What you need to know about asthma and allergies

National asthma and allergy awareness month

In this month’s UIC Pharmacy blog, you can find information asthma and allergies, their impact on health, and important steps you can take to prevent or reduce the symptoms of allergies and their effect on asthma control.

How many people are affected by asthma and allergies?

According to the 2007 World Health Organization Global Surveillance, Prevention, and Control of Chronic Respiratory Diseases report, over 70% of people with asthma have allergies. The Asthma and Allergy Foundation of America states that nearly 60 million people have asthma, allergies, or both, which is more than  the number of people with diabetes, heart disease, and cancer combined. 

What is asthma?

Asthma is a chronic respiratory disease characterized by narrowing and inflammation of the small airways in the lungs.  Several factors can play an active role in the development of asthma such as a genetic predisposition (family history), socioeconomic status, family size, exposure to secondhand smoke, allergen exposure, viral respiratory infections, and limited exposure to common childhood infections.

What are the common signs and symptoms associated with asthma?

When the airways become inflamed, they become hyperresponsive (an over reaction to small changes). Airflow then is limited, and symptoms can develop.  There are several common asthma-related symptoms, such as coughing, wheezing, shortness of breath, chest tightness, and difficulty breathing (typically upon awakening in the morning or at night).

What medications are used in the treatment of asthma?

There are a number of medications used for asthma to relieve or control the symptoms of the disorder.  All of the medications used to treat asthma require a prescription from your doctor.

Inhaled short-acting bronchodilators

This type of medication is often called a “rescue inhaler” and is for short-term use only during acute asthma attacks.  It helps open up the airways in the lungs to improve breathing and relieve symptoms.  Since short-acting bronchodilators are inhaled through the mouth, proper technique when using an inhaler is important for the medication to work properly.  The inhaler needs to be shaken well before any use and primed when a new inhaler is used or if it has not been used for a long time. Most inhalers require proper timing between actuation of the device (pushing down on the inhaler to release the medication) and inhalation of the medication.  A spacer device (a tube attached to inhaler mouthpiece) is sometimes used for individuals who have difficulty using the inhaler.  Talk to your pharmacist for instruction on the proper technique for using an inhaler or if you think you could benefit from using a spacer device.

Inhaled corticosteroids

This type of medication is classified as a “chronic control inhaler” for long-term use in controlling asthma.  It is not meant to help relieve symptoms in the short-term or during an acute asthma attack.  Rather, inhaled corticosteroids are used to help reduce inflammation in the airways, improve lung function, and decrease symptoms over time.  When using this medication, it is important to rinse out your mouth after each use to prevent the development of an infection in the mouth. 

Inhaled long-acting bronchodilators

This long-term asthma controller medication helps to decrease the dose of inhaled corticosteroids needed to maintain adequate asthma control.  This medication should be used in asthma only when taking an inhaled corticosteroid.  Although the long-acting bronchodilators work to keep the airways of the lungs open, they are not used for relief of acute asthma attacks because they have a slow onset of action.   

Leukotriene modifiers

These medications are useful in patients with asthma, allergies, or both and have been shown to be effective in long-term asthma control when used along with inhaled corticosteroids.  The leukotriene modifiers work by blocking the action of chemicals in the body that cause inflammation seen with asthma, preventing symptoms from occurring. It is especially useful for asthmatic patients who also have indoor/outdoor allergies or who have exercise-induced asthma. 

What are allergies?

Having an allergy to something means your body is overly sensitive to that substance (referred to as an allergen) and over reacts when exposed to it.  An allergen is a substance that triggers an exaggerated response by your body’s immune system, that can be life-threatening (as with  anaphylaxis) or result in varying degrees of irritation to the eyes, nose, or skin as seen with seasonal and perennial (year round) allergies.  Some factors that can play an active role in the development of allergies are genetic predisposition (family history), exposure to allergens, the presence of other allergic-type conditions (for example, eczema), and exposure to secondhand cigarette smoke. Allergies can be caused by both outdoor and indoor allergens.  Some common seasonal, outdoor allergens include trees, grass, and weed pollen, mold spores, and plants.  Perennial indoor allergens include pet dander, dust mites, and cockroaches.

How does the time of year affect someone with seasonal allergies?

The cross pollination of many species of weeds, grasses, and trees by the wind occurs at different times during the year.  In the United States, pollination of trees occurs from March to May, grasses from June to July, and ragweed from August to October. So, if someone is allergic to tree pollen, for example, his/her allergy symptoms would likely be worse during the spring.  Similarly, someone with ragweed allergies would have a worsening of symptoms during late summer and early fall.  

What are the common signs and symptoms associated with allergies?

Runny and itchy nose, sneezing, watery and itchy eyes, itchy ears, nasal congestion, itchy skin, and rash are all common symptoms seen with allergies.  In addition, some patients can have postnasal drip, which can lead to a chronic cough.  Patients who also have asthma in addition to allergies may experience a loss of asthma control and a worsening of  symptoms as well.

What steps can I take to limit my exposure to indoor allergens?

Preventing direct exposure to allergens is the single best way to control allergies.  This means completely avoiding areas where allergens are present.  So, if your boyfriend has a cat, for example, and you are allergic to cats, try to find a new boyfriend.  If this is not possible, the next best thing is to limit the amount of exposure to the allergen.  This can be done by encouraging the use of proper hygiene and care regarding allergen exposure, particularly in the house.  Proper hygiene involves prohibiting or reducing allergens present in the area where you spend the most time.  If your family has a dog and you are allergic, close your bedroom door everyday, and do not let the dog come inside.  Pet dander can penetrate carpet and upholstery, and preventing this is crucial in limiting exposure for those with allergies.  This habit will establish an allergen-free zone and provide at least one barrier to help keep allergies in check.  Other methods to reduce indoor allergen exposure include use of mattress and pillowcase covers, weekly washing of bed linens, and the use of a high-efficiency particulate air (HEPA) filter. 

