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Alavert (Loratadine)

Other names: Claritin
All asthmatic children suffer from allergies, although some are more severe than others. It would seem logical to try to identify these allergens, so they can be avoided. The commonest method available is skin testing, which involves placing a drop of liquid on the arm and pricking the skin through the drop with a small needle. In the liquid is an extract of a particularly allergic substance, for example house dust. If the child has an allergy to this then an itchy red weal will form around the pin-prick, and the size of this weal is a reflection of how strong the allergy is to that particular trigger factor. Usually about six tests are carried out at the same time and normally include house-dust mite, feathers, dog and cat dander, grass and tree pollens. These can be added to if there is anything the parents think the child may be allergic to; nowadays skin tests can be prepared for virtually any chemical.
The usefulness of allergy tests is well illustrated by 10 year-old Suzie, who had never previously had any breathing problems. She was very keen to start horse-riding, but after a couple of lessons noticed a tickly cough and a tight sensation in her chest. The next week Suzie became a little short of breath when running to catch the horse. Then after a vigorous grooming and brushing session she became obviously wheezy and distressed. At the surgery I carried out a skin test with horse hair extract which produced a large red weal indicating a strongly positive allergy to horses. As it happened Suzie’s keen desire to learn riding had lessened so she decided to give it up rather than go through a course of desensitizing injections.
Some allergies are caused by inhaled substances which act directly on the lungs. However, there is a group of allergens which occur in food and drink which is thought to be responsible for between 10 and 20 per cent of all childhood asthma. The foods most commonly incriminated are dairy products including cow’s milk and cheese, eggs, wheat, yeast, fish, pork and nuts. Some children are sensitive to colorants and preservatives used by food manufacturers, and without doubt there has been an increase in the number of asthma cases caused by these in the past few years.
Mark was a 9 year-old boy who had always had a finicky appetite, periods of irritability, poor sleep and difficulty in concentration at school. This combined with his asthma suggested a food allergy. On asking about his diet Mark’s father remarked that he liked to drink plenty of orange squash and cola. The tartrazine in both these drinks is a well known allergen and on omitting both squash and cola all Mark’s symptoms greatly improved. On one occasion he did have a glass of squash at a party and this was followed quite quickly by a wheezing episode.
The difficulty with food allergies is identifying them accurately. Skin tests are occasionally useful but more often than not only a trial diet to avoid various foods will confirm sensitivity. This can be a problem because it may be several weeks before the allergy dies down. An example of this is dairy produce which can take up to six weeks before the airways settle. How to manage food allergies is discussed at greater length in the section on prevention.

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