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Asthma and Allergies


Asthma

About 1 in 12 people (25 million) have asthma and the numbers are increasing every year. The American College of Emergency Physicians (ACEP) says — if you’re one of those people — getting a good asthma management plan organized before an emergency may help you or your child stay out of the hospital altogether. Check out the video link. https://www.youtube.com/watch?v=8yxlgvL9CE4

"The good news is that fewer children are dying of asthma; the bad news is that it remains one of the leading causes of childhood hospitalizations," said Jay Kaplan, MD, FACEP, president of ACEP.  "Spring is an ideal time to put together an asthma management plan with your doctor, which should include the fall allergy and winter flu seasons as well."

About 1.8 million emergency visits occur every year because of asthma. If you are not sure whether your child has asthma, but he or she has the symptoms of asthma (coughing, wheezing, shortness of breath), talk to your doctor. After a child has been diagnosed with asthma, the parent or guardian and child should meet with a physician to develop a plan for monitoring asthma symptoms (usually a peak flow meter) and for medicating the child when trouble develops. 

Some children with asthma will benefit from two types of medication: one they use daily to prevent asthma attacks ("controller" medications or inhalers), and one they use to relieve symptoms ("rescue" inhalers). Children with asthma should carry a rescue inhaler with them or have one readily available to them at school. It is important that when children develop symptoms, they and their caregivers or teachers know how to administer the medication and do so quickly.

Asthma

Consistent use of controller medications can prevent many asthma attacks and help children lead a normal, physically active life.  How and when medications are used may vary from season to season, depending on what an individual child's triggers are. 

Typical triggers are:

  • Exercise
  • Colds and flu
  • Laughing or crying hard
  • Allergens from plants, animals, house dust, cockroach droppings or mold
  • Irritants such as cold air, chemicals and smoke

Dr. Kaplan recommends that you do what you can to limit your child's exposure to his or her asthma triggers.  For example, if your child is allergic to furry animals, minimize his or her exposure to them at friends' houses and in the classroom at school.  If cold air is a trigger, arrange for your child to exercise indoors during the winter instead of outdoors.  If dust is a trigger, replace carpeting with wood, tile or vinyl floor coverings.
 
Be sure to get your child a flu shot as soon as they are available in the fall. 

Even with the best planning, some children will have asthma attacks that require immediate attention from an emergency physician at the emergency department.  The following conditions should prompt a call for emergency help (911 in most areas):

  • Symptoms do not improve quickly after the use of rescue inhalers.
  • The child strains to breathe or cannot complete a sentence without pausing for breath.
  • The child's lips or fingernails turn blue.

Older children (ages 11-17) have the lowest rate of emergency department visits, but the highest rate of death from asthma.  It suggests that although they are more independent than younger children in many areas, they still need close monitoring by their parents for signs that their asthma symptoms are worsening and in need of medical attention.

"Emergency physicians want your children to lead fully active, energetic lives without visiting the emergency department," said Dr. Kaplan.  "However, if your child is in trouble, we will be there to get him or her back in action as quickly as possible

Allergies

Allergies involve an overreaction of the body's immune system, which is responsible for fighting infections. There are many types of allergies, including seasonal allergies (which involve allergic reactions to pollens, grasses and weeds), perennial allergies (which last for 9 or more months out of the year), chronic allergies (to allergens such as dust and mold), food allergies, medicine allergies, insect venom allergies, and animal allergies, among others. In addition, some people develop a potentially life-threatening allergy to latex, which is found in rubber gloves, while others can become "sensitized" to substances they have been repeatedly exposed to at work, a condition known as "occupational allergy."

Allergic responses range from mild to life threatening. Common mildly annoying allergy symptoms include sneezing, congestion, runny nose, watery eyes, headache and fatigue. However, exposure to some allergens, such as peanuts, shellfish, insect stings, medications, and latex can quickly progress to severe life-threatening reactions or anaphylaxis. For that reason, seek emergency care right away if you experience a mix of some of the following symptoms:

  • Difficulty breathing
  • Wheezing (along with high-pitched breathing sounds)
  • Confusion
  • Anxiety, fear, apprehension
  • Slurred speech
  • Swelling of the face, eyes, tongue or extremities
  • Trouble swallowing
  • Severe sweating
  • Faintness, lightheadedness, dizziness
  • Heart palpitations (feeling one's heart beat)
  • Nausea and vomiting
  • Diarrhea
  • Abdominal pain, cramping
  • Panting
  • Rapid or weak pulse rate
  • Pale, cold, moist skin or skin redness
  • Blueness of skin, including lips or nail beds (or grayish for darker complexions)
  • Loss of consciousness

To help prevent the need for emergency care for allergy attacks, you can take the following preventive measures:

