Kara Wada, MD: If your kid is always sick, it might not be just colds. Many kids get labeled as just having a bad immune system, and parents are often told to wait it out. It's the frequency and the pattern that matters so much more than labels. On today's episode of Allergy Actually we are gonna talk about colds, flus, allergies, five ways as moms, we might be able to better tell what's going on with our kiddo and get them the much needed relief that they need. It's that time of year, we are in winter, heading really close to allergy season. This can be so confusing. You hear it all the time in the office, oh, it's just allergies when it's like the middle of December and you're like, I dunno about that.

So, I mean, we have all these overlapping symptoms of runny nose, cough, congestion, and just feeling tired. It's really hard, especially if our kids are younger or even, you know, kiddos with some neurodevelopmental issues that they're not always the best at articulating what exactly is going on. You know, we throw daycare or school exposure into the mix and it's really hard.

Amber Patterson, MD: To know if it's allergy or cold.

Kara Wada, MD: Yeah. Or like if they're sick all the time, is this normal? I know we had this conversation at home. My 4-year-old is due for his well-child checkup next Friday. And so my husband's like, Hey, can you really make sure to mention like how often he's having fevers? 

And I'm like, I can. And also he goes for preschool. And the fact that he's gotten a fever with a runny nose, you know, every two to three weeks for the last few months, like as a board-certified pediatrician, I also know that that's not atypical. My husband's an adult doc, so he has that worry, right?

And we have to walk that line of listening to our patients and understanding, like, especially, you know, our parents have spidey senses, especially mamas, right? And so walking that line of like, okay, this could be normal and also I wanna honor and hear your worries and come up with a plan together.

Amber Patterson, MD: Sometimes it just takes time for that to sort out too. Like if you think it's allergies, you can get allergy testing, but also there's a, a little bit of we gotta see how this plays out from season to season and year round. But we can do some things preventatively treatment wise with even just simple over-the-counter hacks, right? I'll use that word as like tricks. What's up your sleeve guys? What are we doing to prevent these cold symptoms?

Why Prevention & Controlling Baseline Disease Matters

Meagan Shepherd, MD: Number one, I always tell patients and I explain this because this also applies to parents of young children as well, not for your knowledge as far as exactly what to do and all of that, but you get sick a lot too. That is a very real thing. I've had adults come in for workups, for immuno deficiency because I get sick so often and I'm like, oh, you have a 2-year-old and they're in daycare and they're sick all the time then so are you. But one of the biggest things, of course, we are seeing a lot of patients who have allergies and asthma as an underlying disease, or we're discovering for that patient that they have that as an underlying disease.

So controlling your baseline to the best of your ability is one of the things that is not necessarily going to prevent you from getting sick. But it can make it when you do get sick, you don't get as sick and you have symptoms for a shorter amount of time. And this holds true with a lot of asthmatics once we get their asthma that they may not have even known they had under control, when they get a cold, they're sick for five to seven days. It doesn't linger for, you know, two or three weeks with that cough that just persists. So the biggest preventative thing that I tell my patients aside from flu shot each year would be to control any other comorbid diseases that can affect that to the best of your ability.

Kara Wada, MD: Yeah. And I think that, you know, that's also when thinking about kiddos, you know, do they have issues with snoring or, you know, enlarged tonsils, adenoids, you know, other things, thinking about that holistically of is reflux or other things that all could be adding into that chronic inflammation.

And I think, you know, going back to the timing, viral colds tend to cluster a little more randomly, usually exposed with hanging out with other humans. Allergies more often are gonna follow the calendar too. So you tracking those episodes over time can be helpful when you go in to see the pediatrician or your primary care physician.

The Two-Year Period When Kids Are Sick All the Time

Meagan Shepherd, MD: One of the spiels that I always tell families is you are gonna have a two year time period where your kids are sick as snot,

and it is likely to happen if they are little and you put them in daycare then, it will happen if they stay at home until pre-K four. There's gonna be a time period where they get sick a lot and you're gonna get sick a lot too.

