’Tis the season – time to celebrate with family and friends. But for people with allergies or asthma, some holiday get-togethers are more stressful than festive. What do you do about your favorite aunt’s delicious walnut brownies? Or Grandpa’s smoking? Or Uncle Bob’s dander-laden dog?
All year long, you work hard to control asthma or allergy symptoms, carefully staying away from allergens and irritants that take your breath away. Now you face a full plate of family traditions and personal habits that threaten to wreak havoc with your health – or the health of your child.
You might think it would be easy. Surely your family wants the best for you and your child.
The reality is that families are people – full of different personalities, perspectives and levels of awareness. All too often, our relatives simply do not understand – or choose to ignore – the challenges facing family members with asthma or allergies.
Fortunately, with some careful preparation, diplomacy and persistence, you can make the season as merry – and comfortable – as it’s meant to be.
An Ounce of Prevention
Before you leave for a family gathering, be sure to review your asthma or allergy management plan and do everything you can to prepare yourself or your child medically. Dan Atkins, MD, who directs ambulatory pediatrics at National Jewish Research Center in Denver, Colorado, talks to his patients about potential triggers they might encounter over the holidays. “We talk about likely exposures, what medications to take – sometimes I’ll have them pretreat with albuterol or antihistamines – and who to call in case there’s a problem.” Atkins also emphasizes the importance of taking along all medications, as well as a nebulizer and peak flow meter, when traveling.
Then, sidestep holiday woes by talking to relatives before the party begins. In the case of food allergies, Barbara Smith of northern New Jersey suggests you ask which guests will be bringing dishes to share. Then you can contact them directly to discuss what they’ll be making. Smith’s six-year-old daughter, Katie, is severely allergic to nuts. “I e-mail everyone and remind them not to put nuts in or Katie won’t be able to stay,” she says, since her daughter is so sensitive she can react through contact with people who have recently handled or eaten nuts. Even food without nuts can be dangerous for Katie if prepared without proper precautions, so Smith makes her own versions of dishes on the menu and brings them along for Katie so she doesn’t feel “different.”
Social psychologist Susan Newman, PhD, author of The Book of No: 250 Ways to Say It and Mean It and Stop People-Pleasing Forever (McGraw-Hill, 2005), recommends you make your family aware of health issues throughout the year. “Let’s say your child had a really bad asthma attack. Don’t keep it a secret,” she advises. “Rather than saying, ‘Oh, they don’t need to know,’ it might make it easier for you in the long run to have told your sister and brother and parents about what happened.” This also increases the likelihood of having another family member – one who does understand your child’s condition and its severity – back you up with those who seem skeptical.
Sharing books and articles about your child’s condition with family and friends can go a long way toward gaining their support. Melanie Reinke’s son Asa, who is now five, was first diagnosed with life-threatening peanut and egg allergies at the age of 15 months. She says it was hard for her to comprehend the condition, much less try to explain it to family and friends. “I figured the best way for them to get the picture was to read what I was reading,” Reinke remembers.
Reinke gave her mother, who babysat for Asa, a book on peanut and food allergies. She ordered laminated cards listing alternative names for peanuts and eggs and gave them to family and friends who might cook or care for Asa over the holidays. She also copied articles explaining the seriousness of food allergies. “For some reason if a person reads it, they are more likely to believe it,” Reinke says.
Now when giving cakes or cookies as gifts, Reinke’s friends deliver packages of dry, premeasured ingredients and baking instructions instead of the finished goodies. All Reinke does is add an egg substitute and turn on the oven. “It’s not an idea I can take credit for,” she says, “but it shows the thoughtfulness of the people in our lives.”
Besides sharing articles, tell relatives what your doctor has told you, recommends Newman. “Explain what you were told about how serious the condition is, what triggers it and what you are to do. Explain that there can be no exceptions and rule changes – that one little rule change could get you into trouble and into the E.R.”
This approach can work well when skeptical ex-spouses are spending holiday breaks with your child. Type up the doctor’s instructions, suggests Newman, listing important points to remember and medication schedules. That way, she says, you avoid emotional tones or accusatory words. “Statements like ‘You need to remember this,’ suggest that the spouse is incompetent or forgetful,” explains Newman. “Include the doctor’s phone number in case your ex-spouse has a question. Adding the contact information also validates the instructions you’ve provided.”
Your Place or Mine?
