Q: My 6-year-old son has food allergies and now also seems to be coughing a lot during the night (long after he’s eaten). Could he be developing asthma? How can we know and what are the next steps?
Dr. Bassett: You are right to be concerned. A history of atopy or allergy, including to food, increases the risk for other allergic conditions, such as asthma. And it’s possible that your son is experiencing nocturnal asthma, which refers to symptoms that are worse during the night, especially between the hours of 2 a.m. and 4 a.m. Potential causes of nighttime asthma include a viral upper respiratory infection, sinusitis or postnasal secretions triggered by indoor allergens.
Your son’s circadian rhythm can also play a part. Our bodies produce natural epinephrine and steroids that normally serve to protect against asthma, but levels of these two allergy fighters are lowest after midnight, creating the potential for susceptible individuals to awake with symptoms.
The first step is to schedule an office visit with your son’s pediatrician or an asthma specialist. The appointment should include a symptoms discussion and physical examination to look for any telltale signs of asthma. If possible, a pulmonary function test will also be performed, which can further identify patterns seen in a child with asthma. Comprehensive allergy testing might also be helpful in understanding the dynamics and identifying potential asthma triggers.
If asthma is pinpointed as the culprit, asthma medicines, including rescue and daily controller inhalers should be considered. These treatments are particularly important for children with persistent asthma-like symptoms that occur during the night.
Dr. Clifford Bassett, an allergist and asthma specialist, is the Medical Director of Allergy & Asthma Care of New York (www.allergyreliefnyc.com; Twitter @allergyreliefny). He is also on the faculty of NYU School of Medicine and Weill Cornell Medical College in New York City.