Allergies and Asthma
More than 50 million people in the United States suffer from allergies and/or asthma. Fortunately, there are many effective medications available to treat these conditions. The following information is intended to help asthma and allergy sufferers better understand the most commonly used types of medications. It is not intended as a specific recommendation for your treatment. You should consult your personal physician to choose the best treatment plan for control of your allergies and asthma.
Asthma and Allergy Medications
AntihistaminesIf you have allergies, your physician may prescribe an antihistamine for treatment of allergic rhinitis ("hay fever") and other conditions such as hives. Antihistamines help prevent the effects of histamine-a chemical substance released by the body during an allergic reaction. By preventing the action of histamine the symptoms of the allergy can be reduced. Antihistamines are available in liquid, tablet or nasal spray form.
Antihistamines are divided into:
- "First generation, sedating:" these are known to cause drowsiness in some people
- "Second generation, low-sedating or non-sedating:" these have much less chance of causing drowsiness
- Dry mouth
- Difficulty in urination (especially in men with prostate proble
- In some children: nightmares, unusual jumpiness, restlessness, irritability
Decongestants:Decongestants reduce the nasal congestion and other symptoms associated with allergies. They work by constricting blood vessels, thereby decreasing the amount of fluid that leaks out into the lining of the nose which can cause congestion.
- Available in liquid form, nasal spray and tablets.
- Most of these are available over-the-counter as well as by prescription.
- Very often antihistamines and decongestants are combined so that they may control more symptoms.
- Increased blood pressure or heart rate
- "Rebound rhinitis" can occur with the decongestant nasal spray form if used for more than three or four days in a row. This rebound will cause the nasal congestion to become more severe which may lead to becoming "dependent" upon the use of the medication.
"Controller" medications:The disease process underlying the symptoms of allergies and asthma includes swelling and mucous production in the lining of the nose and airways, caused by inflammation. There are three classes of medications that are used to treat allergies and asthma which can help prevent or reduce inflammation:
- Mast Cell Stabilizers: These are non-steroidal medications that help control inflammation by preventing the release of inflammatory chemicals. They include cromolyn and nedocromil and are available in various forms to treat allergic disease including rhinitis and asthma. Some of these medications are available "over the counter" for treatment of nasal allergies.
- Corticosteroids: These are anti-inflammatory medications. When taken properly, they are very effective for treatment of asthma and allergies. These medications are very different from the anabolic steroids that are misused by some athletes.
- Corticosteroids are available in topical creams or ointments, nasal sprays, inhalers, pills and by injection.
- Corticosteroid use needs to be supervised by a physician.
- May be required to control severe asthma not stabilized by other medications.
- Oral corticosteroids are usually considered as short-term medications for asthma flare-ups, marked nasal congestion, and at times for skin conditions such as poison ivy.
- Side effects of short-term use may include weight gain, increased appetite, menstrual irregularities, muscle cramps, heartburn or irritation of the stomach lining. These side effects should go away shortly after stopping the corticosteroids.
- Long-term use (months to years) of oral corticosteroids may be associated with ulcers, weight gain, cataracts, decreased density of the bones, thinner skin and easy bruising, high blood pressure, elevated blood sugar, and potential decreased growth in children.
- Minor side effects from using corticosteroid inhalers can include hoarseness and thrush (a fungal infection of the mouth and throat). Both are less likely if you gargle with water after use.
- Long-term use of inhaled corticosteroids in children could potentially result in transiently reduced growth velocity; however this tends to be minimal (approximately half an inch in the first year of use, generally without ongoing effect). In most cases the benefit of having the asthma controlled is far greater than the potential for any significant side effects.
Anti-Leukotrienes: Many of the cells involved in causing airway inflammation are known to produce potent chemicals within the body called leukotrienes (lu-ko-try-eens). Leukotrienes are responsible for increasing inflammation causing contraction of the airway muscle and swelling of the lining of the airways.
- These drugs are primarily used to help gain control in patients with mild persistent asthma and in combination with inhaled corticosteroids in more moderate to severe disease.
- One is also approved to treat allergic rhinitis (montelukast).
BronchodilatorsThe smooth muscle surrounding the airways can be constricted in people with asthma resulting in difficulty breathing. These medications relax this smooth muscle, helping to improve the air flow and relieve the tight breathing. There are several classes of bronchodilators available to treat asthma.Beta-agonist bronchodilators relax the smooth muscle surrounding the bronchial tubes.
- Short-acting beta-agonist bronchodilators are use d as quick-relief medications. These are available as inhalations, liquids, injectables and pills. (Albuterol and levalbuterol are two examples.) These agents usually take effect with minutes and last for up to 4-6 hours.
