Back-to-school sniffles, sneezes, and wheezes: it is easy for parents and teachers to mistake allergies or asthma for a series of colds.

Is it a cold, an allergy, or asthma? It's not always easy to know the difference. As children return to school and are exposed to various "bugs," as well as pollens and other allergy triggers, it's even more important for parents and teachers to recognize the symptoms of a passing cold, bothersome allergies, or the early signs of asthma.

"It is easy for parents and teachers to mistake allergies or asthma for a series of colds and simply think that the child just catches every cold that goes around," says Dr. William J. Davis, director of the Allergy-Immunology Program at Columbia Presbyterian Medical Center. "Unfortunately, this often results in undetected and untreated allergies or asthma."

Symptoms ranging from itchy eyes and seemingly endless sneezing attacks to a chronic cough and continuous mouth breathing can follow contact with ragweed pollen (which flourishes during August and September in most areas of the country), chalkboard dust, classroom pets, and viruses transmitted from other students. As a result, a child can be miserable, unable to concentrate, and even lose his or her desire to play.

While a cold requires lots of fluid and bed rest, it is important that a child with suspected allergies or asthma be under the supervision of a family physician or allergy specialist. And because allergies and asthma are ongoing conditions, it's essential that both the child and the parents understand the triggers and recommended treatments. A family physician or allergy specialist can advise parents on an individual treatment plan.

Allergies. "In most instances we begin early allergy therapy with medications, such as cromolyn sodium nasal spray, that actually stop most cells from degranulating [breaking down], prohibiting the release of histamine [which triggers attacks] and preventing symptoms from occurring," says Dr. Davis. "If a child already has obvious allergy symptoms, cromolyn sodium can be used in conjunction with a nonsedating antihistamine and/or nasal decongestant until symptoms clear. In more serious cases we may recommend either intranasal steroids or immunotherapy to bring flagrant attacks under control."

Asthma. The treatment program for asthma is usually more comprehensive because the condition itself is so multifaceted. Asthma is manifested by airway inflammation, airway hyperresponsiveness ("twitchy airways"), and bronchospasm. As a result, the National Heart, Lung, and Blood Institute recommends a new treatment protocol for asthma that underscores a stepcare approach to asthma.

"Patients with mild asthma [symptoms less than three days a week] are usually started on bronchodilators as needed. Nonsteroidal antiasthma medicines, such as cromolyn sodium, that treat airway inflammation--the underlying cause of asthma--are added if the patient experiences symptoms more than three days a week," says Dr. Davis. "In more severe cases inhaled steroids are introduced to the treatment plan. But it's critical that all asthma patients are under the care of a physician who can modify their therapy if necessary."

Cold, Allergy, or Asthma?

SYMPTOM               COLD         ALLERGY       ASTHMA
Family history        Not
                      applicable   Often         Sometimes
Persistent cough      Often        Rarely        Often
Sneezing              Often        Almost
                                   always        Sometimes be-
                                                 cause of asso-
                                                 ciated allergies
Duration of           Two days
                      to two       More than
                                   two           Persistent
symptoms              weeks        weeks
Wheezing              Seldom       Rarely        Frequently
Fever                 Often in
                      early stage  Rarely        No
Nasal discharge       Copious:
                      watery       Thin, clear,
                                   and watery    Sometimes,
                      early-on:
                      thick later                usually thin
Shortness of breath   Rarely       Rarely        Frequently
Tightness or "funny"  Rarely       Rarely        Almost always
feeling in chest
Allergic "shiners"    Rarely       Often         Sometimes,
(discoloration                                   because of
under the eye)                                   associated hay
                                                 fever

For additional information, including Asthma: What Every Patient Should Know, a basic overview of asthma and guidelines for managing the condition, and Inspiration, a booklet featuring listings of physicians' associations and support groups nationwide, write to the Asthma and Allergy Information Center, P.O. Box 790, Springhouse, Pennsylvania 19477-0790.

(A Fisions News Release)