What steps can I take to limit my exposure to outdoor allergens?

Unfortunately, unless you live in a bubble, there is no effective, comprehensive strategy to avoid outdoor allergens.  After being exposed to outdoor allergens for an extended period, it is best to change clothes, wash them in hot water, and take a shower once you reenter your home.  This will reduce the likelihood of continued exposure to outdoor allergens once you come back indoors.

What can I do if I cannot limit my exposure to allergens?

Another way to reduce the impact of allergen exposure is to be proactive with medication.  Most of the medications used to prevent and treat allergies are now available over-the-counter (OTC), with the exception of topical nasal steroids, leukotriene modifiers, and allergy shots.  Certain decongestants, such as pseudoephedrine-containing products, are available behind the pharmacy counter for purchase by adults with proper identification.

Antihistamines

This class of medication is useful for relieving allergy-related symptoms. It stops the action of histamine in the body, which is responsible for producing many of the common symptoms of an allergy.  Oral antihistamines are useful when you are experiencing multiple allergy-related symptoms.  These can be taken as needed or on a regular basis depending on allergen exposure.  Antihistamines can sometimes cause a “drying” effect, which can lead to dry eyes, nose, and mouth, urinary retention, and constipation.  In addition, antihistamines can cause drowsiness, perhaps the most bothersome effect, and selecting a different antihistamine may decrease this side effect.  Depending on your situation with allergies, drowsiness could be a positive (trying to sleep) or a negative (trying to be productive at work or school). Topical antihistamines (nasal sprays or eye drops) are useful when experiencing nose or eye symptoms alone.  Topical antihistamines can allow for direct application of the medication for quick relief, while sparing the rest of the body from unwanted side effects.

Decongestants

This class of medications is useful for relieving nasal congestion.  Decongestants cause blood vessels in the nasal passage to narrow, alleviate pressure, open up the nasal cavity, and improve breathing.  Oral decongestants can have an alerting, caffeine-like effect, which may keep you awake.  Again, depending on your allergy symptoms, this could be a positive (trying to be productive at work) or a negative (trying to sleep).  Topical decongestants can offer similar nasal congestion relief and reduce unwanted side effects.  However, topical decongestants should only be used for a few days because long-term use can cause rebound congestion that may last for several days or weeks.

Topical nasal corticosteroids

This class of medication is useful in patients with perennial allergy symptoms.  Like inhaled corticosteroids for asthma, the action of nasal corticosteroids is preventative.  These medications offer nasal congestion relief, with only minor side effects.  However, unlike antihistamines and decongestants, these medications take some time to work, and will not provide immediate relief. 

Leukotriene modifiers

As described above, this class of medication is particularly useful in patients with both allergies and asthma.  When used by themselves, leukotriene modifiers have been shown to be effective in patients with perennial allergies and mild persistent asthma. 

Allergy shots

These immunotherapy agents are given to patients to increase their tolerance for a particular allergen over time.  By gradually escalating the dose of allergen in each shot, patients build up a tolerance and increase the amount of exposure he/she can handle.  This is commonly the last option in patients who do not want to get rid of pets, or have tried everything else and failed to achieve symptom relief.  Allergy shots are expensive, have potential risks, and are invasive.  Make an appointment with an allergist or your doctor if you want to learn more information about allergy shots.

How can allergies affect my asthma control?

Allergies are one of the major precipitating factors that can worsen asthma control.  Through proper prevention and treatment of allergies, there is a greater chance of maintaining or improving asthma control.  Adequate allergy control is crucial for the prevention of asthma exacerbation (a sudden worsening of symptoms) and loss of symptom control

What should I do if my allergies begin to affect my asthma?

After limiting exposure to allergens and taking allergy medications, continue to take your long-term asthma controller medications and use your rescue inhaler as needed.  If you find you are using your rescue inhaler more often, you should discuss this with your pharmacist or doctor.  If there is anytime you continue to experience symptoms despite the use of a rescue inhaler, seek immediate medical attention.

What about allergy testing?

The National Asthma Education and Prevention Program (NAEPP) Expert Panel guidelines recommend patients who require daily asthma medications to have allergy testing for airborne-allergens (pollen or spores).  An allergy test can be done via the skin or blood.  The blood test is  expensive and takes longer to get results.  On the other hand, the skin test is cheaper and provides results in 20 to 30 minutes, but is more invasive.  The more common test is the skin test because of the quick turn around of results, allowing allergists to implement a treatment plan or perform further testing all in one visit.  Because of variability in coverage by insurance providers, you should check to see if this test is covered prior to making an appointment.

Where can I find more information?

Several professional organizations have websites that provide information for patients.  And you can always discuss your allergies or asthma with your pharmacist. 

American Academy of Allergy, Asthma, and Immunology (AAAAI): www.aaaai.org.

AAAAI National Allergy Bureau: www.aaaai.org/global/nab-pollen-counts.aspx.  

World Health Organization (WHO): www.who.int/respiratory/en.

Asthma and Allergy Foundation of America (AAFA): www.aafa.org.

Written by: Robert Lucas, PharmD candidate

University of Illinois at Chicago

May 2012