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How Combining Pediatric Allergy and Pulmonology in One Clinic Optimizes Patient Care

Managing children who have asthma and allergies can be a complex endeavor. Different children may have different triggers, so it’s important to identify and manage specific triggers for each child.

An estimated 5 million children have asthma, according to the National Institutes of Health, making it the most common chronic disease among children. Furthermore, more than half of children with asthma have concomitant allergies.

“Asthma often coexists with various allergies. Having both conditions dramatically impacts a child’s quality of life and can lead to poor health outcomes down the line,” said. Irina Dralyuk, MD, a pediatric pulmonologist with Cedars-Sinai Guerin Children’s. “Effective management requires addressing both conditions simultaneously”—a service Guerin Children’s provides through a new Pediatric Allergy Asthma Clinic.

The Link Between Asthma and Allergies

Asthma can affect a child’s entire airway from the trachea to the smallest tubes in the lungs, and it’s especially problematic when it’s compounded by allergies. In fact, allergic asthma—which is when allergens worsen asthma symptoms—is the most common type of asthma in children.

“Allergic asthma can be triggered by pollen (including from grasses, trees and weeds), molds, dust mites and pets,” said Shazia Lutfeali, MD, an adult and pediatric allergist at Cedars-Sinai. “Asthma can also be triggered by smoke, chemical fumes and strong odors.”

During an asthma attack, the muscles surrounding the breathing tubes spasm, restricting the airways and compromising the child’s ability to breathe.

While constant exposure to irritants can cause chronic inflammation in the lungs, even a single exposure (if a child is allergic to cats, for example) can trigger an attack. Exercise, colds and flu, and even weather changes can make kids more susceptible to asthmatic episodes.

“Allergies affect the upper airway. Asthma affects the lower airway. But the two are connected,” said Lutfeali. “When you treat asthma, you also want to treat allergies because better control of allergies leads to better control of asthma.”

The Advantages of a Comprehensive Allergy and Asthma Clinic

Asthma and allergies can happen at any age. Asthma can be more difficult to detect in very young children since they tend to cycle through respiratory viruses with symptoms that mimic asthma.

Unfortunately, many children with asthma and allergies don’t receive optimal care. The current medical model requires scheduling multiple visits with subspecialists, which can result in delayed or ineffective treatment.

“With the Pediatric Allergy Asthma Clinic at Guerin Children’s, we not only offer comprehensive care all in one place, but we also combine our skill sets to ensure that each patient receives the highest-quality care for every aspect of their disease,” Dralyuk said. Features of the clinic include:

  • Advanced diagnostics: While doctors often diagnose asthma without specialized testing, pulmonary function tests, including spirometry, can help determine whether asthma is mild, moderate or severe. At the same time, clinicians can do a test to uncover allergies. All of these tests are available on site at Guerin Children’s. “In special cases, we also order additional testing and imaging to identify underlying conditions that may be contributing to the child’s breathing difficulties,” Lutfeali said.
  • Consolidated care: When children have severe asthma, there’s often an allergic component to their condition, so having an allergist on board provides streamlined care. “Working together allows us to see patients on the same day and come up with an action plan that addresses both conditions simultaneously,” Dralyuk said. “That’s a much smoother approach than when patients see two specialists, weeks or even months apart, each of whom has different management recommendations.”
  • Novel therapeutics: Guerin Children’s offers the most advanced therapeutics to children with asthma and allergies, including inhaled corticosteroids, leukotriene modifiers, combination inhalers, biologics and immunotherapy. Doctors also arm parents with an emergency plan for severe attacks.
  • Patient education: According to Dralyuk, education is a huge component of effective asthma and allergy management. Guerin Children’s clinicians devise an allergy and asthma action plan that helps caregivers identify the signs of an impending attack and effectively manage symptoms, including the proper delivery of medication. “Our job is to educate patients on the pathophysiology of their disease process and also help them recognize their triggers and strategize how to avoid them,” Dralyuk said.

Long-Term Asthma and Allergy Management

Treating asthma and allergies is a long-term pursuit. Symptoms and triggers can change over time, and even in mild cases, the type of medication and dosing may need to be adjusted.

“It’s important to connect children who have asthma, allergies and atopic diseases to the appropriate specialists early in the disease process to ensure the best long-term outcomes,” Dralyuk said. “Even mild to moderate cases can benefit from the services at our clinic, particularly when attacks are sporadic or difficult to control.”

Most children with asthma will experience changes in disease severity throughout the course of their lives. Some children even outgrow allergies and asthma. When symptoms are well controlled, doctors can step down treatment. Similarly, when children have breakthrough episodes, doctors may step up treatment with a higher dose or different medication.

“When kids have asthma and allergies, it’s critical to prevent exacerbations with specialized and continued long-term care,” Lutfeali said, “and we are happy to help.”

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Pate C, Zahran H, Malilay, J, Hsu J. The shifting prevalence of asthma and allergic disease in United States children. Ann Allergy Asthma Immunol. 2022 Oct;129(4):481-489. doi: 10.1016/j.anai.2022.06.030. [Published online 2022 Jul 14].