asthma? allergy? what's going on?

[iris777888]

I'm trying to make sense out of what's been happening with my son's health recently and hoping someone can help. I'm not quite understanding the issue, looking for input and suggestions. Sorry this is so long.

First some background: In his first 3 1/2 years of life, he was rarely sick, like two gastro episodes and a handful of colds. With the colds/viruses he had some wheezing/squeakiness, but nothing severe enough to be that concerned or take him to the doctor. His only ER visit was for multiple bee stings when he was 2 and he recovered completely within hours, with no meds given. He also had a couple of times where he got hives from dogs licking him. Only med ever received was benadryl, once for the hives. He also has a milk intolerance, but we are now vegan so it rarely is an issue.

A few months back, we visited some friends that had two cats and had been previously fostering a dog. We'd never been to their house before. Within minutes his nose was running, then turned to coughing, then wheezing. I didn't catch on what was happening quickly enough, just thought he was getting sick, and we were there for a couple hours in total. The wheezing got worse overnight and we ended up taking him to the quick care, who gave him nebulizer treatments with albuterol, then sent him on to to the ER because they didn't think his oxygen stats were high enough yet. When we got there and were seen, like 1/2 hr later, he was completely back to normal, lungs sounded clear, 99% on the oximeter. They gave us an inhaler/spacer with albuterol and told us to use it if he had troubles. We saw his regular doc for a follow up who said the same.

Since then, after any extended exposure to cats (or a house that cats live in, even if they're not around), he's getting wheezy. This has happened 4 or 5 times since that first big attacks. It's a delayed reaction though, usually hits like 6-12 hours later and takes a couple of days to go away completely. We've given the inhaler/spacer a couple of times when the wheezing got severe and it knocks it back (kicks in about 15 mins after use) but it doesn't clear it up completely.  Our son absolutely hates it, is terrified of it. It takes both parents holding him down, and still sometimes we can't administer it. It's traumatic for us too. A couple of times, we've just waited until he goes to sleep to give it so he gets a good dose and isn't so upset.

Since one of these places with a cat is his grandparent's house, and we knew we'd be going there for Christmas, we tried giving him an allergy med (claritin 24-hr non-drowsy) several hours in advance. It didn't help. He still got wheezy, started in the middle of the night. Perhaps we needed to give it earlier, for several days in a row or something?

The only other episode we've had, when cats haven't been a factor, was one time when we were out in the cold and he was crying upset and he got huge lungs full of cold air. That caused wheezing too, though it didn't stick around for as long as the cat-induced kind. Also, he'd been wheezy from cats just a few days previous. Not sure if it works that way, but perhaps his lungs were still recovering, which is why it was an issue just the one time ever?

We have cats in our house, but they are confined to an area in the lower level. We are trying hard to find them new homes, but having little luck so far. Our son has never reacted to them with wheezing, only red, itchy eyes a few times after playing with them up close. Since the new, frequent wheezing issues, we've kept him away from them though for fear it would set him off. He seems not to have any issues at home.

Also, he had been going to the grandparents house weekly, sometimes even spending the night, without much of a reaction to their cat. Only the red, itchy eyes on occasion and that was after very long exposure, like 24 hours+.  It seems like ever since that one big allergic episode, now he's reacting with wheezing, and every time. That has the potential to be a big problem, he loves going there and asks to go all the time.

He doesn't seem very concerned when he is wheezy. He sounds horrible, and you can sometimes hear the audible squeak along with the heavy breathing, but it doesn't affect his behavior at all unless it gets really severe. Then he reduces his activity a bit and asks for water frequently. He doesn't gasp though sometimes sounds grunty. Oxygen sats usually drop to about 96. The few times it's seemed really bad, it's been registering 92ish.

