Diagnosis While, in general, the ‘clinical manifestations’ of a severe AAE are ‘fairly obvious’, the signs and symptoms are not specific. For instance, children with an AAE may complain that they have a ‘tummy ache’ (Asthma UK, 2015) and the differential diagnosis for wheezing, cough and respiratory distress may include respiratory tract infections, vocal-cord dysfunction, mechanical obstruction and bronchiolitis (Guibas et al, 2012). School nurses should consider whether the school protocol and staff training needs to cover the difference between, for example, AAE and mechanical obstruction.