Due to COVID-19, there are a lot of things to be stressed out about. If you’re a parent, that stress may be compounded by worries about remote education, explaining the importance of social distancing to your child, and keeping the entire family sane, safe, and healthy as you spend an indefinite amount of time at home together.

And although the novel coronavirus doesn’t put children at risk to the degree it does older adults, that doesn’t mean there’s no risk. As of May 2020, only one systematic review with data on children has been published. It concluded that children account for 1 to 6 percent of the diagnosed COVID-19 cases, and often have milder disease than adults and extremely low mortality rates.¹

However, the Centers for Disease Control and Prevention (CDC) lists moderate-to-severe asthma as a possible risk factor for serious illness from COVID-19.² So if your child has underlying health conditions such as allergies and asthma (which are often connected), you may be understandably concerned. On top of that, COVID-19 is new, and data on how the virus affects different populations is growing and changing every day. This has led to a lot of uncertainty.

We’re here to tell you what we do know about managing childhood allergies and asthma during this challenging time.

Much of this information is rooted in the basics of pediatric asthma and allergy management. But on April 22, 2020, the E‌uropean Academy of Allergy and Clinical Immunology (EAACI) Section on Pediatrics released a statement in the Journal of Pediatric Allergy and Immunology making specific recommendations for the treatment of childhood asthma and allergies in light of COVID-19. This article is supported by those recommendations.

Gain control of asthma and allergy symptoms.

Perhaps the key takeaway from the EAACI’s statement is that proper treatment of diseases such as allergic asthma, allergic rhinitis, and other allergic conditions might prevent unnecessary visits to healthcare providers and hospitals, thus reducing risk of exposure to COVID-19.¹ That’s why it’s now more important than ever to help your child gain control of his or her allergy and/or asthma symptoms.

This can seem difficult, given that in-person visits to healthcare providers may have some restrictions across the United States. However, almost all providers are offering telehealth or phone appointments.

Use telehealth.

Be proactive in making telehealth or phone appointments with your child’s provider. Use this as an opportunity to ask questions about your child’s symptoms and what you can do at home to help achieve symptom control.

Here are some tips to help ensure a productive appointment:

Keep track of your child’s symptoms for at least a week or two prior to the appointment. We know this can be tough with children who aren’t always great at communicating how they’re feeling. Try some tactics like having your kids tell a story about how they feel and listen closely to the descriptions of their symptoms. They likely won’t describe how they’re feeling the way an adult would, so you’ll have to use some parental interpretation skills. You can also ask them about activities, e.g. “Why did you stop playing?” “Can you keep up with your siblings?” etc., to see if they’re struggling with breathing. (Our symptom tracker tool may help, too. Just answer the questions from your child’s point of view and share your findings with your healthcare provider.)

Know the “Rules of Two” for asthma symptoms. If your child has two or more days of asthma symptoms per week, two or more asthma symptom nights per month, and two or more refills of his or her rescue inhaler per year, asthma may not be well controlled.³

Ask your healthcare provider about allergic triggers. If you suspect your child has specific allergic triggers, write them down and tell your provider. Keep in mind that they may have triggers that you’re not aware of or new ones that become clear now that you’re spending more time indoors. In fact, there may be things in your home that are triggering allergic symptoms. (To learn more at allergy triggers in our new normal, check out "Social distancing is best practice. What does it mean for allergies?")

Ask your healthcare provider about allergy testing. Blood allergy testing can help you get a better understanding of your child’s allergic triggers. You can have the conversation anytime via phone or telehealth service or visit your healthcare provider or lab to have your child tested.

Have exposure reduction and asthma action plans.

Your child’s healthcare provider should give you an exposure reduction plan and an asthma action plan. An exposure reduction plan provides an overview of your child’s allergic and non-allergic triggers and how to avoid them. Asthma action plans are also a sort of “cheat sheet” that tell you how to help keep asthma symptoms controlled and what to do if they get out of control.

Download a customizable exposure reduction plan

Understand your child's medications.

For children, taking medication of any sort can be a struggle, spoonful of sugar or no. When it comes to inhalers, whether rescue inhalers or inhaled corticosteroids, kids often struggle to understand how to use them. But making sure your child is using his or her medications and using them properly is a critical step in helping to mitigate an emergency.

You can use the time during your telehealth appointment to have your child’s provider watch your child use his or her medicine and give instructions on proper techniques. It may also help kids to have an additional “authority figure” present (figuratively speaking) to guide them through the process.

If you’re concerned that asthma and allergy medications may make you or your child more prone to contracting COVID-19 or more likely to get severely ill as a result, the long and short of it is: don’t be. According to the EAACI’s statement, there’s been no evidence that allergy treatments either increase susceptibility to the illness or severity of disease. They recommend that pediatric allergists treat their patients with allergic asthma, allergic rhinitis, or other allergy conditions according to the usual guidelines and without restricting the use of any specific medication.

Keep calm and stay informed.

As you’re probably sick of hearing by now, this is a trying time, but we’re all in it together. Despite this phrase fast becoming a cliché, it doesn’t make it any less true. The best things you can do right now are to adhere to the social distancing and hygiene practices recommended by the Centers for Disease Control and Prevention (CDC) and keep in touch with your healthcare providers—regarding both your children and yourself.

References

Brough, HA et al. Managing childhood allergies and immunodeficiencies during respiratory virus epidemics – the 2020 COVID-19 pandemic - A statement from the EAACI-Section on Pediatrics. Pediatr Allergy Immunol 2020; doi: 10.1111/PAI.13262
Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fgroups-at-higher-risk.html#asthma. Retrieved July 2020
Millard M, Hart M, Barnes S. Validation of Rules of Two™ as a paradigm for assessing asthma control. Proc (Bayl Univ Med Cent). 2014;27(2):79-82. doi:10.1080/08998280.2014.11929063