So what seems to be the underlying issue here? Does it sound like a cat/pet allergy that has just gotten worse over time? If so, does it make sense that we could prevent the allergy from ever manifesting as wheezing?  Can someone explain when something like this would be diagnosed as asthma? Is asthma always triggered by something? If so, could it be said that he has asthma, triggered by cats? (I know that is a very common trigger.) Or, does he have allergies that just happen to manifest as wheezing, same as that's always been symptom for him with his colds? Probably makes no difference I suppose. DH's family all have lung issues, and DH had exercise-induced asthma as a child.

Should the albuterol clear up the symptoms completely when it's given? Does the fact that it does not indicate we should give him a stronger dose, or consider giving him something else? Should we maybe be giving it to him earlier, after the exposure to cats (if unavoidable) but before the wheezing even starts? If this were you, what would your next step be? Another trip back to the primary care doctor? We've decided to avoid the grandparent's house for awhile to make sure he has a long time to fully recover.

Any good web sites or books for me to read to help better understand the situation? Is there a tribe for moms of kids with asthma, or something similar where I could as in-depth questions? The search is turning up nothing for me.

I have to say, I'm not one that typically gets upset about much, but I have a very hard time dealing with this since that ER visit. I think in part, it's because multiple people (including one of the docs) have told me that little kids may not often show much of a change in behavior until they collapse, and that this can re-model the lungs, permanently. I understand this is a potentially serious issue.

Thanks so much to anyone that made it through my whole post. I appreciate the help. :-)

Edited by iris777888 - 12/29/10 at 11:35am

[sbgrace]

It sounds like asthma and, yes, sounds allergen induced. Lungs can certainly stay reactive after a severe asthma episode. Twice in his life my son has needed steroids to get the asthma response completely squelched. Given your son is not completely responding to albuterol (right?) that may be necessary. However, I think most doctors would ask you to try albuterol sort of "round the clock" is it every 3 hours...I can't recall..pharmacy who filled it should have that information if you don't. It's possible that, given the difficulty in administering, you've simply not got enough to stop the underlying reaction.

My son can't be around dog. He's allergic to cat too but it isn't such an asthma trigger as dog. Your son sounds like he's similar with cat to me. We did rehome our cats. I know finding homes is hard--can grandparents add some cats? The low level exposure in your own home is likely not doing him any favors or at least that's what we decided with my son.

So my advice would be:
1. You should try to dose that albuterol more frequently to see if you can tamp down this reaction. Most kids will resist the nebulizer at first...mine did. We played videos and I held him and it was horrible and then in time it was no big deal. I know it's hard. He'll adjust though--he really will. And the faster he adjusts the better you can control the asthma and, if needed, help him when in distress. Another option might be to ask for an inhaler with spacer. If he can do it (some kids can't...) it might be less traumatic. Have them help you know how to use it properly if you decide to go that direction. You stay calm and reassuring and try to make like it's no big deal or even fun if possible. We talked a lot about the "smoke" from the albuterol and made up songs about the smoke machine. It didn't help in the early days. But when my child is screaming and thrashing I'm stressed and kids do pick up on that.

Also, dose albuterol before you go where you know he's reactive.

2. Consider asking grandparents to do a HEPA in the room he spends the most time in while there. It makes a huge difference for my son. We have a HoneyWell 50250-N with permanent filter. It's been great. We don't visit friends in their homes with dogs anymore. I made that decision partly because of how long it took him to get it under control after visits and also because adults with asthma/allergy reactions to animals told me the chose to avoid homes with the animals that were reactive for them as much as possible. This is true to the person. When adult after adult made it clear they wouldn't subject themselves to that I realized I had to make that decision for my son--at least for now. He can make his own decisions as he gets older.

3. Singulair may help. It does my son. Some kids don't handle it well. If that happens you stop and they are fine. It took me a long time to try it with my child but I'm so glad I did. Similarly, many people (adult and child ) don't find Claritin helpful. My son does better wtih zyrtec. It does affect his moods.

4. If the albuterol (dosing as specified by the doctor in frequency) doesn't resolve the asthma you do have an issue and you need him to be seen. In those situations my son needed steroids. I hope you can avoid that but if you can't realize short courses are ok. If this is continual my son would be on an inhaled steroid to avoid any further oral steroids. In his case, though, he's only needed them twice for asthma.

