Dr. Debashish Roy

Wheezing is very common in young children under three years old, and it does not always indicate asthma. The most common cause of recurrent wheezing in toddlers is viral-triggered wheezing, where a respiratory virus causes the small airways to narrow and produce the characteristic whistling sound on breathing out. Many of these children wheeze with viral infections in the first two to three years of life and then outgrow the tendency as their airways grow larger. However, some children with recurrent wheezing in the toddler years do go on to develop persistent asthma, particularly when there is a family history of asthma or allergy in parents or siblings, when the child has eczema or allergic rhinitis themselves, when wheezing episodes are triggered by allergen exposure or exercise in addition to respiratory infections, or when episodes are frequent, severe, or require emergency treatment. For parents whose toddler has wheezed on two or more occasions, particularly if there has been one episode severe enough to require hospital treatment or nebuliser administration, specialist paediatric assessment is appropriate and worthwhile. At my Child Care and Allergy-Asthma Center, Dhupguri, I assess wheezy toddlers with a detailed history, clinical examination, and, where appropriate, a trial of bronchodilator and anti-inflammatory treatment to assess response, which helps guide whether a diagnosis of early asthma is likely and what ongoing management is needed.

Skin prick testing is the standard, rapid, and minimally invasive method for identifying specific allergen sensitisation in children with allergy and asthma. The procedure involves placing a small drop of each allergen extract on the forearm skin and using a fine lancet to make a tiny prick through the drop that introduces a microscopic amount of the allergen under the skin. The forearm is examined after 15 to 20 minutes, and a raised, reddened wheal at the site of a specific allergen indicates sensitisation to that allergen. Positive controls, typically histamine, and negative controls, typically a diluent, are always included to ensure the test is interpreting correctly. Skin prick testing is well tolerated by children of most ages, takes approximately 30 minutes from application to result, and is performed without blood sampling, which makes it much more acceptable to young children than blood testing. The test identifies sensitisation to the specific allergens included in the panel, which is selected based on the child's clinical history and the allergens relevant to their environment. Common panels include house dust mite, cockroach, moulds, local pollen, and common food allergens. The results of skin prick testing, interpreted in the context of the child's clinical symptoms, guide the personalised treatment plan including allergen avoidance strategies and immunotherapy candidacy. I hold the Fellowship in Advanced Allergy Procedures (FAAP), which specifically covers the performance and interpretation of allergen skin testing, and skin prick testing is performed at Dr. Debashish Roy's Child Care and Allergy-Asthma Center, Dhupguri, as part of a comprehensive allergy evaluation.

A cough that has been present for more than four weeks in a child is defined as a chronic cough and warrants systematic assessment rather than repeated courses of cough syrups or antibiotics. The most common causes of chronic cough in children that benefit from specific treatment include asthma, where cough is often the predominant or only symptom particularly at night or with exercise; allergic rhinitis with post-nasal drip; protracted bacterial bronchitis, a low-grade airway infection that responds to a prolonged course of the right antibiotic; pertussis (whooping cough) that was missed or atypical in its initial presentation; and post-viral cough that follows a respiratory infection and resolves slowly over weeks. Less commonly, chronic cough in children can indicate a foreign body in the airway, bronchiectasis, or other structural or immunological conditions that require investigation. The history of the cough, its character, its triggers, its timing, and associated symptoms, combined with physical examination, spirometry where age-appropriate, and chest X-ray where indicated, guide the diagnosis. At my Child Care and Allergy-Asthma Center, Dhupguri, with my International Certification in Paediatric Pulmonology (ICCP), I assess chronic cough in children systematically, using objective lung function testing and a structured diagnostic approach rather than empirical sequential antibiotic prescribing.

Allergy immunotherapy, also known as allergen desensitisation or allergen-specific immunotherapy, is the only treatment that modifies the underlying cause of allergic disease rather than simply suppressing its symptoms. It works by administering gradually increasing doses of the allergen to which the patient is sensitised, either as injections under the skin (subcutaneous immunotherapy, SCIT) or as drops or tablets under the tongue (sublingual immunotherapy, SLIT), over a period of three to five years. This systematic exposure trains the immune system to become progressively less reactive to the allergen, producing a sustained reduction in allergic symptoms that persists after the treatment course is completed. Immunotherapy is most effective for allergic rhinitis and allergic asthma caused by common aeroallergens such as house dust mite, pollen, and mould, and should only be administered following accurate allergen identification through skin prick testing or specific IgE blood testing. At Dr. Debashish Roy's Child Care and Allergy-Asthma Center, Dhupguri, I hold the Fellowship in Advanced Allergy Procedures (FAAP) qualification, which specifically covers allergen challenge testing, skin prick testing, and the administration and monitoring of immunotherapy. Immunotherapy is available for children in Dhupguri who have been assessed and found to be appropriate candidates, meaning that families in the Dooars region do not need to travel to Siliguri or Kolkata to access this treatment.