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.
Written by: Robert Lucas, PharmD candidate
University of Illinois at Chicago
May 2012