  • Visit your physician regularly. The continuing advice of a doctor is crucial to the long-term treatment of allergic conditions. Your physician may refer you to a medical specialist, known as an allergist/immunologist, who has received special training in diagnosing and treating allergic diseases. This type of specialist can recommend certain drug therapies or desensitization treatments (also known as "allergy shots").
  • Know your allergies. If you and your physician suspect you have allergies, you may be tested to determine what is triggering your symptoms.
  • Avoid allergens. Once you know what you are allergic to, avoid the allergen. For example:
    • If you are allergic to shellfish, don't eat it; your first reaction may be mild but additional exposures can quickly lead to life-threatening reactions.
    • If cats make you break out in hives, don't pet them or keep them in your home.
    • If you are allergic to insect venom, take precautions when going out of doors, particularly at certain times of year when such insects are more prevalent or aggressive, or when picnicking or in wooded environments. Persons with insect-venom allergies should also carry self-injectable epinephrine (EpiPen or TwinJect), diphenihydramine or a bee-sting kit (per a health provider's instructions); injectable epinephrine should be used only on the person for whom it has been prescribed.
    • If you are allergic to pollen or mold, avoid the outdoors on windy days or when you begin to notice symptoms. The wind often stirs up pollen and mold and carries it through the air. Also, don't hang laundry out to dry. Pollen and molds can collect on sheets and clothing And minimize activity outdoors at dawn (5 a.m. to 10 a.m.) when pollen is usually emitted into the air. -To minimize exposure to outdoor allergens, keep car windows closed when you drive, and consider using air conditioning when your seasonal allergy symptoms are at their worst, both in your car and at home (provided the system is regularly cleaned and maintained and filters are frequently changed).
    • If you are allergic to grass or molds, do not cut your grass and avoid the outdoors when others are mowing their lawns.
    • If you are allergic to mold (or have an allergic asthmatic reaction to it) and experience heightened allergic symptoms in your everyday home or work environment, consider hiring someone to investigate and address the problem. (Do not attempt to remove moldy insulation and other items from your home yourself; doing so can cause an intense allergic reaction.)

Additional Precautions and Prevention

People with allergies and asthma, which are often related, should always carry medications with them and ask their doctors about wearing medical alert bracelets or jewelry. (The MedicAlert® Foundation sells medical identification bracelets on their website at www.medicalert.org.)

More specifically, individuals with asthma should always carry a quick-relief inhaler (bronchodilator), such as albuterol, and avoid known asthma triggers when possible. Individuals at risk of anaphylaxis, for whom a doctor has prescribed self-injectable epinephrine (such as an EpiPen or TwinJect), should carry it at all times and know how to use it in an emergency. Show your family and friends how to use it on you as well.

Persons with allergic asthma and related allergies should avoid exposure to pollution from poor air quality or tobacco smoke. If you live in a city that measures and forecasts air quality, stay indoors as much as possible when the forecast is poor (e.g., "Code Red," Code Orange"). If you are prone to exercise-induced asthma, be aware of your limitations, especially if you do strenuous activity in polluted or high-pollen areas (e.g., places that have a lot of trees, grass, weeds).

Injectable epinephrine should not be used on persons other than the person for whom it has been prescribed (e.g., asthmatics or persons allergic to insect venom). Some people may have underlying health conditions that could be adversely affected by this drug.

Preventing Attacks While Traveling

  • Take all necessary medications with you in their original prescription bottles, in case you need to refill prescriptions while away. Pack extra quantities of medications to make sure you don't run out. Do not pack medications in checked luggage in case your luggage is lost; keep it in a carry-on bag.
  • Carry topical hydrocortisone cream and antihistamine medication with you - if you are using an over-the-counter medication, make sure you have used it before and that it is effective.
  • If using a nebulizer for delivering anti-asthma medication, don't forget to take it on vacation, along with an electrical current converter for it if traveling abroad; portable nebulizers that are plugged into auto cigarette lighter receptacles are also available.
  • If your doctor requests that you use a peak flow meter and record chart, be sure to take these items with you.
  • Bring your allergy-proof pillow or bedding to guard against dust mites.
  • If staying in a hotel or bed and breakfast, check ahead of time to find out whether perfumed air fresheners, deodorizers or other scented products will be used. (Scented carpet cleaning agents also may be a problem.)
  • In hotels, ask for a nonsmoking room, preferably on a nonsmoking floor.
  • If sensitive to mold, call ahead to determine whether this might be a problem, particularly if you are staying in a cabin or a beach bungalow. If driving, check your vehicle for mold and mildew problems, and if camping, check tents and other mold-prone items.
  • If sensitive to sulfites, when eating out check with the restaurant staff to find out whether this additive has been used as a food preservative. If so, ask if your meals can be prepared without it. (Sulfites are commonly used as a preservative in wine, dried fruits and dried potato products. They also occur naturally in wine.)
  • If food allergies are a significant problem, pack snacks at home you can eat while traveling - in case you find yourself without access to "safe" foods.
  • If allergic to pollens (e.g., trees, grass, weeds), check the pollen counts in the area you are traveling to by calling the local Chamber of Commerce or the National Allergy Bureau at 1-800-9-POLLEN. Also, call 1-800-7-ASTHMA for local support group contacts who may be able to offer useful local information.
  • Check with your insurer on coverage limitations and policies regarding out-of-state or out-of-network coverage.