Expert advice on identifying and treating allergic asthma

Individuals who develop sneezing, wheezing and shortness of breath all at once may have allergic asthma, which can impact on their quality of life, but there are many ways to manage the condition, says an expert from global health system Cleveland Clinic ahead of World Asthma Day today, May 2, 2023.

While tests and definitions vary, bodies such as the World Health Organization have estimated that more than 260 million people worldwide have asthma.

Allergic asthma is the most common type of asthma and is triggered by environmental factors, says Cleveland Clinic allergist and immunologist Ronald Purcell, MD.

“When your allergies combine with asthma, it’s known as allergic asthma. This causes your airways to tighten whenever you breathe in an allergen. While many different allergens can trigger allergic asthma, they all have one thing in common: They’re in the environment, not in your food or your medication,” says Dr. Purcell.

Environmental allergies can include pet dander (dead skin cells), dust mites, cockroaches, mold and pollen. “If pollen or mold trigger the condition, it may occur only seasonally. If your pets or the dust mites on your bedding trigger it, you may have symptoms year-round,” Dr. Purcell notes.

With allergic asthma, a person will most likely have both allergic rhinitis and lung symptoms at the same time, says Dr. Purcell. “Allergic rhinitis, or hay fever, affects the nose and sinuses and may cause symptoms including sneezing, congestion, itchy nose and eyes. Asthma, on the other hand, mainly affects the lungs and may cause symptoms including coughing, wheezing, chest tightness, shortness of breath or rapid breathing.”

In children, the symptoms of allergic asthma can be more subtle, notes Dr. Purcell. “They might say they’re too tired to play, but parents should check for wheezing or coughing. If the other kids are running around playing, and your child wants to sit on the sidelines, they may be having trouble breathing,” he says.

Testing and treatment

Allergy testing can help identify what is triggering allergies, and additional testing can help to confirm a diagnosis of asthma, says Dr. Purcell.

Once allergic asthma has been diagnosed, identifying and avoiding its triggers will help to control the symptoms.

To reduce allergens in the home, Dr. Purcell recommends:

• Using a high-efficiency particulate air (HEPA) filter to reduce airborne triggers.
• Minimizing or eliminating pet exposure if necessary.
• Using special dust mite covers on bedding and aiming for indoor humidity levels of 35% to minimize dust mite exposure.
• Eliminating food sources for cockroaches by using sealed food containers and regularly cleaning kitchen floors and surfaces.
• Changing clothes and showering once indoors if the individual is allergic to pollen, and closing doors and windows when pollen counts are high.
• Checking for and eliminating mold, which can develop indoors if there is an unwanted source of moisture such as leaky plumbing.

The good news, says Dr. Purcell, is that today’s allergic asthma treatments — mainly medication and inhalers — are very effective. “They’re relatively easy to use and have minimal side effects,” he says.

“In cases where there are severe symptoms that don’t respond to medication or where triggers cannot be avoided, a course of allergy shots (allergen immunotherapy) is very effective,” he adds. “These shots help build immunity against allergens such as cat and dog dander, dust mites, mold spores and pollen from trees, grasses or weeds. The shots can relieve allergic asthma, rhinitis and  conjunctivitis.”

While allergy shots are generally suitable for adults and children over the age of five, they aren’t for everyone. “People with severe heart disease, or who need to take medications such as beta blockers, aren’t good candidates, for example,” Dr. Purcell cautions.

“One option that shouldn’t be on the table is letting allergic asthma ruin your quality of life,” Dr. Purcell concludes. “The goal is to manage your condition so that it never limits the activities you love because they trigger an allergic reaction. Working with your doctor will help you find a treatment plan that’s right for you.”