And not saying that it completely ends after that, but once they have started to have most of the general viral infections that the normal population has, that they're exposed to when they're in a group setting, at that point you do develop some antibodies to them. And so it typically improves. And if you do have, again, allergies or asthma, if we fix that, that also helps it improve.

But that is something that I always say, just be prepared. There'll be a two year time period that sucks. It's not your imagination. They are sick all the time. And I always say we get eight to 12 viral infections, upper respiratory infections that can be viral each year. And it takes anywhere from 10 days to 17 days to really kind of get through that.

So if you're saying that they have one good week and then they're sick again for three weeks, one good week, that's exactly that pattern. So, that is real. 

Building Immune Strength: A Positive Mindset

Amber Patterson, MD: I try to use one of those positive affirmations to keep from going nuts about that. I say, thank you for this opportunity to build my child's immune system. Thank you for giving me this opportunity to build my own immune strength by being exposed to my sick children. You know, it can feel overwhelming when you're like, not good or like, it goes one person. You know, there's six of us and it's like one gets sick and then two days later, another one gets sick and you're like, oh gosh, when's our next thing? We're like, we all need to be healthy 'cause we gotta time this out but, yeah. It's actually good. It's just hard.

So one of the things like you mentioned, control your chronic disease. So a lot of our patients have rhinitis, whether it's allergic or non-allergic, they may or may not already be on a nasal steroid like Flonase 

where they're doing that every day routinely or they have it on hand. And that helps reduce the inflammation in your nose. Interestingly, when COVID happened, there were some studies early on that showed that patients who were using a nasal intranasal steroid, like Fluticasone propionate, which is Flonase, had reduced infection rates with COVID.

Now, I have not seen anything about just viral infections in general, but I think it's interesting. It kind of speaks to that point, like you were saying, Meagan, like if you can keep inflammation down, that's helping your immune system focus on functioning the way it's designed to.

Fever: The #1 Sign of Infection vs Allergy

Kara Wada, MD: Yeah. I think going back to some of the things that can help us decide allergies versus cold versus flu. You know, a big thing is fever. If there's a fever, almost overwhelmingly it's going to be an infection of some way, shape, or form. 

Amber Patterson, MD: What are we calling a fever?

Kara Wada, MD: 100.4 and above is considered fever. And that will strongly suggest infection. And this alone can be pretty helpful. I mean, the other thing we've started to do is to try to keep some of the little triple tests at home, that test for COVID, flu A, flu B, just so that you can kind of one, pick up if it is viral, you know, of the viruses we can check for versus worrying about possible bacterial infection.

But two, you know, that also would open up the opportunity if you wanted to use antiviral medications like Xofluza or Paxlovid or something along those lines. But, you know, thinking about we're gonna start coming into allergy season really quickly, and I don't think everyone understands how early allergy season starts for many of us across the US.

Azelastine's Surprising Antiviral Properties

Meagan Shepherd, MD: One of the things that we actually didn't say specifically that we've talked a lot about today amongst ourselves behind the scenes is, there was a cool study that did come out looking at trying to prevent COVID by controlling nasal inflammation. But possibly also because of direct antiviral effects, there's a medication that's a nasal antihistamine spray. And we prescribe it all the time for various different reasons. But Azelastine is the one that was actually the generic name that was actually studied for this, but they found that they could decrease it potentially decreases your risk for COVID for like if you were to do it, it's actually beyond the normal dosing.

I would consider this super therapeutic dosing. But it was two sprays per nostril three times a day. Now because it's an antihistamine spray for a lot of people that can be drying, but I am using that method right now. I have a child that presented to my clinic who has a unique susceptibility to influenza and tends to get it. The history suggests once a month and it will go back, could be flu A, flu B and he's tested appropriately every time. We're now working with 

to try to figure out precisely what's going on and looking at his immune system as well. But he did get his flu shot and at that time started doing Azelastine. I told him up to twice a day that we could try that because he's a school aged sort of teenager and I, I'm not interested in making him totally drowsy. Azelastine doesn't do that to everyone or even most patients. But I just thought, uh, you know, we need to just make sure we don't contribute to the adolescent need for sleep.