5. My son's doctor found some interesting research showing that b12 injections (so high dose) greatly reduced asthma in kids in 80% of cases. It was pretty interesting when I read it. We're trying them with my son in the next week. I will see if I can find the study online.

[iris777888]

Thanks so much for the reply! I figured there had to be other MDC mamas that had kids with asthma. I've been able to find a few more old threads via the advanced search and have done additional research since I posted and am feeling a bit more knowledgeable about it all now. I really appreciate the first hand experience though.

Originally Posted by sbgrace 

However, I think most doctors would ask you to try albuterol sort of "round the clock" is it every 3 hours...I can't recall..pharmacy who filled it should have that information if you don't. It's possible that, given the difficulty in administering, you've simply not got enough to stop the underlying reaction.
 

This may absolutely be the case that he hasn't gotten enough. We've not got a nebulizer at home, both ER doc and primary care doc told us to go with the inhaler/spacer because of its portability. We've ordered a nebulizer now, and filled a prescription for it, so that hopefully next time we can try that. He didn't mind that so much at the Quick Care, and the excellent doc there had told us that for little kids it's just as effective and since often easier to give, can make it even more effective.

We did rehome our cats. I know finding homes is hard--can grandparents add some cats? The low level exposure in your own home is likely not doing him any favors or at least that's what we decided with my son.

I do think that could be contributing. I'm trying hard to find them new homes. I found a home for one, but still have two to go. The grandparents are absolutely not interested, nor any other relatives or friends. I've also posted on PetFinder, Craigslist, through our vet's office, our work classifieds, etc. and nobody seems at all interested. :( Maybe because they're 9 years old? They've still got a lot of life left and are in good health, but they're competing with a million other cats and kittens.

You should try to dose that albuterol more frequently to see if you can tamp down this reaction. Most kids will resist the nebulizer at first...mine did. We played videos and I held him and it was horrible and then in time it was no big deal...We talked a lot about the "smoke" from the albuterol and made up songs about the smoke machine. It didn't help in the early days. But when my child is screaming and thrashing I'm stressed and kids do pick up on that.

I'm thinking (hoping!) our son would do the nebulizer a lot easier than the inhaler/spacer. That's what makes him freak out right now. We're getting one so we can at least give it a try. He did OK with that at the doctor's office. Good point about keeping my attitude in check so he doesn't pick up on it and the tips for making the smoke less scary. The excellent doc sang to him and kept him entertained while we gave it to him there. She also said that if really necessary we could waft it in his face, not even make him hold it in his mouth or wear the mask.

Also, dose albuterol before you go where you know he's reactive.

So we should give it to him after the exposure, but before he becomes wheezy? I was thinking we should try this. The doc had told us to wait until we heard the first signs of wheezing but it seems like by the time that starts it's too late to knock it back.

2. Consider asking grandparents to do a HEPA in the room he spends the most time in while there. It makes a huge difference for my son. We have a HoneyWell 50250-N with permanent filter. It's been great. We don't visit friends in their homes with dogs anymore. I made that decision partly because of how long it took him to get it under control after visits and also because adults with asthma/allergy reactions to animals told me the chose to avoid homes with the animals that were reactive for them as much as possible. This is true to the person. When adult after adult made it clear they wouldn't subject themselves to that I realized I had to make that decision for my son--at least for now. He can make his own decisions as he gets older.

Good idea about the HEPA filter. We were thinking we should also make sure their whole house furnace filter is replaced often and set to continuous run. They made a big effort to clean more than usual for Christmas and it really did not help.

I am leaning towards not visiting anyone with cats other than the grandparents, and dropping our frequency of doing that unless we can find a way to get things under control a lot better. I am NOT willing to keep doing this, 6 hour visit and then 2 days recovery!

Singulair may help. It does my son. Some kids don't handle it well. If that happens you stop and they are fine. It took me a long time to try it with my child but I'm so glad I did. Similarly, many people (adult and child ) don't find Claritin helpful. My son does better wtih zyrtec. It does affect his moods.