If the family or friends you plan to visit have pets you or your child are allergic to, or if relatives live in homes where residents smoke, offer to host the party in your home. When Suzanne Masterman’s son Duncan, now 6, was diagnosed with asthma, her in-laws didn’t understand that they couldn’t smoke when he came to visit. So Masterman invited them to her house and explained that they could smoke outside. “We put ashtrays and chairs outside, far from the house, and tried to be accommodating,” she says. “We also offered to help other relatives who don’t smoke host family functions at their homes.”
“When we’d visit relatives who smoke, we’d stay in a hotel, in a nonsmoking room,” says Phyllis Briskman Stanfield, mother of now 20-year-old Maxwell, who has severe asthma. “We’d stay where we could control the environment, and we would go to the Thanksgiving or other holiday occasion equipped with everything he might need in a backpack: nebulizer, EpiPen®, Ventolin®, antihistamine. We always had his allergist’s telephone number in case of emergency. If Maxwell started to have a breathing problem, we would have to leave.”
During holiday breaks from school, instead of sending Maxwell to a relative’s home where he might encounter breathing problems, she’d invite others to spend the vacation at her home.
Families can also suggest some new holiday traditions that lessen exposure to triggers. Try enjoying holiday meals at a nonsmoking restaurant or engaging in outdoor activities. Sledding, caroling or walks around the neighborhood are great ways to celebrate special days and spend quality time with the people closest to you.
Even with early and good communication about your child’s health needs, some loved ones still may not understand. “When you have to explain to those who don’t understand or who may not have been listening to you [talk about the condition], it can be both frustrating and exhausting,” Newman says. In those cases, she suggests a response such as, “I understand how you feel because he looks so healthy and vibrant. But we do know from experience that inhaling fragrances like the ones from those candles (or cigarette smoke) can set off an asthma attack. It’s happened before; the doctors have told us it can happen again; and we’re not going to take that chance. I don’t want our family to spend the holiday in the emergency room.”
If others continue to ignore your requests, you may have to leave. “When the health of your child is concerned, nice goes out the window,” says Masterman.
She and her husband used a three-part strategy when her in-laws continued to smoke in their home while Duncan was visiting. “We made sure my husband was the one to address it, not me. If it came from their son, they seemed to be more open to listening.”
The couple was careful, too, not to make accusatory statements. When Duncan started to have trouble breathing, Masterman’s husband would say, “We’re really sorry, but we have to go. He’s having trouble breathing and so we have to leave.”
“We were really careful not to accuse,” she says. “We tried to make sure they understood that we wanted to be there, but we couldn’t because there was an air quality problem.”
The couple’s third strategy was persistence. “Sometimes we would arrive and be there for five minutes, but it would be too smoky and we’d have to leave,” Masterman recalls. “It took about a year of that – probably five or six times of our coming and having to leave early. We decided early on that we’d keep trying. We wanted them to understand that we wanted to be there but that our main purpose was to keep their grandchildren safe.”
Their persistence has paid off. Now Duncan’s grandparents smoke outside when he comes to visit, and he can stay longer. Masterman also invites them to her home for dinner frequently to spend time with Duncan and his brother, Jeremiah. “They realize it’s not that we didn’t want to be around them, it was just the smoke.” And that, she says, “has made a huge difference.”
So whether it’s Thanksgiving dinner or a week-long winter break, preparation, information and persistence can make your family time festive and healthy.
Winter Health Smarts
Respiratory viruses and cold air can exacerbate asthma symptoms, explains Dan Atkins, MD, of National Jewish Medical and Research Center in Denver, Colorado. Because people tend to travel and socialize more around the winter holidays, they’re more likely to be exposed to cold air and the viruses that cause colds and flu. Not to mention allergy-triggering molds and dust mites. To make your holiday season brighter, Atkins encourages these precautions:
• Take all of your medications along when traveling, including related equipment, such as a nebulizer and peak flow meter to monitor lung function.
• Talk with your doctor about any pretreatment regimens you should follow before holiday parties or traveling.
• Although some contact is unavoidable, steer clear of people who are coughing, sneezing and sniffling. Don’t share food or drinks with others. Try not to kiss someone who’s sick. And don’t be afraid to turn down an invitation if members of the host’s household – or other guests – have cold or flu symptoms.
• Pace yourself. Be selective about which gatherings you’re going to attend and get plenty of rest during the holiday season.
Written by Kimberlee Roth, a freelance writer specializing in wellness, nutrition, psychology and relationships. She is the author of ”Surviving a Borderline Parent“ (www.survivingborderlineparent.com).
Illustrations by Paul Tury, Creative Director, Allergy & Asthma Today
First published: Allergy & Asthma Today, Fall 2006
Updated: December 2009
Medical Editors: Martha Hogan, MD; Tera Crisalida, PA-C