician because they know the child's medical history, and that would be the best first place to start.
Once a child is diagnosed with asthma, Dr. Gupta clarifies that there are two types of medications that can be used: rescue medication (which helps open up airways fast and quickly because it works on the muscles) and controller medication (which helps with the inflammatory part of asthma). Treatment can be confusing, but Dr. Gupta emphasizes how important it is to take asthma medication consistently and as prescribed.
Inhaled steroids for asthma are a very critical preventative step to make sure things don't get even worse. Inhaled steroids are different from oral steroids because they only affect the airways, while oral steroids are stronger, more potent anti-inflammatories that affect every part of the body. Many parents fear the word "steroids," so they try to take their children off of them early or not to give them as much as instructed by the prescribing physician. However, when parents over-restrict their child's prescribed inhaled steroids, they are inadvertently increasing the chances of their child needing to take oral steroids in the future. As counterintuitive as it sounds, it is essential to stay on inhaled steroids to prevent getting the oral steroids.
All of the nuances and complexities of asthma management may sound daunting, but Emma offers one piece of advice to parents whose kids were newly diagnosed with asthma: "don't panic". It's scary to have a child with asthma, but you should arm yourself with as much info as you can, talk to the doctor, and give medicine consistently and properly (as they were prescribed).
"If you have any concerns, trust your instinct, go and see your child's primary care doctor again. Don't be afraid of pushing for more info or more care. If you are uncertain at all in the middle of the night about their breathing, take them to the ER and get checked out." -Emma Amoscato
At the end of the day, the key thing to remember when managing a child's asthma is to stick to the treatment plan that you've decided on with your child's doctor. From there, your child's asthma can be effectively managed so that both you and your child can breathe easy.
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