Topic of the Month: April 2006: Avoid springtime allergens to reduce symptoms of asthma
In this month's topic you will learn:
- Symptoms of allergic asthma
- What triggers allergic asthma
- How to manage asthma
- Types of medications used for asthma
- When to see an allergist/immunologist
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Spring is here and that means for 40 to 50 million Americans, so are allergies. Allergic diseases, such as allergic asthma, affect more than 20% of the population, and are the sixth leading cause of chronic disease in the United States.
Allergic asthma is the most common form of asthma. Asthma is considered allergic when symptoms become more intense, perhaps resulting in an asthma attack, when the individual is exposed to allergens to which their immune system is sensitive.
 Symptoms of allergic and non-allergic asthma are similar. They include:
- Coughing
- Wheezing
- Shortness of breath or rapid breathing
- Chest tightness
About 60% of asthma attacks are caused by allergens, such as mold spores, pollen and animal dander. Other allergens, such as dust mites, medications, food and cockroaches, can also trigger a reaction.
If your asthma is triggered by allergens, it is important to avoid exposure to them. See your allergist/immunologist for recommendations on control measures to help avoid allergens.
Managing asthma
However, allergens cannot be totally avoided, especially in the spring, the following tips can be used to help reduce attacks caused by allergens and irritants:
- Watch for ozone alerts. These alerts will keep you aware of the potential triggers for the day.
- Minimize outdoor activity on days when temperatures are excessively high.
- Take medications as prescribed in the recommended dosage. Do not take more medication to ease severe symptoms without consulting your doctor. Request a written asthma treatment plan from your doctor.
- Use an air conditioner in both your home and car to keep air clean, cool and dry.
- Do not stand directly behind cars that are running. Exhaust fumes could trigger an asthma attack.
Asthma management also includes using proper medications to prevent and control asthma symptoms, and to reduce airway inflammation. Therefore, asthma medications are categorized into two general classes, quick-relief and long-term control medications.
Quick-relief medications that are used to provide temporary relief of symptoms include:
- Bronchodilators, generally used as "rescue medications," open up the bronchial tubes so that more air can flow through. Bronchodilators include beta-agonists and anticholinergics, and come in inhaled, tablet, liquid or injectable forms.
- Corticosteroids are administered for short-term use orally or by injection to speed up the resolution of airway inflammation.
Long-term control medications are taken daily to control the airway inflammation in persistent asthma. This class includes:
- Inhaled corticosteroids are the most effective long-term therapy available for persistent asthma. They are generally well tolerated and safe at recommended dosages.
- Cromolyn or Nedocromil prevent the development of inflammation in the lungs. Response to these two are less predictable then the response to inhaled corticosteroids. These medications are not corticosteroids.
- Leukotrienes modifiers fight potent chemicals called leukotrienes (lu-ko-try-eens) responsible for airway inflammation within the body. They are generally safe.
- Inhaled beta 2-agonists are long-acting and beneficial when added to inhaled corticosteroids. [Insert: "Their use needs to be carefully discussed with the doctor".]
- Methylxanthines provide mild to moderate dilation of the airways and may have a mild anti-inflammatory effect. Theophylline is the most frequently used methylxanthine.
- Omalizumab was approved in 2003 as a new class of therapy, known as anti-IgE, for patients with moderate to severe persistent allergic asthma. IgE is an antibody that we all have and it is responsible for causing allergic problems in some people. It may reduce allergic reactions by causing free IgE to disappear from the body so that the IgE cannot attach to allergens (and other substances that are present).
Combination therapy, with the addition of a long-acting beta2-agonist to low-to-medium doses of inhaled corticosteroids, results in improvement in asthma control. Adding a leukotriene modifier or theophylline to inhaled corticosteroids also improves asthma control but the evidence is not as substantial.
 Make sure you follow your physician's instruction on the appropriate use and dosage of your prescribed medications, and ask for a written asthma action plan.
The better informed you are about your asthma triggers and management, the less asthma symptoms will interfere with your activities. It is important to avoid your triggers, work with your physician on a management plan and take appropriate medications as prescribed. Together, you and your allergist/immunologist can work to ensure that asthma does not interfere with your optimal quality of life.
When to see an allergy/asthma specialist
The better informed you are about your asthma triggers and management, the less asthma symptoms will interfere with your activities. It is important to avoid your triggers, work with your allergist/immunologist on a management plan and take appropriate medications as prescribed.
The AAAAI's How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:
- Need to confirm the diagnosis of asthma.
- Have asthma and see their symptoms get worse after a new pet has been introduced into the home.
- Have a history of seasonal or persistent asthma, to evaluate their sensitivity to inhaled allergens and provide instructions regarding avoidance measures.
- Need education on asthma and guidance in techniques for self-management.
- Need for daily asthma reliever medications.
- Are not using medications as prescribed, and this is limiting their ability to control their asthma.
Additional Resources
This topic was reviewed on 4/1/2006 by Stuart Friedman, MD, FAAAAI, Patients & Consumers Web Editor
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