What is Allergic Asthma?

Exposure to allergens causes a particular type of asthma called allergic asthma. Allergens are harmless substances that only cause an immune reaction in susceptible people. Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways due to hyperresponsive airways. In allergic asthma, the immune system overreacts to allergens, causing inflammation and symptoms such as wheezing, coughing, shortness of breath, and chest tightness.

If you have allergic asthma, you may also react to other triggers such as exercise, tobacco smoke, and respiratory infections.

Causes and Triggers

Allergic asthma is triggered by exposure to allergens, but susceptibility to allergic asthma is believed to be due to a combination of genetic and environmental factors.¹ Common allergens and triggers that may exacerbate allergic asthma include the following:

Indoor Allergens

Common indoor allergens include:

• Dust mites
• Animal dander: dogs, cats, birds, rodents, etc.
• Mold
• Cockroaches
• Perfumes
• Household cleaners
• Smoke

Outdoor Allergens

Common outdoor allergens include:

• Mold spores
• Tree pollen
• Grass pollen
• Weed pollen

Allergic Asthma Symptoms

Allergic asthma symptoms are similar to other types of asthma. Common symptoms include the following:

• Cough
• Shortness of breath
• Chest tightness
• Wheezing

Asthma symptoms can vary from mild to severe. It is important to recognize and manage these symptoms promptly to reduce the risk of a severe asthma attack.

If you have severe asthma symptoms such as rapid breathing, a racing heart, an inability to catch your breath, a blue tinge to your lips or fingers, or nighttime symptoms, seek emergency care. Follow the instructions provided by your TelegraMD doctor on call regarding the use of rescue medications and when to seek emergency care.

Diagnosing Allergic Asthma

Your doctor can often diagnose allergic asthma based on your signs and symptoms. Many people with allergic asthma have a history of eczema, food allergies, and hay fever before developing allergic asthma symptoms.

Allergy Testing

Your doctor may suggest allergy skin testing to verify that allergens are causing your asthma symptoms. Allergy testing is especially beneficial to the diagnostic process if it is negative for common allergens because this makes it less likely that allergic asthma is the correct diagnosis.

If allergy testing reveals that you are sensitive to allergens such as grass, mold spores, dust mites, or pet dander, your allergist will probably recommend reducing your exposure to these allergens.

Lung function tests

Lung function tests are used to differentiate between obstructive and restrictive lung diseases. Asthma is an obstructive lung disease due to airway inflammation and narrowing.

Your doctor may recommend spirometry and peak expiratory flow (PEF) measurements to measure the amount of air you can forcibly exhale in a specified period of time. They may also do tests that measure lung volumes and capacities to determine how much air you can bring into and out of your lungs under certain conditions.

Finally, your doctor may repeat lung function tests after having you use an inhaler that contains medications that dilate your airways and make it easier to bring air into your lungs.

Allergic Asthma Treatment

Allergic asthma treatment options depend on the severity and persistence of your asthma symptoms. Asthma is commonly classified as intermittent or persistent, mild, moderate, or severe. Talk to your doctor to develop an asthma action plan, so you know when to use a rescue medication and when to seek emergency care.

Controller Medications

Long-term controller medications should keep your airways open so you can minimize the use of your rescue medications. These medications are used regularly, whether or not you have symptoms.

Steroid inhalers reduce inflammation and can prevent asthma exacerbations. Steroid inhalers are a first-line therapy for treating persistent asthma, and daily use has been a recommended asthma treatment for decades. Side effects include hoarseness and oral thrush.

Long-acting beta agonists (LABAs) are bronchodilators that open your airways in the same way that your rescue medications do, but unlike short-acting beta-agonists (SABAs), their effects last 12 hours or more. LABAs are used as a step-up in therapy when steroid inhalers alone are not effective in keeping your asthma symptoms under control.

Combination inhalers contain steroids and a LABA or SABA.

Telemedicine doctors can prescribe controller medications using online prescriptions. This is a fast and convenient way to refill your asthma treatment medications.

Rescue Medications

Rescue medications are short-acting beta-agonists (SABAs) that dilate the airway and are used for quick relief from asthma symptoms. They can also be used preemptively when you know you will be exposed to a known asthma trigger. These rescue medications provide relief when you develop unexpected or unpreventable symptoms.

SABAs can cause a fast heartbeat, irritability, and jitteriness. No more than three treatments at 20-minute intervals are recommended. If you need a SABA rescue inhaler more than two days per week, contact your doctor. Increased use may indicate inadequate asthma control and a need to step up in treatment.