But he started doing it once a day and as of the last time I'd seen him, he had gone two months without developing influenza. Which was amazing. And so there is a study that it was somewhat vague. It looked at major respiratory illnesses, but it seems to be that they think that Azelastine itself has some antiviral properties, that it might not just be the anti-inflammation, which you can do with the nasal steroids like fluticasone and all of that as well. But the addition of Azelastine may specifically have its own illness, fighting properties or illness preventing properties. So, when you're looking at things that you can do, aside from the general wash your hands, don't drink after each other, stick your, you know, nose and mouth into your elbow when you cough, all of those things, that might be a treatment that you could possibly add that could help prevent that.

Amber Patterson, MD: And those are over the counter. 

Have you guys heard of Profi? So it's another, it's a non-medicated spray that essentially creates like a barrier over the mucosal tissue that is supposed to be helpful in blocking viral binding to those sites in the nose. And I've had a couple of, it's a patient, an immune deficiency patient who brought it to my attention, and so I've had a few patients use it.

Kara Wada, MD: Not perfect in that it lasts about eight hours, so you'd need to kind of repeat dosing. But for those who maybe have difficulty with Azelastine or the other nasal steroids being too drying, it doesn't have ingredients that are as drying. It does have some common preservatives that some folks have issue with. It originally was created to be a platform for other medications that are easily administered. So this was kind of like the vehicle that those other meds would, would be in.

Amber Patterson, MD: You know, it's interesting, but it makes me think about our defense system, our immune system. And for those of you who listen to our demodex mite issue, we talked about putting vaseline or petroleum jelly along the eyelashes to kind of like smother those mites. And if you think about like just a physical defense system, if you had a moat of slime, it would keep a lot of people out of your space that you're trying to keep them out of.

So this is almost along those same lines. It's like covering that mucosa with this slimy goop that can either crack things, prevent them from making their way to your nasal mucosa. Just kind of cool to see all those things aligning.

Kara Wada, MD: Yeah, trying to repair that barrier. 

When to Call the Doctor: Chronic Infections & Immune Concerns

Kara Wada, MD: So, you know, as moms, one of the questions is when to call? Who should we call? You know, if you're having more infections, needing more antibiotics, symptoms don't get better, gosh, that is a time, I think it's really critical that you talk with your pediatrician, your primary care doc and say, Hey, can we get an allergy referral?

As allergists, we're not only allergists, we're also immunologists. And so we're trained to think about, okay, could this be allergy and that inflammation that's contributing to things being worse? Could this be an immune deficiency? Which although not the most common thing, some of the more mild ones can affect up to one in 500 people.

So that's not that uncommon. And I think that's really important as we think about, you know, this big picture. So, I think one of the things, think about our kids are gonna get hit with a whole lot. What was the number again, Meagan? Eight to 12 in a year?

Meagan Shepherd, MD: I'd say eight to 12. I've lost the true statistic and it's sourced many moons ago, but I've been saying that since I started an allergy fellowship in 2011. So at least at that time I'm sure. But on average, I mean, it is around that, especially if you do go to daycare and you're out in the general population.

Kara Wada, MD: So if this episode gave you clarity, or if you have questions, gosh, put those below. That will help inform future episodes for us. Share it with your mom friends, you know, I'm sure you've had these conversations lately. Is this normal? Let's continue this conversation because sometimes it's one conversation that really can change the trajectory of the whole school year.

And just how we think about these things can lower our stress levels as we worry. You know, we're always worrying about our kiddos. Thank you for joining us for this episode of Allergy Actually, and can't wait to see you for our next episode. 

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