Allergies, injuries and poisoning symptoms in children indoors and outdoorsJaiva Larsen, MD

Staying out of the Emergency Room

Allergies

Allergies

• Eczema• Hives• Allergic rhinosinusitis/conjunctivitis• Asthma• Anaphylaxis

Major Allergens in Children• Indoor

▫ Dust mites▫ Pets/animal allergens▫ Mold▫ Cockroach▫ Tobacco smoke▫ Solvents/chemical irritants▫ Products of combustion

• Outdoor▫ Pollens▫ Molds▫ Bites/stings

Diagnosis & Treatment

• Diagnosis▫ Pediatrician ▫ Allergy specialist▫ Blood testing▫ Skin testing

• Treatment▫ Comprehensive Action Plan▫ Environmental Control

Environmental Control – Dust Mites• Allergen impermeable casing for pillows

and mattresses • Wash pillows/mats etc weekly

▫ Wash in hot water (130˚ F) to kill mites▫ Choose synthetic materials that withstand

washing• Vacuum

▫ HEPA filter or double layered microfilter bag• Dust with damp cloth• Consider stuffed animals, upholstery,

drapes, carpet • AC filters• NO ozone generators

▫ generate harmful ozone

Environmental Control – Warm blooded Animals• Reduce child’s exposure to pets if

allergic▫ New home▫ Keep pets outdoors

• Reduce allergens▫ Bathing animal 2x/weekly▫ HEPA filter

• Rodent Pests▫ Use least toxic extermination

method e.g. traps▫ Rodenticides are most toxic

pesticides

Environmental Control - Cockroach Allergens• Deprive roaches of food/water

▫ Clean up all food items/ crumbs/ spills as soon as possible

▫ Store food and trash in closed containers▫ Limit spread of food around house, especially

bedrooms▫ Fix water leaks under sinks▫ Mop kitchen floor at least once a week▫ Clean counter tops daily

• Use least toxic methods first

Environmental Control - Mold• Control Sources of moisture

▫ Check faucets, pipes, ductwork, roof for leaks and repair as soon as possible Clear ductwork annually American Society of Heating, Refrigerating and Air

Conditioning Engineers (ASHRE) standards▫ Clean small areas with chlorine bleach 1:10 solution

• “Toxic” Mold/ black mold▫ Stachybotrys chartarum▫ Clinical effects same as other common molds▫ Allergenic in sensitive individuals

Environmental control Outdoor Allergies• Stay indoors• Air conditioned

environment• Especially during

the afternoon• Check pollen count

forecast

How to use an Inhaler

• Remove Cap• Shake inhaler• Breathe out.• Place inhaler in mouth• Press down on the inhaler• Breathe in slowly (3-5 seconds)• Hold breath (10 seconds)• Consider a spacer

How to use an Epinephrine Autoinjector• Remove the safety release

mechanism• Firmly push the auto-injector

against the middle of the outer thigh until you hear a clicking sound. This can be done through clothing, if needed.

• Hold firmly against the thigh for 5-10 seconds (depending on the manufacturer) to deliver the medication.

• Remove the device from the thigh and discard it.

Bites and Stings

• Allergic reactions▫ Bees▫ Kissing bugs

• Venom Effects▫ Bee swarms▫ Bark scorpion▫ Black widow▫ Arizona brown recluse▫ Rattlesnake

Injuries

Injuries

• An estimated 9.2 million children annually had an initial emergency department visit for an unintentional injury

• Injuries are the leading cause of death in children ages 19 and younger

Drowning Prevention

• Learn life saving skills▫ Swimming▫ CPR

• Fence it off• Life jackets • Supervise kids around

water▫ Even the bathtub▫ Basin/bucket

Playground Safety

• Check that playgrounds have soft material under

• Use playground equipment that is right for the child’s age.

• Make sure there are guardrails in good condition

• Look out for things in the play area that can trip a child

• Supervision

Sports Safety

• Gear up▫ Helmets, wrist guards,

knee or elbow pads• Good equipment• Action plan for injuries• Consider heat injury• Model safety focused

behavior

Head injury worries

• Loss of consciousness• Not acting normally• Change in skull shape• Bruising on side or back of head• Vomiting• Severe headache• Severe mechanism

▫ e.g. fall more than 3 feet,

Poisonings

Pediatric Poisoning in AZ

• 48% of poison exposures in AZ are children under 6 years old

Why are children vulnerable to poisoning?• Exploring the

environment ▫ Crawling, licking hands

• Eat & drink more per pound

• Breath more per pound• Greater skin surface area• Still developing

Pediatric Environmental Toxins• Pesticides • Heavy Metals

▫ Lead, arsenic, mercury• Endocrine disruptors• Indoor Air Quality

▫ Mold▫ SVOC/VOC▫ Particulates

• Outdoor Quality▫ Particulates/diesel ▫ Sun Exposure

• Second hand smoke

Pesticides• A pesticide is a substance, natural

or synthetic designed to kill, control or repel living things

• All pesticides are potentially harmful▫ Mechanism of action▫ Potency▫ Dose▫ Length of exposure▫ Route Ingestion Inhalation Skin contact

Case Report• January 2017• Amarillo, Texas• Aluminum phosphide

applied under mobile home

• Washed with water • 5 hospitalized • 4 children die

▫ Yasmeen Balderas, age 17

▫ Josue Balderas, age 11▫ Johnnie Balderas, age 9▫ Felipe Balderas, age 7

IPM Pesticide Use• Nonchemical• Least toxic

chemical• Least

mobilized • Out of reach

TOXICITY CATEGORY (Signal Word)2

High toxicityDANGERCategory I

Moderate ToxicityWARNINGCategory II

Low ToxicityCAUTIONCategory III

Very Low ToxicityCAUTION(optional)Category IV

Acute Oral LD50

≤ 50 mg/kg 50-500 mg/k >500-5000 mg/kg >5000 mg/kg

Inhalation LC50 ≤0.05 mg/L >0.05-0.5

mg/L>0.5-2.0 mg/L >2.0 mg/L

Dermal LD50 ≤200 mg/kg 200-2000 mg/kg

>2000-5000 mg/kg >5000 mg/kg

Primary Eye Irritation

Cornea opacity not reversible within 21 days

Corneal involvement or other eye irritation clearing in 8 -21 days

Corneal involvement or other eye irritation clearing in 7 days or less

Minimal effects clearing in less than 24 hours

Primary Skin Irritation Corrosive

Severe irritation at 72 hours

Moderate irritation at 72 hours

Mild or slight irritation at 72 hours

Cleaning agents

• Detergents• Caustics• Hydrocarbons

Carbon Monoxide

Medications/herbs/supplements• > 60,000 children seen in ED

each year because they got into medications

• One pill can kill▫ Opioids▫ Sulfonylureas▫ Clonidine▫ Wintergreen oil

• Over the counter ≠ safe▫ Acetaminophen most common

cause of liver failure in USA

Ibuprofen

Recreational Drugs

• Nicotine• Alcohol• Caffeine• Marijuana

Poisonous Plants

First aid for pediatric poisoning• Call 911 for Emergency

▫ Unconscious▫ Not breathing▫ Throat/lip swelling▫ Seizure▫ Bleeding

• Questions? Possible poisoning Call Arizona Poison and Drug Information Center

• Do not induce vomiting• Irrigate for eye or skin contact• For gases, get into fresh air

• Consider simple low costs interventions to keep kids safe▫ Environmental control

for allergies▫ Preventative measures

for injuries▫ Safe handling of

dangerous chemicals• Call the poison center

anytime 1(800) 222-1222

Conclusions

Thank You