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Aerolate, Theo-24 (Theophylline)

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Other names: Quibron-T, Slo-bid Cr, Slo-phyllin Cr, Theolair Cr, T-phyl Cr, Uni-dur Cr, Uniphyl Cr
CHILDHOOD ASTHMA: ALLERGY TESTS IN CHILDREN
Let us see how some tests were applied to our two cases, Simon and Julie. Let us consider Julie first. Julie had two main groups of trigger factors; she had longstanding eczema of the skin which strongly suggested allergies, and any cold or sore throats were often followed by wheezing, indicating that infection was a major precipitant of her asthma. Her parents were both very keen to try and pinpoint the causes for her asthma and actually asked if Julie could have a chest X-ray.
Initially I took a small sample of blood from her arm, which Julie was not too happy about but I assured her it would help us in identifying the reason for her wheezing. Fortunately the levels of the different blood cells were normal, although her IgE level was raised, which confirmed she suffered from allergies. Her mother was worried that the colds were causing infection to spread on to Julie’s chest, so a chest X-ray was arranged at the local hospital. The specialist’s report indicated the lungs were completely normal in appearance with no evidence of any infection or other condition. I carried out simple lung function tests in the surgery using a peak flow meter and this confirmed some reduction in the passages of air in and out of the lungs.
Julie had a cat and dog as pets so these were included in her skin tests. The six tests carried out were to grass pollen, feathers, house-dust mite, and dog, cat and horse hair. All six showed a positive reaction, particularly pollen, feathers and house-dust mite. Julie was very pleased that her pets were not the main problem as they would definitely have been under threat of expulsion!
Before considering the meaning of these test results let us first consider Simon’s situation. We know that the main trigger factors are allergies, emotion, exertion, cold winds and pollution in the atmosphere. His parents felt that their son had gone through a great deal with his asthma and were not at all keen for him to have any tests performed unless they were completely necessary. The diagnosis of asthma was not in doubt as I had seen Simon in a severe attack. On clinical examination he was a good healthy colour so it was most unlikely that a blood test would show up any deficiency. We were already aware that he suffered from hay fever so his blood would be sure to be positive anyway for allergies.
Between attacks his chest was completely clear and there had never been any sign of infection on his chest. Although I suggested a chest X-ray his mum said she wasn’t keen on him having any unnecessary radiation. As far as identifying the allergens by skin-testing I must admit they are not particularly pleasant for the child and Simon always in the past had become most upset at the sight of a needle. We already knew from his hay fever that he would show positive to grass and tree pollen. His mother had previously changed from feather pillows to synthetic and he didn’t have any pets. Furthermore I had to admit that I haven’t yet seen an asthmatic child who hasn’t shown positive allergic reactions to house-dust mite. So, in fact the only test that Simon had was one for lung function and he quite enjoyed blowing into this small machine. It was easy to demonstrate that he had marked reduction in airflow, which was accentuated after a simple exercise of jogging on the spot for a few minutes.
Simon and Julie represent the two extremes when it comes to testing for asthma with Julie having virtually all of them and Simon only one! There are many tests that are available for asthma and many doctors and specialists do still carry out all of them as a sort of blanket investigation. However, some of the procedures, particularly anything to do with needles, are not going to be popular with the child.
So which ones are really necessary? Much depends on how much confidence and faith you have in your own doctor. Actually diagnosing asthma in a child is not difficult for anyone with medical training and does not really need any tests to confirm it. While Julie’s parents accepted their daughter suffered from asthma they had experienced problems with their previous GP so were not keen to rely purely on my opinion. They were quite happy therefore for Julie to have all the tests. In Simon’s case I had looked after the family for many years and had been present at his birth.
*10/211/5*

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