Allergic Asthma

Background

Asthma is a chronic disease that affects over 20 million Americans. This disease is characterized by wheezing, chest tightness, shortness of breath, and coughing at night or early morning. This is caused by the inflammation and narrowing of the airways in the lungs. Asthma often presents in childhood but can also present and be diagnosed in adulthood. The majority of patients that have asthma also have allergies, and if allergens trigger asthma, then the disease is often referred to as extrinsic or allergic asthma; this is the more common form of asthma.

The symptoms of allergic asthma range from mild and needing no or minimal treatments, to severe which may require visits to the emergency room or possibly be fatal. However, when a patient works with their nurse, doctor, and pharmacist on a plan to control asthma symptoms and attacks, a patient can often have very few attacks and lead active, healthy lives. An asthma control plan usually includes avoidance of allergens, long and short acting medications, and having a plan in place if an attack occurs.

Causes

Allergic asthma typically occurs because of a combination of genetics and triggers that can lead to an allergic asthma attack. It is thought that general sensitivity to allergens and asthma can be passed down through families so if an immediate family member has allergic asthma, a patient may also be more likely to have the disease.

Common allergens that can cause an attack include mold, dust mites, cockroaches, and pet dander. The reason these triggers cause such a profound response in some patients can be linked to a substance, IgE, produced by the body's immune system. Immunoglobulin IgE is an antibody that is made when the body detects allergens. In patients with allergic asthma, the body becomes overly sensitive to certain triggers and the body produces excess IgE. The high levels of IgE can lead to inflammation in the airways which causes an asthma attack.

Symptoms

In response to an allergen, IgE causes inflammation in the airways to the lungs, which in turn causes the symptoms of allergic asthma. The symptoms of allergic asthma can include:

  • Coughing (most likely a dry cough)
  • Wheezing
  • Shortness of breath/rapid breathing
  • Tightness of the chest
  • Increased production of mucous

A patient that has allergic asthma may describe their symptoms as feeling like a chest cold. However, with allergic asthma, the chest cold does not go away after a few days and typically lasts for over ten days.

Diagnosis

When a patient sees a healthcare provider for asthma symptoms, it is crucial to discuss all of the asthma symptoms that he or she is experiencing in order to get an accurate diagnosis. A patient can expect the provider to ask about medical and family history, particularly if anyone else in your family has allergies or asthma. It is also important for a patient to know when their symptoms occur in order to figure out what is triggering the asthma. This information may include the months or time of day symptoms worsen, or a certain place or activity that triggers an attack, knowing this type of information will assist in a diagnosis and treatment plan.

The healthcare provider will also perform tests on a patient which typically include listening to a patient's lungs, looking for any other signs of allergies and a lung function test. If the healthcare provider suspects allergens as the cause for asthma they may refer a patient to an allergist or pulmonologist for further testing. Testing at an allergist or pulmonologist may include allergy testing to find out what specific allergens a patient is sensitive to and a skin or blood test to check a patient's IgE level.

Treatment

Specialty drug list

The goals of treating asthma are to maintain lungs that function well, provide patients the ability to participate in physical and day-to-day activities, to sleep without shortness of breath or coughing, prevent asthma attacks, lower missed school or work days and trips to the hospital, and to decrease usage of rescue inhalers. To help patients achieve treatment goals, it is important for a patient to work with healthcare providers to come up with a treatment plan that works best for the patient and to follow the treatment plan accordingly. It is advised to avoid all known allergens or triggers as much as possible. Uncontrolled asthma can slow a child's growth and can cause permanent lung damage in any patient from long-term inflammation in the lungs. Treatment may include:

Long acting therapies

  • Anti-inflammatory medications that help to control swelling in airways. Examples of these medications include:

    • Inhaled or oral corticosteroids
    • Oral leukotriene modifiers
    • Inhaled cromolyn
  • Bronchodilators that help to open airways. Examples of these medications include:

    • Inhaled beta2-agonists
    • Inhaled beta2-agonist and corticosteroid combination
    • Oral theophylline
  • Anti-IgE- injections to stop IgE from being produced
  • Sublingual immunotherapy which can help the body tolerate allergen
  • Allergy shots that can help the body tolerate allergen

Fast Acting Therapies

  • Inhaled beta2-agonists that help open airways quickly but does not reduce inflammation

Side Effects

Side effects of these treatments can include:

Inhaled corticosteroids
oral thrush, tremor/shakiness, nervousness, upper respiratory tract infections, fast heart rate, headache, dizziness, throat or nasal irritation, nausea and vomiting, change , muscle cramps
Oral corticosteroids
headache, nervousness/anxiety, fluid retention, weight gain, increased blood pressure, increased blood sugar, nausea/vomiting, if used long-term raises risk of cataracts and osteoporosis
Oral leukotriene modifier
nightmares, headache, nausea, dizziness, drowsiness
Inhaled cromolyn
cough, change/bad taste, nausea, nose bleed
Inhaled beta2-agonists
headache, cough, change in taste, nose/throat irritation, nervousness
Anti-IgE
chance of anaphylaxis at injection, headache, nausea, injection site reactions
Sublingual immunotherapy
throat/mouth irritation or pain, upset stomach
Allergy shots
chance of anaphylaxis, injection site reactions, allergy symptoms

Resources

There are many resources and organizations available to patients that provide support, advocacy and information:

Asthma and Allergy Foundation of America

American Academy of Allergy Asthma & Immunology

References

Asthma and Allergy Foundation of America Accessed September 2015.

American Academy of Allergy Asthma & Immunology Accessed September 2015.

National Institutes of Health, National Heart, Lung, and Blood Institute Accessed September 2015.

Xolair website Accessed September 2015.

National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, Summary Report 2007

Clinical Pharmacology Accessed September 2015.