Connecting the dots: Asthma and allergies

By Payel Gupta, MD, FACAAI | Fact-checked by Barbara Bekiesz

Published June 22, 2023

Key Takeaways

Allergic asthma, the most prevalent form, typically emerges in childhood and often coexists with conditions such as atopic dermatitis and allergic rhinitis.
Symptoms vary from patient to patient, but allergic asthma is usually triggered by common allergens such as pollen and pet dander.
Doctors can effectively address the needs of patients with allergic asthma by understanding the mechanisms of the allergic response in asthma, employing accurate diagnostic tools, and implementing comprehensive treatment strategies.

Asthma and allergies are prevalent medical conditions that significantly impact the lives of patients. It’s crucial doctors have a comprehensive understanding of the connection between asthma and allergies for accurate diagnosis, effective treatment, and optimal management.

Allergic asthma, the most prevalent form of asthma, is triggered by exposure to common allergens, including pollen, dust mites, pet dander, and mold spores. It typically emerges in childhood and often coexists with conditions such as atopic dermatitis and allergic rhinitis.^[] The persistence and severity of allergic asthma can vary significantly from patient to patient.

Mechanisms of the allergic response in asthma

In allergic asthma, the immune system overreacts to specific allergens, triggering the release of chemicals, such as histamine, which cause inflammation, bronchoconstriction, mucus production, and other asthma symptoms in the airways.^[] This condition is primarily driven by TH2 mechanisms, with biomarkers such as serum IgE levels and aeroallergen sensitization tests (eg, specific IgE or skin prick tests).

Typical asthma symptoms include wheezing, breathlessness, chest tightness, and coughing.

Understanding these mechanisms is vital for identifying the underlying cause of asthma symptoms and developing appropriate treatment strategies.

Diagnostic considerations

Accurate diagnosis is essential for effective management of asthma and allergies. When evaluating patients, doctors should obtain a detailed medical history, paying particular attention to the presence of other allergic conditions, such as eczema and allergic rhinitis, which often coexist.

The diagnostic tools listed above can help identify specific allergens responsible for allergic reactions. Determining the allergens that a patient is most sensitive to allows for personalized treatment plans that include allergen avoidance strategies and immunotherapy options.^[]

Treatment approaches

Managing allergic asthma requires a comprehensive treatment approach that addresses both asthma control and allergy management.

The following strategies are crucial for optimal patient care:

Allergen avoidance

Reducing exposure to dust mites
Maintaining clean indoor spaces
Regularly changing mattress and pillow covers
Avoiding exposure to pet dander or pollen during peak seasons.

Recognizing triggers

Educating patients about common allergens and their impact on asthma symptoms
Encouraging patients to keep a symptom diary to identify potential triggers.^[]

Asthma control

Physicians can review updated recommendations for asthma management issued by the Global Initiative for Asthma (GINA).^[]
Asthma medications, including inhaled corticosteroids, long-acting beta-agonists, leukotriene modifiers, and biologic medications can be used to control airway inflammation and bronchoconstriction.
Quick-relief medications, such as bronchodilators or SMART therapy, provide immediate relief during asthma attacks.
Oral steroids should ideally only be used during acute flares.
An assessment for the addition of other controller medications should be assessed promptly with the help of a specialist (eg, an allergist or pulmonologist).
For patients with moderate to severe asthma who are not responding to inhalers and leukotriene modifiers, biologics should be considered.
Developing an individualized asthma action plan is essential for patients to understand and manage their condition effectively.

Immunotherapy

Allergen-specific immunotherapy, such as allergy shots or sublingual immunotherapy, may be recommended for individuals with significant allergen sensitivities.
Immunotherapy helps desensitize the immune system to allergens over time, leading to long-term reduction of asthma symptoms and allergic reactions.^[]^[]

Patient education and management

Using shared decision-making and providing patients with comprehensive education about their condition and treatment options is crucial for successful management of allergic asthma.

Physicians can emphasize the importance of regular medication use to their patients in order to control inflammation and prevent asthma symptoms. Potential side effects can also be discussed, along with addressing any medication-related concerns or misconceptions.^[]

GINA emphasizes the importance of clear communication with patients about managing their asthma. They suggest developing an individualized asthma action plan that outlines steps to manage worsening symptoms or asthma attacks. Patients should be counseled on when to seek medical help, and decisions to adjust their medication regimen should be clearly outlined.

What this means for you

Allergic asthma requires a tailored approach to treatment and management. Patient education and self-management play a vital role in empowering individuals to manage their condition and improve their overall quality of life. Through continued research and an evidence-based approach, medical professionals can further enhance their understanding of the connection between asthma and allergies, leading to improved outcomes for patients worldwide.