Allergies and asthma in children

How asthma presents in children

Asthma in children most often presents with cough, wheezing during breathing, a sense of chest tightness and difficult breathing. Symptoms vary: a child may be completely well for weeks and then have a period of complaints. A cough at night or early in the morning, a cough after running, laughing or crying, and a cough that lasts after a cold are signs the pediatrician assesses with care.

In young children, wheezing is often caused by viral respiratory infections and does not necessarily mean asthma. Suspicion rises when episodes recur, when they occur even without a cold, when the child has eczema or allergic rhinitis, and when asthma or allergy runs in the family. A parent can help greatly with a short diary: when symptoms appear, what precedes them and how long they last.

How the diagnosis is made

The diagnosis rests mainly on the history of symptoms and the clinical examination. The pediatrician listens to the lungs, assesses breathing and looks for triggers such as dust, dogs or cats, tobacco smoke, cold air, infections and exercise. In children who can cooperate, usually from school age, spirometry measures airflow and shows whether there is reversible narrowing of the airways. Spirometry is performed at the clinic when indicated.

In younger children the diagnosis is mainly clinical and may be strengthened by the course over time and the response to appropriate treatment. A normal spirometry during a symptom-free period does not exclude asthma. A chest X-ray is not needed in every case; it is requested when pneumonia, a foreign body or another cause is suspected and, if indicated, is performed at the appropriate service.

What allergy is and how it presents

Allergy may affect the nose (allergic rhinitis), eyes, skin (eczema and hives), airways and digestive system. Allergic rhinitis presents with sneezing, a blocked or runny nose and itching of the nose and eyes, often seasonal or after contact with house dust, pollen or animals. When untreated it can disturb sleep and concentration at school and worsen asthma symptoms.

Food allergy usually appears within minutes to two hours after eating, with hives, swelling of the lips or face, vomiting, abdominal pain or, in severe cases, difficulty breathing. A delayed or vague digestive complaint is not always an allergy. Do not remove foods from the child’s diet on suspicion alone, because unnecessary restrictions can lead to nutritional deficiencies and make feeding harder.

Allergy tests and their interpretation

Blood tests for specific IgE and skin tests are not a general screen and should not be requested without a clinical suspicion. A positive test shows sensitization, but not necessarily disease: a child may test positive to a food that they eat without any problem. The result is therefore always interpreted together with the symptoms and the history of the reaction.

We offer interpretation of allergy tests and of tests performed outside the clinic, including the eosinophil count and total IgE, and guidance toward specialist allergy assessment when needed. A food challenge, when necessary, is done only under controlled medical conditions and not at home.

How asthma is treated long term

Treatment has two aims: daily control of inflammation and quick relief of symptoms when they appear. Controller medicines, usually low-dose inhaled corticosteroids, are taken regularly even when the child feels well, because they work by preventing attacks. Reliever medicines, which quickly widen the airways, are used as needed. Frequent use of the reliever shows that asthma is not under control and needs reassessment.

Inhaled corticosteroids at the doses recommended for children have a good safety profile, and unnecessary fear of them is a frequent cause of inadequate treatment. Inhaler technique matters greatly: in young children a spacer with a mask or mouthpiece is used, and the technique is checked at every visit. Do not change the dose or the medicine yourself and do not stop controller treatment without guidance.

Action plan and prevention of attacks

The pediatrician prepares a written plan describing what to do when symptoms are mild, when they worsen and when urgent help is needed. The plan includes the medicines, doses, warning signs and contact numbers. A copy is given to the nursery or school, together with instructions for using the inhaler.

Reduce contact with triggers: no smoking at home or in the car, regular cleaning of bedding and curtains, humidity under control and care with animals when allergy to them is proven. Vaccination according to the schedule and regular check-ups help reduce the infections that cause worsening. A child with well-controlled asthma can play sport and lead a normal life; physical activity should not be forbidden without reason.

Follow-up visits review symptoms, growth, inhaler technique and the need to change treatment. They are scheduled every 6 months, at most within a year, or sooner when the doctor considers it reasonable, especially after an attack or when night symptoms return.

Care at Tirana Polyclinic: we offer pediatric consultation, spirometry as indicated and interpretation of allergy tests and of tests performed outside the clinic. When severe allergy or uncontrolled asthma is suspected, the child is referred for specialist assessment.