What Is Allergic Asthma, the Most Common Type of Asthma?
Pollen, mold, and other common allergens could be triggering your wheezing and shortness of breath. Here's what to do about it.
“The majority of people have allergies as triggers, 60 to 80%” says Alan Mensch, MD, a pulmonologist and senior vice president of medical affairs at Plainview and Syosset Hospitals in Long Island, New York. (Other triggers include stress, cold weather, exercise, and cigarette smoke, which is considered more an irritant than an allergy. Many people have more than one type of asthma.)
The airways of people with allergic asthma are hypersensitive to certain allergens, like pollen or mold. Coming into contact with one or more of these allergens sets off an immune response; the body overreacts, releasing chemicals that cause the muscles around the airway to tighten. This results in all the symptoms of allergic asthma (which are the same as other types of asthma): trouble breathing and shortness of breath, tightness in your chest, and coughing and wheezing.
In addition to pollen and mold, allergic asthma can also be triggered by pet dander and saliva; cockroaches (especially in cities); and dust mites (found in pillows, bedcovers, mattresses, carpets, upholstered furniture, clothes, and stuffed toys).
Tobacco, air pollution, cold air, fragrances, and chemicals can also trigger asthma, but they are considered irritants, not allergens, because they usually don’t set off the immune response that is characteristic of allergic asthma.
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Allergic asthma treatment
The first step in treating or managing allergic asthma is identifying what your triggers are.
“Patients often have an idea of their triggers, then we can do skin tests or allergy evaluations to see if they are sensitive to known allergens,” says Sara May, MD, assistant professor of allergy, asthma, and immunology at the University of Nebraska Medical Center in Omaha. “Some blood work also helps us to know if it’s more of an allergy-type asthma.”
Allergy shots (also called immunotherapy) can greatly reduce the symptoms and severity of asthma over time and, in some cases, even prevent asthma from developing in people who already have hay fever or other allergies, says Dr. May. The shots, which usually are given over three to five years, deliver small amounts of your particular allergens so that you can build up immunity.
You’ll also want to avoid triggers as much as possible. “If you have pets, remove them for sure out of your bedroom,” says Dr. May. If you have dust mite allergies, make sure dust doesn’t build up in your home, reduce the number of things that dust mites like to burrow into (like carpeting and stuffed animals), and get allergen-proof coverings for pillows and mattresses.
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Medication for allergic asthma is usually based on how frequent and severe the symptoms are.
For people with episodes once or twice a week that have never required emergency treatment, doctors might start with a short-acting beta agonist. (Albuterol is the generic name for many brands.) These inhaled medications should open the airways and clear up symptoms in five to 10 minutes. Drugs called anticholinergics can also help and take effect relatively quickly.
More severe cases of allergic asthma may require long-term medications that are taken every day, even if you’re not having symptoms. Montelukast (sold under the brand name Singulair) is a type of drug known as a leukotriene modifier. It actually blocks the body’s allergy response, so it treats both allergy and asthma symptoms. Omalizumab (Xolair) is an anti-immunoglobulin E (IgE) therapy that also blocks the body’s immune response. Many people with allergic asthma also benefit from over-the-counter antihistamines like Zyrtec or Allegra.
Inhaled corticosteroids can be a game changer for people with more severe allergic asthma. “Inhaled steroids have really revolutionized treatment,” says Dr. Mensch. Some inhalers contain both steroids and long-acting beta agonists.
Thanks to new drugs and procedures, most asthma cases can be controlled, Dr. May says–as long as people adhere to their medication plans.
“The biggest problem is that when patients start to feel better once they’re on their medications, [taking the medication] slips their mind,” says Dr. May. “When they’re not adhering to their medications, symptoms flare again.”
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