I'm sorry you're having so much difficulty with your son and his asthma. Your story is not unique; every year, I see so many children struggle with asthma during the school year. Viral infections, air pollution, and allergies are among the most common triggers for asthma attacks. This can lead to missed days of school as well as missed activities, including sports and social events for the child as well as missed work days for the parents.
Unfortunately, there is no one size fits all solution for children with this problem. I would definitely urge you to seek out a pediatric allergist in your community who can help you identify and minimize the most prominent triggers for your child's asthma and partner with you to put together a treatment plan that will keep him as healthy as possible. The majority of parents I work with are interested in reducing the burden of asthma using the least amount of the safest medications possible. Best wishes on your journey to achieve and maintain the best possible health for your son!
The usual recommended dose for a six-year-old is 1 teaspoon or 5 mL or 5 mg by mouth daily. I would usually recommend 4 mL or 4 mg in my 5-year-old patients. However, I would recommend checking with your child's pediatrician. There could be extenuating circumstances that would suggest a different dose. I hope your child (and the rest of the family) have a safe and enjoyable trip!
The rash on your feet that you experience while walking barefoot on grass could certainly suggest that you have a grass allergy. I would expect, additionally, that you would have some nasal congestion, runny nose, sneezing, and even some eye irritation during the grass pollination season in your area. Less commonly, we have seen patients with rashes on their feet after walking in grass that are sensitive to chemicals such as weed killers or fertilizer that are on the grass that you are walking on. A simple test by an allergist can help you determine the answer to this question.
Hope that helps!
Lactose intolerance is not a true allergy to cow milk protein, but it results from an inability to to digest lactose, the main sugar in cow milk. We see an increase in lactose intolerance in certain ethnic groups such as Asians, but the inheritance pattern is not well established. It is certainly possible for your child to develop lactose intolerance, but just because you are lactose intolerant does not guarantee that your child will have it. Fortunately, lactase, the enzyme that allows one to digest lactose (the sugar) is readily available and will allow you to digest lactase without too much difficulty and enjoy milk products.
I'm sorry to hear that you're so uncomfortable! If the rash completely disappears after you take antihistamines, you likely have hives, or urticaria. If you've had the rash for less than six weeks, it's called acute urticaria; if the rash keeps coming back for more than six weeks, it's called chronic urticaria. There is also a condition called dermographism, where the rash is linear rather than roundish. Mild physical trauma like scratching your skin will produce welts in the area of the skin that was irritated. Given that you've had the rash for six months, I would suggest you see an allergist for evaluation. In the meantime, a long-acting antihistamine like cetirizine might give you some temporary relief until you are seen. Please watch for sleepiness, as some patients become a bit drowsy on this medication.
I hope you feel better soon!
The treatment for lactose intolerance is either avoidance of milk products or drinking lactase-treated milk (Lactase milk that is now lactose free), or giving lactase tablets when the patient is about to consume dairy products. There should be no difference in efficacy between an adult or a pediatric patient, assuming the pediatric patient can swallow the caplet. Please note that the proper dose of lactase is very individual and will depend upon how much lactase one can produce and how much milk product is being consumed at that time. Some individuals require one caplet for 8 oz of milk; I’ve seen others that require 4 caplets for the same amount of milk. It could take a bit of experimenting to figure it out. Fortunately, it is difficult to overdose lactase; it’s just an enzyme. Hope that helps!
I'm sorry to hear that your reactions to milk seem to be increasing in severity. This is not rare; food allergy reactions can change with time and frequency of exposure. There are people that outgrow their milk allergies, but others will have their milk allergy for their entire lives. In general, we recommend diagnostic testing to confirm the particular food allergy. After confirmation, our patients are advised to avoid the offending food allergen as well as to carry an antihistamine, such as Benadryl, as well as injectable epinephrine for accidental ingestions. There are food desensitization protocols being developed for patients that do not appear to be outgrowing their food allergies. I would suggest a consultation with an allergist for testing and a comprehensive treatment plan.
Your daughter could certainly have a true allergy to apple, but it is more likely that she has “oral allergy syndrome” (OAS). OAS occurs because pollen proteins can sometimes cross-react with proteins found in raw fruits and vegetables. Most patients with oral allergy syndrome will have some pollen sensitivity and will only react to raw fruits and vegetables. Cooking or baking the fruit or vegetable, in question, usually removes the oral irritation. Please note that OAS is benign; unlike true food allergy, there is not generally thought to be a risk of anaphylaxis with oral allergy syndrome. An allergist can help your daughter differentiate between oral allergy syndrome and true food allergy. The patients that I see with oral allergy syndrome generally fall into two groups. One group will continue to eat foods in question because they really like the food and they are willing to put up with some oral discomfort. The second group of people are quite bothered by the oral irritation and will refuse to eat the food!
Duane Wong MD
Yes, allergies can change. There are certain food allergies, such as wheat, soybean, and egg, that 80% of patients outgrow by five years of age. Approximately 80% of patients outgrow milk allergy by 10 years of age. Unfortunately, most people do not outgrow certain allergies, such as peanut, tree nut, fish, and shellfish. One can also develop certain food allergies during adulthood. The research seems to be focused on desensitization options for the people that do not outgrow their allergies. Most of the work is currently being done with peanuts, but it should expand to other food allergens with time.
I hope this was helpful!
Duane W. Wong, M.D.