About 4 million to 5 million American children have persistent asthma, and about 90 percent of them also have allergies. Studies have found that treating the allergies can not only make asthmatic children more comfortable, but it can even keep them out of the emergency room.
"For the vast majority of children with asthma, allergies are a very important, if not the most important factor in causing symptoms and determining risk for hospitalizations and emergency room visits," says asthma expert Dr. William Busse of the University of Wisconsin.
And federal guidelines for treating asthma say children with persistent asthma should be checked for allergies. Still, there are many asthmatic children whose allergies go undiagnosed and untreated. Dr. Karen DeMuth sees it every day at her clinic at Emory University. "I don't know if anyone has been keeping data," she says, "but there definitely is a lot of undermanaged asthma."
She points to 4-year-old Abbie Denham, who came to her office in February. Before Abbie saw DeMuth, she had drugs for asthma flare-ups and medicine for her skin allergy, eczema. But no one had even diagnosed her respiratory allergies.
Abbie's mother, Carla Denham, said that despite asthma medication, her daughter wheezed at night, and couldn't run or play without running out of breath. When DeMuth checked Abbie for allergies, she found that the girl was pretty much allergic to everything: all sorts of pollens, molds, cats, dogs, dust mites and cockroaches. DeMuth counseled the mother on avoiding allergens, kept Abbie on asthma medication, and gave her nasal sprays for the allergies.
"She's keeping up with everybody, and she's sleeping wonderfully — she's a different child at night," says Denham.
That experience is evidently pretty common. Busse estimates that 30 or 40 percent of children with allergic asthma never have their allergies diagnosed.
Dr. Stephen Teach of Children's National Medical Center says that among the inner-city kids he sees, it's a lot more. "The vast majority of inner-city children have not had a comprehensive evaluation for allergies," he says.
Tackling Allergies Is Tricky Business
One reason is that allergies are a challenge to diagnose. Doctors need to have a thorough understanding of what a child is exposed to. There are blood and skin tests, but they can be difficult to read. And once doctors identify a problem, allergies are a challenge to treat. Allergy shots offer relief to some, but patients need to continue to get a shot about once a month for three to five years to attain immunity. Allergy drugs have side effects, and can't be taken with certain other drugs. Avoiding allergens like pollen, dust or animal dander can also be hard.
There is, however, compelling evidence that avoidance helps with asthma. One such study appeared in the New England Journal of Medicine in 2004. Researchers trained parents of about 500 kids with asthma on how to protect their children from exposure to allergens like dust, cockroaches, mold and animals, as well as tobacco smoke. Compared to a similar group, the kids in the treatment group had an average of 21 fewer days of wheezing. A study last year in the American Journal of Public Health showed that when parents were trained in how to protect their kids from allergens and tobacco smoke, emergency room visits went down by 30 percent.
Teach says allergen avoidance is a good approach, but it takes a lot of effort. "In order to educate a family, you have to talk about a lot of different things," he says. "And primary care doctors have a limited amount of time." He estimates that it takes an hour to an hour and a half to fully educate parents on allergens and other things that can spark asthma. Most insurers don't pay doctors for that kind of time.
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