If you find you need to use your rescue inhaler more often than outlined in your asthma action plan, contact your doctor. You may need a change in your controller medications.

A stepwise approach is used to manage asthma. For children aged 12 and older and adults, the following steps are recommended:²

Intermittent asthma:

• Step 1: Use a SABA as needed.

Persistent asthma

• Step 2: Use a daily low-dose inhaled corticosteroid and a SABA as needed, or a combination of an inhaled corticosteroid and a SABA as needed.
• Step 3: Use a daily and as-needed combination of low-dose inhaled corticosteroid and formoterol.
• Step 4: Use a daily and as-needed combination of medium-dose inhaled corticosteroid-formoterol.
• Step 5: Use a daily and as-needed medium-high-dose inhaled corticosteroid-LABA and a long-acting muscarinic antagonist, and a SABA as needed.
• Step 6: Daily high-dose inhaled corticosteroid and LABA with oral systemic corticosteroids and a SABA as needed.

Different agencies and society’s guidelines recommend slightly different treatment protocols. If you require a step up in management, talk to your doctor about all your treatment options.

Allergen Immunotherapy

The NIH conditionally recommends immunotherapy or allergy shots in their Focused Updates to Asthma Management Guidelines for children and adults aged 5 and older with persistent asthma managed using steps 2-4 treatments whose asthma symptoms are controlled.

After identifying your allergens using an allergy test, your allergist may recommend allergy shots. Small amounts of a specific allergen are injected to gradually desensitize your immune system to allergens and reduce your asthma symptoms.  

Managing Allergic Triggers

Depending on your allergy triggers, the following steps to allergy-proof your home may help reduce your allergic asthma symptoms:^2,3

• Cover mattresses and pillows with dust-mite-proof covers
• Remove wall-to-wall or area rugs
• Use vacuum cleaners with HEPA filters
• Consider using a whole-house air filtration or purification system
• Mitigate any mold growth or pest infestations
• Confine pets to specific rooms
• Wash sheets, pillowcases, and blankets in water heated to at least 130 F (54 C) at least once a week
• Reduce clutter and dust regularly
• Maintain humidity levels between 30% and 50% to discourage mold growth
• Repair any leaks to reduce moisture buildup
• Keep windows closed during peak allergy seasons
• Limit indoor plants
• Use blinds instead of curtains
• Leave your shoes and coats in a mudroom
• Take a shower after being outdoors
• Clean air filters regularly
• Avoid smoke exposure
• Limit the use of upholstered furniture
• Regularly clean and groom pets

Lifestyle Tips for Allergic Asthma

To reduce the impact and severity of allergic asthma, maintain an overall healthy lifestyle:

• Follow your treatment plan to minimize asthma flares
• Practice stress-reducing techniques such as deep breathing, meditation, yoga, and mindfulness exercises
• Engage in regular physical activity to maintain or improve cardiovascular fitness and lung function
• Consume a healthy diet rich in antioxidants and foods with anti-inflammatory properties
• Limit alcohol consumption
• Aim for 7 to 9 hours of restful sleep each night
• Stay hydrated to keep mucus and secretions thin
• Avoid tobacco smoke

When to Seek Medical Help

If you have severe asthma symptoms or breathing difficulties, or your rescue inhaler is not helping, seek immediate medical attention.

If you are concerned about your allergy or asthma symptoms and need advice and treatment guidance, but it is not an emergency, contact a doctor on call on the Telegra MD platform. Specialists are available 24 hours a day to provide help when you need it. Doctor visits can be costly. You may find that telehealth provides a cost-effective alternative when seeking routine medical care.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Toskala E, Kennedy DW. Asthma risk factors. Int Forum Allergy Rhinol. 2015 Sep;5 Suppl 1(Suppl 1):S11-6. doi: 10.1002/alr.21557. PMID: 26335830; PMCID: PMC7159773.

2. National Heart, Lung, and Blood Institute. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. NHLBI, NIH. Published December 2020. Accessed August 21, 2023. https://www.nhlbi.nih.gov/resources/2020-focused-updates-asthma-management-guidelines

3. Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, Dawson DE, Dykewicz MS, Hackell JM, Han JK, Ishman SL, Krouse HJ, Malekzadeh S, Mims JW, Omole FS, Reddy WD, Wallace DV, Walsh SA, Warren BE, Wilson MN, Nnacheta LC; Guideline Otolaryngology Development Group. AAO-HNSF. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg. 2015 Feb;152(1 Suppl):S1-43. doi: 10.1177/0194599814561600. PMID: 25644617.