Allergic Asthma: Symptoms, Treatment

Brief overview

• Treatment: Avoid contact with allergenic substances; well treatable with medication (e.g. asthma inhalers, allergy immunotherapy).
• Prognosis: Currently, allergic asthma cannot be cured, but those affected can positively influence the course of the disease themselves.
• Symptoms: Typical symptoms are cough, shortness of breath and sudden shortness of breath.
• Causes: Is particularly often triggered by pollen from flowers, house dust mite droppings, allergens from the fur of pets or mold spores.
• Risk factors: Certain factors (e.g., genes, secondhand smoke, excessive hygiene) favor the development of the disease.
• Frequency: Allergic asthma usually occurs more frequently within the family. 25 to 40 percent of all patients with untreated pollen allergy develop allergic asthma.
• Diagnosis: The doctor makes the diagnosis by means of a physical examination and a lung function test, among other things.

What can be done about allergic asthma?

Treatment without medication

Measures without medication are as important as therapy with medication in the treatment of allergic asthma. Sufferers are therefore advised to do the following:

Avoid the triggering cause

For people with allergic asthma, the first step is to find out which factors and situations trigger or aggravate the symptoms. Doctors advise sufferers to avoid these triggers – as far as possible. Of course, this is easier said than done in everyday life. Nevertheless, there are some ways to protect yourself from the triggering allergens to a certain extent:

Dust mites: if you are allergic to dust mites, you can use a mattress cover that is impermeable to mites. Wash bedding regularly at a minimum of 60 degrees Celsius. Refrain from using “dust traps” such as carpets, thick curtains or furs in the home, as well as stuffed animals in your child’s bed. Try to avoid increased humidity (above 50 percent) and temperatures above 22 degrees Celsius in rooms. Regular airing helps with this.

Pollen: With the help of a pollen calendar, you can determine when and where which pollen is on the increase – avoid these regions or times as much as possible. If there are particularly many pollen on the move, shower daily before going to bed and wash your hair. Do not keep clothing to which pollen could adhere in the bedroom. Also, do not hang laundry outdoors to dry. Some models of so-called electric pollen filters, which use a fan to direct the room air over a set of very fine-pored filters, have also proven effective and can thus significantly reduce the pollen count.

Adapt lifestyle

People with allergic asthma can do a few things themselves to contribute to the success of the therapy and thus improve their quality of life.

These include:

• See a pulmonary specialist regularly to have the course of the disease monitored.
• Make sure you have an individualized, written treatment plan that includes an emergency plan (e.g., What to do if you have an acute asthma attack).
• Make sure you use your medications and treatment plan correctly and regularly.
• Take part in an asthma training course in which you learn, for example, the correct use of the medication, the application of the therapy plan or behavior in an emergency.
• Take care of a new prescription in time when a medication runs out.
• Ensure a smoke-free environment. This applies not only to asthma patients themselves, but especially to parents whose children are affected by asthma! Secondhand smoke is a powerful and dangerous trigger for asthma attacks and can negatively affect the course of the disease in children with asthma.

Diet for allergic asthma

Home remedy

Allergic asthma belongs in the hands of a doctor! However, some home remedies can support the treatment under certain circumstances. They can help relieve the symptoms of allergic asthma, but never replace a visit to the doctor. These include:

• Turmeric as a tea, spice or drops is said to have a mild anti-inflammatory effect.
• Ginger as a tea or extract is said to protect against inflammation and strengthen the immune system.
• Magnesium (e.g. in the form of effervescent tablets or capsules) relaxes the muscles of the bronchial tubes.
• Medicinal herbs such as Iceland moss, fennel and ribwort plantain in the form of lozenges or extracts facilitate breathing and have an expectorant effect.

Essential oils such as peppermint, menthol or eucalyptus oil are not suitable for asthmatics. They can irritate the mucous membranes and cause respiratory distress.

Homeopathy

The concept of homeopathy and its specific efficacy are controversial in science and not clearly proven by studies.

Medication

In the treatment of allergic asthma with medications, a distinction is made between long-term and on-demand medications.

Long-term medications

Long-term medications are the foundation of any asthma treatment. They counteract the triggering cause of the asthma. The most important active substances in this group are corticosteroids (cortisone), which are similar to the body’s own hormone cortisol. They prevent the bronchial tubes from reacting too violently to certain stimuli and inhibit inflammation. In this way, they improve lung function, prevent acute respiratory problems and alleviate or prevent the typical symptoms.

For this reason, affected individuals are advised to continue therapy with cortisone sprays even if they do not currently have any symptoms. This does not apply to treatment with cortisone tablets. These can increase the risk of serious side effects and secondary diseases (e.g. diabetes, osteoporosis), especially if taken continuously.

