Allergies vs. Asthma: How to Tell The Difference
Allergies and asthma are both common childhood respiratory conditions with similar symptoms, so it can be challenging to differentiate between them. Both can cause shortness of breath, wheezing, and chest tightness. Allergies and asthma attacks also share many of the same triggers, including cigarette smoke, environmental allergens such as mold or pet dander, air pollution, and certain medications. Allergic reactions and asthma attacks can be severe and life-threatening and may require immediate medical treatment (1). If your child has some of the above symptoms, a physician’s visit can provide a correct diagnosis to help determine which treatment would be appropriate.
An allergic reaction occurs when the body’s immune system overreacts to a substance (called an allergen) that is relatively harmless but triggers a physical response in a person who is sensitive to it. Common allergens include medications such as penicillin, peanut foods, and insect bites such as bee stings. One in 5 Americans, or over 50 million people, are diagnosed with allergies, accounting for many lost school and work days, and decreased quality of life (2). If allergies are suspected, your child’s pediatrician may recommend a battery of allergy tests to help pinpoint your child’s specific allergy triggers. Avoiding these triggers is the best way to prevent an allergic reaction. Allergies can affect multiple body organs, including the lungs, skin, sinuses, and stomach. Typical symptoms include a runny nose, sneezing, and rash. Genetics can play a role in childhood allergies: if one parent has allergies, the child has a 50% chance of also having allergies. If both parents have allergies, the child has a 75% chance of also having allergies (3). A child with food allergies can be four times more likely to have other conditions, such as asthma. A complete exam by your child’s pediatrician will help diagnose all the conditions contributing to the symptoms. Bloodwork and skin prick tests can provide more information. Antihistamines are a standard treatment for allergies. Epinephrine (the main ingredient of Epi-Pens) is also a treatment for more severe reactions like anaphylaxis.
In contrast, asthma is a chronic inflammatory condition of the lungs and airways. It is the leading cause of long-term illness in childhood, affecting more than 7 million children in the United States (4). The incidence of asthma cases is increasing for somewhat unclear reasons. Potential contributing factors to the rise of asthma cases include increasing environmental allergens like air pollution and secondhand smoke. A decreased breastfeeding rate may also contribute since breastfeeding passes protective immune molecules to the infant in the breast milk. Typical asthma symptoms usually begin by age 5, including cough, wheezing, and chest tightness. Upper respiratory infections like a common cold can trigger an asthma attack in young children. Pulmonary function tests provide more information and help guide treatment. Typical medications used to treat asthma include bronchodilators, which help open up the airways, and steroids, which help reduce inflammation. About 50% of childhood asthma patients can “outgrow” their asthma by adolescence, noting a decrease in the number of asthma episodes.
The pediatric pulmonologist will help your child develop an “asthma action plan” which details when and how to use the asthma medications, what to do when the symptoms worsen, and when to seek emergency care.
For Children and Infants | ACAAI Public Website
Allergy Statistics in the US | Allergy & Asthma Network (allergyasthmanetwork.org)
When To Ask Your General Pediatrician for a Referral
If you suspect that your child has a respiratory problem that seems recurrent or not improving, you should consider asking your pediatrician for a referral to see a pulmonologist. This doctor specializes in many breathing-related conditions and can help assess your child and recommend the proper treatment (5).
Typical symptoms that should prompt referral to a pediatric lung specialist include a chronic cough that occurs more than two days per week for two or three weeks or more than two nights per month. Other concerning symptoms are:
- Chronic nasal congestion.
- More than one hospital admission for an asthma attack.
- A cough induced by exercise.
If your child has recurrent breathing problems even after the pediatrician treats them, you may want to have a pediatric pulmonologist evaluate your child. A pediatric pulmonologist is a specialty doctor that can assess your child with specific testing and help manage the condition with proper medications. If you have concerns about your child’s respiratory function, discuss your concerns with your pediatrician and request a referral to a pediatric lung specialist.
How To Find Care from Pediatric Pulmonologist Doctor Near You
To find a qualified pediatric pulmonologist near you, ask your child’s pediatrician for a recommendation and referral. Chances are the pediatrician or clinic has a relationship with some.
Additional ways to find a competent pediatric pulmonologist include websites that list physicians in your geographic area:
- Search Google Maps
- Asthma Facebook groups like https://www.facebook.com/groups/615544601964794
- Forums like NextDoor, Reddit, etc.
Then cross-reference your doctor search with medical rating sites:
These sites can point you in the right direction and help you make an informed decision. Make sure to verify the doctors you have chosen are in-network with your insurance company and have positive reviews.
The website https://health.usnews.com/doctors supplies you with US News doctor rankings for pediatric specialists.
Consider consulting with friends or family in your area. A recommendation from someone you trust can carry a lot of weight. You can also search online forums.
Most major cities have a dedicated Children’s Hospital. Often, these hospitals are large academic centers with physicians in various specialties, including pediatric pulmonology, involved in the latest breakthroughs and clinical trials. Most of these doctors also maintain an office clinic where they see patients with different types of lung disease, from the very common to extremely rare. You can check the hospital’s website or physician referral hotline to find a doctor near you and establish care.
Pediatric Pulmonologists or Pediatric Specialists Education & Qualifications
A pediatric pulmonologist has completed at least ten years of training and education, including medical school, residency, and fellowship in the specialty. Those who have passed a rigorous written certification exam also obtain board certification. Looking for a board-certified physician will ensure the doctor is up to date with the current standard of care.
Describing Your Children’s Breathing Symptoms
A child with respiratory symptoms may not always be able to articulate the symptoms, which could make diagnosis difficult. Additionally, a busy pediatrician may need more time during a routine office visit to perform more thorough tests and physicals.
Having cold-like symptoms or a cough doesn’t necessarily mean your child needs a specialist’s care.
While many coughing and congestion episodes are routine and can resolve with minimal treatment, some illnesses are more concerning and should trigger an evaluation by a pulmonologist.
You should ask your child’s pediatrician to have your child evaluated by a pulmonologist if your child has a longstanding cough that is not resolving, has noisy breathing, has recurrent pneumonia, or has frequent shortness of breath. The pediatric pulmonologist is an expert in providing a comprehensive evaluation of breathing disorders in children.
An indication that there may be a more serious underlying condition is if your child has recurrent respiratory infections that return quickly after treatment with antibiotics or that don’t improve at all with them. This specialist can help pinpoint the source of your child’s disorder and rule out other diseases.
Pediatric Asthma Clinical Trials
The field of study of pediatric pulmonology is continually evolving. Many children’s hospitals and medical schools across the country are doing groundbreaking research in chronic pediatric breathing conditions.
For example, the School of Medicine at the University of Indiana is a leader in pediatric breathing condition research (https://medicine.iu.edu/pediatrics/specialties/pulmonology/research). The school has participated in clinical and drug trials for common pediatric lung disease and conditions such as asthma, cystic fibrosis, and allergy diseases. The researchers have received grants from prestigious national medical groups such as the National Institutes of Health and the American Lung Association.
Much of the ongoing pediatric pulmonary research focuses on furthering the knowledge of biochemical and immunological processes in asthma and cystic fibrosis. The development of further treatment options and symptom management is ongoing.
- Asthma – Symptoms and Causes – Mayo Clinic
- Allergies – How To Manage and Treat Allergies | ACAAI Patient
- Allergy Statistics in the US | Allergy & Asthma Network (allergyasthmanetwork.org)
- Asthma in Children: Risk Factors, Diagnosis, Management (clevelandclinic.org)
- What Is a Pediatric Pulmonologist? What They Do, the Conditions They Treat, and When to See One (webmd.com)