- Long-acting beta-agonists bronchodilators (salmeterol and formoterol) are use d for long-term control of asthma. The effect of these medications may last for up to 12 hours.
- Side effects of this class include nervousness, i/ncreased heart rate , restlessness, and insomnia, and rarely headaches.
- The FDA has issued a Public Health Advisory for the long-acting beta agonists that these agents may increase risk of severe, potentially life-threatening asthma flares in some patients. You should not change your medications without consulting your physician. Ask your doctor about the potential benefits and risks of these agents for control of your asthm
Theophylline has been used for over 30 years to treat asthma.
- These are available as tablets, capsules or intravenously.
- Blood levels should be monitored.
- Side effects can include headaches, elevated heart rate, stomach upset. Severe toxicity at higher than therapeutic blood levels can include seizures.
Anticholinergic agentsare available in inhaled form.These can be used alone or combined with the beta-agonist bronchodilators.
- Ipratropium may be used for asthma treatment, although its official use is for chronic obstructive pulmonary disease (COPD).
- Cough and headache can be side effects.
Omalizumab was approved in 2003 as a new class of therapy, known as "anti-IgE," for patients with moderate to severe persistent allergic asthma. It is currently approved only for use in treatment of asthma. IgE, an antibody that we all produce, is responsible for causing symptoms of allergic diseases, including allergic rhinitis ("hay fever") and asthma in some people. Anti-IgE may reduce allergic reactions by binding free IgE so that the bound IgE cannot produce the allergic reaction.
Use of this medication should currently be limited to those patients with moderate to severe persistent allergic asthma who:
1) are inadequately controlled with appropriate combination therapy;
2) have complications due to inhaled or oral steroid use;
3) have increased urgent care, emergency department or inpatient service needs due to severe asthma exacerbations;
4) have significant problems with activities of daily living; or 5) do not tolerate other medications usually prescribed to treat asthma. Omalizumab needs to be administered every two to four weeks by injection based on body weight and total serum IgE levels.
When to see an Allergy/Asthma Specialist
The AAAAI's How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist.Patients should see an allergist/immunologist if they:
- Are not using medications as prescribed, and this is limiting their ability to control their asthma.
- Have potentially fatal asthma, meaning a prior severe, life threatening episode that included intubation.
- Have persistent asthma, particularly moderate-severe or uncontrolled persistent asthma.
- Need for daily asthma reliever medications.
- Would like to try to minimize their need for medications.
Your allergist/immunologist can provide you with more information on asthma and allergy medications and overall measures to help control these diseases. They can prescribe medications that are the most effective for your specific condition. If you have side effects from any medications, be sure to contact your physician.
Tips to Remember are created by the Public Education Committee of the American Academy of Allergy, Asthma and Immunology. These tips are for informational purposes only. It is not intended to replace evaluation by a physician. If you have questions or medical concerns, please contact us.
Allergic disease affects one out of six Americans, and costs millions of dollars in medications, physician services and missed days from school and work. Following are some common questions and answers on allergy. If you have any other questions not addressed here or if you need additional information about a related topic, please visit the Academy’s Web site, for information, and consult an allergist.
FAQs on Allergies
What is an allergy?
An allergy is an abnormal reaction to an ordinarily harmless substance called an allergen. When an allergen, such as pollen, is absorbed into the body of an allergic person, that person’s immune system views the allergen as an invader and a chain reaction is initiated. White blood cells of the immune system produce IgE antibodies. These antibodies attach themselves to special cells called mast cells, causing a release of potent chemicals such as histamine. These chemicals cause symptoms such as a runny nose, watery eyes, itching and sneezing.
What are some common allergens?
People can be allergic to one or several allergens. The most common include pollens, molds, dust mites, animal dander (dead skin flakes from animals with fur); foods; medications; cockroach droppings and insect stings.
Is there only one type of allergic reaction?
Allergic individuals can exhibit a variety of reactions depending on the allergen and the way it was absorbed into the body.
- Seasonal allergic rhinitis sometimes called "hay fever" is caused by an allergy to the pollen of trees, grasses, weeds or mold spores. Depending on what you are allergic to, the section of the country and the pollination periods, seasonal allergic rhinitis may occur in the spring, summer or fall and may last until the first frost. The sufferer has spells of sneezing, itching and watery eyes, runny nose, burning palate and throat. Seasonal allergies also can trigger asthma.
- Allergic rhinitis is a general term used to apply to anyone who has symptoms of nasal congestion, sneezing and a runny nose due to allergies. This may be a seasonal problem as with hay fever, or it may be a year-round problem caused by indoor allergens such as dust mite droppings, animal dander, cockroach droppings or indoor molds/mildew. Frequently, this problem is complicated by sinusitis. Patients with constant nasal symptoms should consult their allergist.