If cortisone alone is not sufficient to control the symptoms, the doctor will combine it with other active ingredients. These include certain agents from the group of long-acting beta-2 sympathomimetics or leukotriene antagonists. Beta-2 sympathomimetics stimulate a part of the nervous system called the sympathetic nervous system. This causes the bronchial tubes of the affected person to dilate. Leukotriene antagonists slow down inflammation in the bronchi.

Medication as needed

For severe allergic asthma that does not respond to the usual therapy, the doctor may administer the active ingredient omalizumab. This is a laboratory-produced antibody that interrupts the allergic reaction in the body. To specifically interrupt the allergic reaction, the doctor injects the drug directly under the skin.

Affected individuals receive the drug, for example, if the total IgE level (IgE is an antibody that is largely responsible for allergic reactions in the body) in the blood remains elevated despite exhausted treatment (therapy with cortisone spray and beta-2 sympathomimetics) and they continue to have symptoms.

Allergen-specific immunotherapy (AIT or hyposensitization).

If the trigger of allergic asthma is a pollen or dust mite allergy, allergen-specific immunotherapy (AIT or hyposensitization) is recommended. It directly combats the cause of the allergic asthma. The principle is as follows: If the body is repeatedly given a small dose of the allergen at regular intervals and this dose is slowly increased, the immune system becomes accustomed to it and the symptoms decrease.

Allergen-specific immunotherapy cannot replace existing asthma therapy, but only complement it.

Asthma control according to the graduated scheme

Asthma treatment with medication is always based on the severity of the disease. The symptoms of asthma can vary in severity. Therefore, in consultation with the patient, the physician regularly monitors the course of the disease and adjusts the therapy if necessary. The basic principle is: as much as necessary and as little as possible.

A step-by-step scheme serves as a guideline, with the help of which the doctor and patient adapt the treatment to the current degree of severity. Each therapy level corresponds to a specific combination of medications; there are five levels in total.

Depending on the degree of asthma control, the physician adapts the treatment to the respective therapy level. The “degree of asthma control” results from different parameters (e.g. frequency of symptoms, lung function of the affected person, etc.).

The degree of asthma control is thereby divided into:

• controlled asthma
• partially controlled asthma
• uncontrolled asthma

The aim is to control the symptoms so well that attacks occur as rarely as possible and sufferers live with virtually no restrictions. Controlling asthma largely prevents acute worsening of the disease (so-called exacerbations) and improves the quality of life of those affected many times over. Especially in children, regular control and adjustment of treatment plays a central role in ensuring that they develop in a physically and psychologically healthy manner.

Treatment of allergic asthma in children

Adults and children are generally treated according to the same principles, but the treating physician adjusts the dosage and administration of medication to the age and physical development of the child. The step regimen for treating children with asthma is also somewhat different from that for adults.

Bronchial asthma due to allergy?

• allergic rhinitis (rhinitis)
• allergic conjunctivitis (inflammation of the conjunctiva)
• allergic bronchial asthma with spasm of bronchial muscles and inflammation of mucous membrane

Asthma or COPD?

Allergic asthma, like COPD (chronic obstructive pulmonary disease), is a chronic lung disease. Since those affected often suffer from similar symptoms, the diseases are easily confused. To choose the right therapy, it is therefore important for a doctor to examine the symptoms in detail. For example, shortness of breath occurs in attacks in people with asthma, while COPD patients primarily have breathing problems during physical exertion. Asthmatics are also more likely to have a dry cough. People with COPD have a pronounced cough with viscous sputum that occurs primarily in the morning.

COPD patients often have little response to treatment with asthma sprays.

Who gets allergic asthma?

If an existing allergy is not treated or not treated sufficiently, the disease worsens: Around 25 to 40 percent of all patients with untreated pollen allergy develop allergic asthma in the course of their lives. In such cases, the disease is referred to as a “change of stage”. This means that the allergic reaction moves from above, from the mucous membranes, down into the bronchial tubes. Sometimes this happens unnoticed.

Allergic asthma in children

Fifty to 70 percent of all asthma in children and infants is caused by allergy. In some cases, allergy-related asthma disappears during puberty, but it can reappear in adulthood. The more severe the asthma is in childhood, the more likely sufferers are to continue to suffer from it as adults.

In addition to the typical symptoms of coughing, shortness of breath and tightness in the chest, children with asthma often have a fever. Because asthma can affect a child’s development, parents are advised to see a doctor at the first signs.

If the disease is detected early and treated consistently, asthma in children can be cured.

