Varicella exposure in a child at risk of being immunosuppressed.

The child with asthma and other atopic symptoms presents many management problems to the pediatric nurse practitioner (PNP) responsible for his or her care. When such a child has an exacerbation of asthma while concomitantly being at risk for contracting varicella after having received parenteral corticosteroids, the consequences can be devastating. The many decisions the PNP must make include modifications to current medications to keep the primary illnesses under control while considering prophylactic and other therapeutic measures to make certain that the threats to the health of the child and the family from varicella are minimized. A case example is used to illustrate the decision-making process in such a situation. Guidelines are drawn from the recent literature, including the recent guidelines on asthma management from the National Heart, Lung and Blood Institute/National Asthma Education and Prevention Program.