- Eczema or atopic dermatitis is a non-contagious, itchy rash that often occurs on the hands, arms, legs and neck, although it can cover the entire body. This condition is frequently associated with allergies, and substances to which a person is sensitive may aggravate it.
- Contact dermatitis is a reaction affecting areas of the skin which become red, itchy and inflamed after contact with allergens or irritants such as plants, cosmetics, medications, metals and chemicals.
- Urticaria or hives are red, itchy, swollen areas of the skin that can vary in size and appear anywhere on the body. Approximately 25% of the U.S. population will experience an episode of hives at least once in their lives. Most common are acute cases of hives, where the cause is readily identifiable as a reaction to a viral infection, medication, food or latex. Some people have chronic hives that occur almost daily for months to years, with no identifiable trigger. Angioedema is a swelling of the deeper layers of the skin. It is not red or itchy, and most often occurs in soft tissue, such as the eyelids or mouth. Hives and angioedema may appear together or separately on the body.
What kind of doctor is an allergist?
An allergist/clinical immunologist is a Pediatrician or Internist who has undergone 2-3 years of special training in the diagnosis and treatment of allergic and immunologic diseases. To understand what you are allergic to, an allergist will take a personalized patient history, including a thorough record of the illness, family history, and home and work (school) environments; perform allergy testing, and possibly perform other laboratory tests. An allergist can create a management plan with you for better control of your environment. Your plan may also include proper medication and perhaps immunotherapy.
What is Immunotherapy?
Immunotherapy, or "allergy shots", is recommended for patients with moderate to severe allergy symptoms throughout most of the year, who do not respond adequately to medications, and whose symptoms are triggered by an allergen that is not easily avoided, such as pollens or house dust mites. Immunotherapy involves the injection of allergenic extracts (tiny amounts of allergens) that are given over a period of 3-5 years. By gradually increasing the amount of extract, tolerance to the offending allergen will increase, and the patient’s symptoms will be relieved.
Currently, immunotherapy is used to treat patients who are sensitive to inhaled allergens—pollens, molds, dander and house dust. Studies have also found immunotherapy to be extremely effective in many cases of stinging insect allergy as well. Immunotherapy for food allergies is not recommended because of the chance of a severe allergic reaction to the injection.
Will moving help my allergies?
People with allergies have an inherited, genetic tendency to produce IgE, the allergic antibody, to many different substances such as seasonal allergens, (trees, grasses, weeds) or year-round allergens (dust mites, pet dander). When a person with allergies moves to another location, exposure to different allergens in the new location will likely result in a new set of allergy triggers, thereby trading one set of symptoms for another. In some cases, the benefits of a change in location may outweigh the negative aspects.
- Before making a move to "get away from your allergies" consult with your allergist. Also, when contemplating a move, if possible, check out the new environment by visiting there for two to four weeks (or more) to see if your symptoms improve. Keep in mind it may take months or years to become allergic to a new allergen i.e., tree, grass or weed species.
- Seasonal allergy sufferers may be able to find temporary relief by taking a vacation during the height of the pollen season to a more pollen-free environment such as near large bodies of water.
Is it dangerous do to nothing about an allergy?
In some cases, it is dangerous to ignore allergy symptoms. Severe and untreated hay fever may lead to asthma, sinusitis, and other serious conditions. Allergic dermatitis or eczema can spread to secondary infections if they are not treated properly, and untreated asthma can lead to chronic symptoms. Early detection and treatment of all allergic diseases is important.
Can I ever be cured of my allergy?
The tendency to have allergies is genetically inherited. Thus, instead of a cure, patients should work with their allergist to keep their allergies under control. Successful treatment of allergies includes early detection, proper usage of medications and simple allergen avoidance techniques.
FAQs on Pollen
Can you recommend any medications for my allergies?
The National Allergy Bureau™ does not offer medical advice. Please consult your allergist to discuss proper treatment of your allergy symptoms.
How do you acquire pollen counts?
The American Academy of Allergy, Asthma and Immunology has a network of pollen counters across the United States. Each counter works under the direction of an AAAAI member and must first pass a certification course provided through the AAAAI. Counters use air sampling equipment to capture air-borne pollens. The number of pollen grains collected are then counted and logged.
When do pollen counting stations reopen for the spring?
Pollen counting stations usually begin reporting in March and April, when pollen levels increase to measurable amounts. The opening date of each station differs slightly from year to year based on local weather conditions. Counting stations in warmer climates generally stay open year round.
Why isn't a certain station counting?
There are numerous reasons why pollen counting stations don't count, including technical difficulties with the pollen counting equipment; illness; temporary lack of staff; time away from the office or the station has closed for the season because pollens have diminished to virtually nonexistent levels.
