Treatment Guidelines in Children With Allergic Asthma

In part 2 of this 2-part episode, Irum Noor, DO, speaks about the differences in treating allergic asthma in children compared with adults, including when a pediatrician should refer a child to a specialist.  

Irum Noor, DO, is an allergist and immunologist with ENT and Allergy Associates (Manhasset, NY).

Listen to part 1 of this episode here


Jessica Bard: Hello everyone. And welcome to another installment of Podcast 360, your go-to resource for medical news and clinical updates. I'm your moderator, Jessica Bard with Consultant360, specialty network. According to the Cleveland Clinic, allergic asthma is the most common type of asthma. Approximately 25 million people in the United States have asthma and 60% of those people have asthma caused by allergies. Dr Irum Noor is here to speak with us today about the treatment guidelines of allergic asthma. Thank you for joining us today, Dr Noor. Please introduce yourself for the audience, with your title, position, and affiliation.

Dr Irum Noor: Hi everyone. My name is Dr Irum Noor. I'm an allergist-immunologist working with ENT and Allergy Associates. It's my pleasure to be talking to you today. A little bit more of a background in pediatrics, given my base training with pediatrics. And so I'm excited to share with you.

Jessica Bard: Well, thank you again for joining us on the podcast. We're talking about allergic asthma in children today. What are the treatment guidelines in children with allergic asthma?

Dr Irum Noor: So the treatment guidelines in children with allergic asthma, the first thing we've gone through is that we want to make sure that we've gone through a workup, essentially, to say, "Okay, this asthma sounds like it's triggered by allergies." And in order to do that, we have to talk about, okay, what's positive on our skin testing, our blood testing, looking at the different allergens. Now there's could be trees, weeds, grasses, mold, insects, animals. And so looking at all of those different groups, there are different strategies to avoid triggers for allergic asthma for every part of it. We know that trees and grasses, they pollinate in the spring, which global warming, unfortunately, has changed the pollination, but generally it's the end of March to about Memorial Day weekend. Then we talk about weeds and outdoor molds. Those are pollinating end of August till about the first frost hits the ground.

So that's one strategy to talk about triggers. Let parents know that if their child has allergic asthma, we should think about when they're outdoors, different precautions that they should be taking. Maybe they should be wearing a mask if their allergic asthma is severe. Also, we can talk about if they have a cat, dog, if there are dust mites in the home, then we could talk about dust mite avoidance measures like dust mite covers. We can talk about air purifiers, decreasing the humidifier use for dust mites. There are a lot of different strategies to avoid triggers that in itself, just by changing our environments can help treat allergic asthma.

Outside of environmental control, in addition, we can talk about immunotherapy. Immunotherapy is life changing, has an excellent cure rate for allergies, about 85%. And so if we target therapy to essentially cure allergies, we are making a big difference with the diagnosis of allergic asthma and really treating.

Outside of treating the allergy portion of allergic asthma, there are short-term relief medications, like we know albuterol every 4 to 6 hours when there's an asthma exacerbation, and then there are maintenance medications. Maintenance medication referring to our steroid inhalers. But also we can think about something that I use often with my patients is montelukast. Montelukast, I use for those patients that especially have allergic asthma. It does a wonderful job of treating, not just the allergies, but the asthma symptoms that are related to allergies. And so I think all of these treatments together can really make a big impact on one's diagnosis of allergic asthma.

Jessica Bard: Now, is there a difference in the treatment of children compared with adults with allergic asthma?

Dr Irum Noor: So in terms of the difference between children and adults, in children, there's rare mortality with asthma in general, whereas in adults we do see there's a larger mortality in terms of severity. There are certain biomarkers like IgE and pheno that can be elevated, eosinophils, that can be elevated. And so when we start talking about the adult population, now there are a lot of different biologics that are out there, monoclonal antibodies that can treat asthma in adults. But what's really nice is that now over time, we are seeing that some of those biologics are getting lower age indications. Six and above can start to use those biologics and really have a difference on their asthma. And so that's something to keep in mind beyond our traditional medications that we used for childhood asthma, like we spoke about earlier. I think the world of biologics has really changed how we look at allergic asthma. And I think it's very reassuring that those biologics that are out there for adults are now slowly getting approved for younger age groups as well.

Jessica Bard: At what point would a pediatrician refer a child to a specialist?

Dr Irum Noor: In my opinion, I think that as soon as a patient is starting to have those symptoms of asthma, whether at the pediatrician level we think that allergies can or cannot play a role, I think it's important to make that referral because like I mentioned earlier, just by controlling a patient's environment if they have allergies can make a significant impact on their asthma control. And so if a patient is starting to exhibit symptoms of asthma, at that point, I would go ahead and refer to a specialist, see if allergies are involved. Because at this age, a lot of parents are hesitant sometimes to put a number of medications for their children. And so if we can focus on a patient's environment and make a huge difference early on, I think that's very important.

Jessica Bard: Absolutely. Is there anything else that you'd like to add today to our conversation?

Dr Irum Noor: Yeah, I would just say that the other thing that is really important about allergies that I see a lot is that those patients that develop environmental allergies when they're younger and they start on immunotherapy, a lot of studies and reports have indicated that those patients not only have better controlled allergic asthma, but it also decreases the incidence of allergic asthma for them. So I think pediatricians being aware of that idea is very, very helpful.

Jessica Bard: Well, thank you again, Dr Noor your time today. We really appreciate you being on the podcast.

Dr Irum Noor: Of course. Thank you for having me.