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Allergic Asthma
By Bill Bergfeld
Allergic asthma is the most common type of asthma. About 90% of kids with childhood asthma have allergies, compared with about 50% of adults. Inhaling specific substances called allergens (allergy triggers, such as pollen, mites, or molds) brings on the asthma symptoms associated with allergic asthma. Nearly everyone with asthma (allergic or nonallergic) gets worse after exercising in cold air or after inhaling any type of smoke, dust, fumes, and sometimes strong smells.
Because allergens are everywhere, it's important that people with allergic asthma understand their allergy and asthma triggers and learn the facts about preventing asthma symptoms.
What Is an Allergy?
A major task of your immune system is to protect you from bacteria and viruses. However, in people with allergies, the IgE portion of the immune system is too vigilant. It may treat harmless substances -- like cat dander or pollen -- as if they were enemy invaders and attack them (in your nose, lungs, eyes, and under your skin).
When your body encounters an allergen, it creates special cells called IgE antibodies. These defensive cells trigger the body's allergic reaction. They cause the release of chemicals like histamine, which result in swelling and inflammation. This creates familiar allergy symptoms like a runny nose, itchy eyes, and sneezing because your body is trying to destroy the allergens.
What Is Allergic Asthma?
If you have allergic asthma, your airways are hypersensitive to the allergens to which you've become sensitized. Once these allergens get into your airways, your immune system overreacts. The muscles around your airways tighten (an effect called bronchospasm). The airways themselves become inflamed and flooded with thick mucus.
Whether you have allergic asthma or nonallergic asthma, the symptoms of asthma are generally the same and may include any or all of the following:
- Coughing
- Wheezing
- Shortness of breath
- Rapid breathing
- Tightening of the chest
Common Allergens for Allergic Asthma
Allergens, which are small enough to be inhaled deep into the lungs, include:
- Windblown pollen from trees, grasses, and weeds
- Mold spores and mold fragments
- Animal dander (from hair, skin, or feathers) and saliva
- Dust mite feces
- Cockroach feces
You may also have allergic reactions if you are scratched with an allergen (causing itchy, red skin), get some in your eyes (causing itchy, red eyes), or eat it, which in rare cases can cause life-threatening anaphylactic shock (including a severe asthma attack).
Keep in mind that allergens are not the only thing that can worsen your allergic asthma. Irritants may still trigger an asthma attack, even though they don't cause an allergic reaction. Irritants that you inhale may also trigger an asthma attack. These irritants include:
- Tobacco smoke
- Smoke from a fireplace, candles, incense, or fireworks
- Air pollution
- Cold air, especially vigorous exercise in cold air
- Strong chemical odors or fumes
- Perfumes, air fresheners, or other scented products
- Dusty workplaces
Your doctor can perform allergy and asthma tests to determine exactly which indoor and outdoor allergens cause your allergic asthma. The two most common (and recommended) tests are 1) pricking your skin with a tiny amount of the allergen (and measuring the size of the red bumps 20 minutes later, or 2) a blood test (RAST or allergen-specific IgE levels).
Environmental Control and Allergic Asthma
A crucial part of controlling your allergic asthma is to limit your exposure to allergens. Here are some tips to get asthma relief:
- When pollen counts are high, stay inside as much as possible. Keep the windows closed. Don't use an evaporative cooler (called a swamp cooler in the Southwestern U.S.). If it's hot, use an air conditioner with a clean air filter. Don't use an old air conditioner if it smells musty or moldy.
- Dust mites live in fabrics and carpets, but they are microscopic, so you can't see them. So wrap your pillows, mattress and box spring using allergen proof covers. Wash your sheets and other bedding once a week in very hot water. Have wall-to-wall carpeting removed, if possible. Get rid of areas where dust can accumulate, like heavy curtains, upholstered furniture, and piles of clothing. If your child has allergic asthma, avoid stuffed animals, or only buy washable stuffed animals.
- Check indoor humidity (using an inexpensive meter). If moisture is a problem in your home (relative humidity above 40%), use a dehumidifier or air conditioner. This will reduce the growth of molds, cockroaches, and house dust mites. Repair any plumbing or roof leaks (but don't do it yourself).
- If you have pets, get allergen skin testing (or RAST) to determine if you've become sensitized to them. We love cats or dogs, but if you are allergic to them, your asthma control will be much better if you keep them outdoors or find another home for them. At the very least, ban all pets from the bedroom by installing an inexpensive mechanism on the bedroom door which closes it automatically. High levels of cat allergen persist for many months in a home or apartment after cats are no longer living there. There are no hypo-allergenic cats or dogs. Washing the pet every week will make very little difference in the amount of their allergen that you inhale. Dusts or sprays that claim to reduce pet allergens have not been shown to be effective.
- Keep your kitchen and bathroom clean and dry to prevent mold and cockroaches. If you are allergic to cockroaches, and you see evidence of them in your kitchen, contact a pest control company for help. Just using insecticide spray is inadequate. You need to eliminate their access to all sources of food in your home, even small crumbs in the carpet and oil stains near the stove. Run the exhaust fan whenever you cook or take a shower to lower the humidity in the room.
- Large HEPA room air cleaners effectively remove smoke and other small particles (such as pollens) from a room but only when the fan is on. They do not reduce humidity, and don't reduce exposures to house dust mites. Avoid electronic air purifiers, since they usually create ozone, which causes airway inflammation.
- Be careful doing outside work. Gardening and raking can stir up pollens and mold. Wearing a HEPA filter mask while outside (especially if working in the yard) can reduce the amount of pollen and mold particles that get into your lungs.
- Medications, Injections, and Allergic Asthma
- Determining the allergens to which you've become sensitized, and then taking steps to minimize your exposure to them, is likely to improve your asthma control. However, it's not likely to completely eliminate your need for allergy and asthma medications. You still have to contend with the asthma flares inevitably caused by respiratory viruses and unintentional (often unavoidable) exposures to asthma triggers.
- Good treatments for nasal allergies include nonsedating antihistamines (like over-the-counter generic Claritin), saline rinses, decongestant nasal sprays (for a few days), and when these fail, nasal steroid sprays (available only by prescription), and stronger antihistamines. When all of these treatments fail, consider a consultation with an allergist to see if allergy shots (immunotherapy) would help you.
- There are many good asthma controller and reliever asthma treatments, but all of them require a prescription from your asthma doctor. These medications include inhaled steroids, long-acting inhaled bronchodilators, asthma inhalers, and pills like Singulair and Accolate. Prednisone for asthma may be given several days to treat severe asthma attack symptoms. When all of the traditional therapies for allergic asthma are not enough, Xolair, an injectable medication that reduces IgE levels, may help.
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