If so, which concerns you more – the asthma or the nut allergy? For me, my son’s peanut allergy is my main concern and I’ve tended to focus on the need to control his asthma as a way of trying to reduce his anaphylaxis risk. However, I attended a talk earlier this month which made me appreciate the importance of managing his asthma for its own sake too.
My son’s medical history
When D was around 12 months old, he was poorly every other week, with chest infection after chest infection. He was usually prescribed amoxicillin, sometimes the oral steroid prednisolone, and on one occasion we were issued with a blue reliever inhaler. One afternoon, I received a call from nursery, where his baby room key worker told me “D’s breathing isn’t right”. I remember driving down to nursery with his blue inhaler and to bring him home, with the niggling feeling that “this isn’t normal”. At that stage, we didn’t know for sure that he had asthma, as our GP told us he was too young for them to confirm an asthma diagnosis.
We then went through several months of being regular visitors to both the out of hours GP and A&E, for him to be given steroids or put on the nebuliser. He frequently missed nursery. And I was continuously having to take last minute time off work and then frantically play catch up once he was well. Until the following week, when the coughing would start again.
Despite this history, it was only after he suffered anaphylaxis to peanut at 20 months’ old, that the hospital confirmed he was asthmatic. Once he recovered from the reaction, one of the allergy team’s first priorities was “to get his asthma under control”. He was immediately put on two puffs a day of a brown “preventer” inhaler (Clenil) and, following his second anaphylactic reaction to grass last year, a daily montelukast tablet.
Since having a brown inhaler, he has rarely had a chest infection. He’s gone from being on antibiotics once a fortnight, to needing them once or twice a year. I appreciate there may be other factors at work: for example, he’s older and has built up his immunity over the past two years. However, it’s a marked improvement and I often wonder whether he should have been given a steroid inhaler earlier on. Had his asthma been under control in April 2012, his reaction to peanut might not have been quite as severe.
As a side point, one bee I have in my bonnet is the need for new parents to be more clearly warned about the risks of food allergies. Wouldn’t it be a good idea if GPs warned of the associated (potentially life threatening) peanut allergy risk whenever prescribing eczema creams and asthma inhalers to babies, and advised parents of “higher risk” babies how to go about attempting to introduce peanut during weaning?
Asthma: a life threatening condition
Of my son’s atopic conditions, I’ve always bracketed asthma with his eczema: something for which he needs medication, but in a different league to the looming threat of anaphylaxis.
At the beginning of March, I attended a Manchester Allergy Support Group meeting, where Dr Rob Niven (Consultant Respiratory Physician, Wythenshawe Hospital) gave a talk on “Advances in the Treatment of Asthma”, including, for example, bronchial thermoplasty and the development of new drugs (such as mepolizimab and various other impossible to pronounce names). As well as learning about the potential new treatments, the talk opened my eyes to the potential dangers of asthma. Dr Niven explained that someone dies of asthma every seven hours and that one of the key reasons for this is that person’s asthma is not under control. It made me appreciate that asthma isn’t “just asthma” and that it’s something to manage in it’s own right (as well as managing it, in the hope that doing so would reduce the severity of any allergic reaction).
Some good news is that the odds for outgrowing asthma are more favourable than for outgrowing peanut allergy. Apparently for children with asthma, 1/3 outgrow it, 1/3 grow out of it temporarily (only to see it return in midlife) and 1/3 stay asthmatic throughout.
- For more information on asthma see the Asthma UK website. Asthma UK are also currently running a campaign Stop Asthma Deaths – with information on the symptoms to watch out for and how to check your risk.
- As with EpiPens, there is a call for schools to hold unassigned blue asthma inhalers, see Daily Mirror, Schools may get spare inhalers to stop needless child asthma deaths by Andrew Gregory (18 October 2013).