Singulair is a prescription med, correct? We may try the Zyrtec. Is this something you give all the time, just prior to exposure, for a few days before and after? I know that Zyrtec worked better than Claritin for me when I was taking it for seasonal allergies. Now I just take Quercetin. Have you seen anything about using this in relation to asthma?

If the albuterol (dosing as specified by the doctor in frequency) doesn't resolve the asthma you do have an issue and you need him to be seen. In those situations my son needed steroids. I hope you can avoid that but if you can't realize short courses are ok. If this is continual my son would be on an inhaled steroid to avoid any further oral steroids. In his case, though, he's only needed them twice for asthma.

We have not really been giving him that much albuterol so far. The doc recommended we give it every 4-6 hours at the first sign of wheezing, and we've never given it more than three times in any one day. Plus, I don't think he's getting a full dose since he fights the inhaler so hard. It seems to reduce it to minimal or nonexistent noisy breathing for about two hours, then picks back up. I think before going back for steroids we'll consider trying the round-the-clock method, and/or giving him two puffs instead of one (which I think the ER doctor said we could do).

My son's doctor found some interesting research showing that b12 injections (so high dose) greatly reduced asthma in kids in 80% of cases. It was pretty interesting when I read it. We're trying them with my son in the next week. I will see if I can find the study online.

If you do find it, please post! This is especially of interest since we're vegans. DS could be low in B12 anyway, it's been awhile since he was checked, so wonder if that contributes. 

Again, thank you so much!!

[sbgrace]

I'll look to see if I can find the article our doc gave us online.

The response you're seeing (then fading) with albuterol makes me think the issue may be the lack of dosing. On top of that I can't see a spacer being effective at all with a distressed child like your son who is resisting. They have to cooperate more for that. I hope the nebulizer is easier (make it fun if you can and be so calm and positive that maybe he won't be scared--maybe you can just hold it in front of him and make funny songs about the fog machine or something like that. Let him be the "switch master" who is in charge of turning it on and off. Pretend the mask is a firemans mask or something maybe?

ER doctors are, in certain areas, not great frankly. Usually they do recommend follow up with issues like this. We see an actual pulmonologist. But, generally, I think it would be good to do albuterol before he goes where you know he's going to have an reaction. It's better to stop asthma on the front side rather than after reaction. That said, doing that may make it hard to know if you've actually got asthma control at all. What you're describing right now (the albuterol wears off and it comes back and on) is not well controlled.

I'd try the zyrtec, yes. My son does do it all the time and in your case I'd think that is what a doctor would recommend. For one, he's not controlled and this is allergen related asthma. For two, it might help with the cats at home issue. I feel for you on rehoming the cats. I was really lucky my husbands parents agreed to take ours (also old). My parents refused. I get it and I know it's hard.

[sbgrace]

http://www.healthiertalk.com/breathe-easy-these-safe-natural-asthma-remedies-0230 This one references the study but doesn't have the detail with those 80%. But in a well done study 80% of pediatric (not adults/adults weren't as effective) asthma responded very well to completely to the B12. The 20% who didn't well, didn't at all if I recall. I will see if I can find the actual thing I read online soon but the article is in the car which is in the shop right now! Still, I'll know it if I see it.

I looked into quercetin with my son. Something made me unsure for kids use but I can't recall what it it was. Real folate (tetrahydrofolate) helps some a lot as well with allergies generally along with b12. Ideally find a b supplement with the active forms. We do Thorne. Extra b12 would probably be great especially when the diet doesn't contain it. I don't know that it would help him now but adequate vitamin D levels (50 or above on 25OHD) would be important for his health generally and any child over 2 can take up to 2000 IU per day. That said, the most effective form is D3 and that's not vegan (I think it is sheep lanolin or fish oil derived). I don't know if the D2 forms are safe at those doses. I imagine they are but there is a problem for many with it not raising things.