Why is there a disparity between two counting stations in the same city?
There are a number of reasons that could explain the difference, including the time of day that the sample was taken; a change in temperature, wind conditions, humidity or precipitation; or differences in surrounding geography.
- The time of day that aeroallergens are sampled can account for variances in the amount of pollen measured. Pollen concentrations are usually highest (between 5 a.m. and 10 a.m) after the dew dries after sunrise to late morning. If one station samples at 8 a.m. and the other station samples at 2 p.m., there could be a significant difference in pollen concentration.
- Weather conditions also affect pollen levels. The most variant factors influencing different pollen counts from approximately the same region are wind, humidity, and the proximity of the sampling equipment to pollen producing vegetation.
- Because pollens are small, light and dry, they can be easily spread by wind, which keeps pollen airborne and carries it over long distances. If one station samples when the wind is strong and the other station samples when the wind is calm, there's bound to be a difference in the pollen levels.
- When the air is humid, such as during or after it rains, pollen becomes damp and heavy with moisture, keeping it still and on the ground. If one station samples right before a rain storm, and the other station samples just after it rains, there will probably be a significant difference in the concentration of pollen.
- Proximity of the sampling equipment to pollen producing vegetation. Samples taken from an urban area, where there is little vegetation, will most likely differ from samples taken from a rural area, where there is more vegetation.
Is the pollen season the same from year to year?
The beginning and ending times of tree, grass and weed pollen seasons are very similar from year to year in the same location. Intensity differs every year based on the previous year's weather, current weather and other environmental factors.
Why isn't there a counting station in my area?
The NAB is always working to add more counting stations. The NAB will continue its efforts to enlist additional volunteers to its network of certified counting stations so that most areas of the country are represented.
If a station is x miles from my home, will the counts apply to my area?
It's difficult to provide accurate pollen and spore levels for areas not near a pollen counting station. If the climate and geography are similar, chances are the figures reported by the station are a good indicator of conditions nearby.
FAQs on Mold
What is mold?
There are hundreds of thousands of types of molds. All are fungi, which means they are many-celled organisms that reproduce by sending tiny seeds called spores into the air. Molds need four things to grow: food, air, the right temperature and water. Although fungi grow naturally “outdoors", molds are very common in buildings and homes and will grow anywhere indoors where there is sufficient moisture. They like dark, damp, warm environments, and can grow on anything from basement walls to garbage pails to houseplants, and many building materials. Moisture can come from water damage, excessive humidity, water leaks, condensation, water infiltration, flooding, leaking roofs, leaky plumbing, sewer backups, and frequently overflowing washing machines.
What are the health concerns about molds?
Mold and its spores contain allergens, meaning that in some people sensitivity to fungi (molds) can cause allergic reactions such as allergic rhinitis or asthma. Certain molds can cause infection, in the same way bacteria do. Molds may also produce musty odors known as volatile organic compounds that may cause irritation to the eyes, nose and throat.
What is stachybotrys chartarum (Stachybotrys atra)?
Stachybotrys chartarum (also known by its synonym Stachybotrys atra) is a slow growing, greenish-black mold that needs an environment of constant moisture. It grows only on wood, paper and cotton products and can be found in 2% to 5% of American homes. Under specific environmental conditions, Stachybotrys chartarum may produce several toxic chemicals called mycotoxins. These chemicals can be present in spores and small fungus fragments released into the air, but there is currently no evidence that these small levels of exposure are harmful to humans.
What are the health effects of stachybotrys chartarum?
If Stachybotrys chartarum spores are released into the air, there is a potential for humans to develop symptoms such as coughing, wheezing, runny nose, irritated eyes or throat, particularly if the person has developed an allergy to this fungus. Stachybotrys chartarum has been blamed for pulmonary hemosiderosis (bleeding in the lungs) in a small number of infants. However, experts claim that this is “not proved”. Other factors such as second-hand tobacco smoke may be more important.
What should people do if they have stachybotrys chartarum in their building or home?
Mold growing in homes and buildings, whether it is Stachybotrys chartarum or other molds, indicates that there is a problem with water or moisture, and this should be addressed immediately. Once mold starts to grow in insulation or wallboard the only way to deal with the problem is by removal and replacement. Mold under carpets typically requires that the carpets be removed. Walls and other hard surfaces can be cleaned with a weak bleach solution of 10 parts water to 1 part chlorine bleach to prevent mold growth only if done immediately after flooding has occurred. Moldy items should be thrown away. For more information on mold, visit the Environmental Protection Agency Web site, http://www.epa.gov/iaq/molds/moldresources.html
This FAQ section was edited for medical accuracy by Dr. Robert Bush of the AAAAI Aerobiology committee, on 12-07-04.