Despite intensive research, asthma cannot yet be cured. The symptoms usually persist over a long period of time and subside only temporarily, if at all. However, the disease can be treated well in most cases with medication. A well treated asthmatic has the same life expectancy as a healthy person. With proper treatment, the disease will also develop favorably in the long term.

What are the symptoms of allergic asthma?

Regardless of the cause, asthma changes the person’s bronchial tubes (airways that conduct air): The airways narrow, causing the typical asthma symptoms.

These include:

• cough (usually dry)
• whistling breathing (wheezing)
• chest tightness
• Shortness of breath
• Shortness of breath
• Chest pain

In the event of an asthma attack, keep calm, inhale your emergency asthma spray, and assume a position that makes it easier for you to breathe. If your symptoms do not improve quickly, call 911!

What triggers allergic asthma?

In people with asthma, the airways are chronically inflamed. At the same time, the bronchi of those affected are hypersensitive (bronchial hyperreactivity) to stimuli such as smoke or cold air in winter. These two factors lead to a narrowing of the bronchial tubes (airway obstruction), which in turn triggers the typical symptoms of asthma.

Bronchial asthma can be allergic and non-allergic, and many adults have mixed forms.

What are the triggers?

Triggers for allergic asthma include the following:

• Tree pollen: hazel, alder, birch, ash
• grass, plantain, nettle, mugwort, ragweed pollen
• House dust mite allergens (feces and carapace)
• Animal dander (e.g. cat, dog, horse, guinea pig, rat, …)
• Mold spores (e.g. Alternaria, Cladosporium, Penicillium, …)
• Occupational allergens (e.g. flours, isocyanates in paint, papain in textile production)

What are the risk factors for allergic asthma?

It is not yet clear why some people develop allergies and – associated with them – allergic asthma. Doctors suspect certain risk factors that favor the occurrence of an allergy or allergic asthma:

Genes

Hereditary predisposition plays a major role in allergic asthma. Children whose parents suffer from allergic asthma have a higher risk of asthma than children whose parents are not affected.

External influences

Environmental factors also influence the development of allergic asthma. For example, children whose mothers smoke during pregnancy have an increased risk of developing allergies (e.g., hay fever, allergic asthma) later in life. The same applies to children who are regularly exposed to secondhand smoke. They are also more likely to develop allergies and allergic asthma than children who grow up smoke-free.

Excessive hygiene

Viral infections in childhood

In addition, viral infections (e.g. bronchiolitis, respiratory infections with chlamydia and rhinoviruses) in early childhood increase the risk of disease.

How does the doctor make the diagnosis?

The main diagnostic tools for allergic asthma are a detailed conversation (medical history), a physical examination, and measurement of lung function (peak flow measurement; spirometry).

Discussion with the doctor

If allergic asthma is suspected, the general practitioner is the first point of contact. If necessary and for further examinations, he or she will then refer the patient to a specialist in lung diseases (e.g. pulmonologist/pneumologist; also allergologist). Thanks to detailed examinations, the doctor can usually make the correct diagnosis quickly. To do this, he begins with a detailed discussion with the patient, which often provides important information about the nature of the disease. The doctor asks the following questions, among others:

• When, how often and in which situations/environment do you have cough/breathlessness?
• Are there allergic diseases within the family (e.g. neurodermatitis, pollen allergy, …)?
• Are there animals in the household or in the immediate environment?
• What do you do for a living?

Physical examination and lung function test

This is followed by a physical examination and a pulmonary function test (spirometry). This involves the patient blowing into the mouthpiece of a device that measures the force and speed of the airflow. This allows the lung function, which is usually reduced due to asthma, to be determined.

Three measurements in particular are important here:

• Vital capacity (VC): the highest possible capacity of the lungs
• Seconds capacity (FEV1): the amount of air exhaled in one second
• FEV1/VC: the ratio of second capacity to vital capacity

If the FEV1/VC ratio is less than 70 percent, bronchi are constricted. In asthma, the values for FEV1 and VC are usually also below the norm, and in severe asthma even very significantly so. If only the small airways – less than 2 mm in diameter – are narrowed, this is referred to as “small airways disease”.

Reversibility test

The narrowing of the airways has therefore improved significantly as a result of treatment with a bronchodilator. People with asthma typically respond positively to bronchodilators, but this is not the case with COPD.

Allergy test

The physician uses an allergy test to determine the exact trigger – the allergen. For the so-called “prick test”, the doctor applies the most common allergens (e.g. cat, house dust mite droppings, grass or birch pollen) in liquid form to the skin of the affected person, then lightly scores the skin (“prick”). If the patient has an allergy to a particular substance, skin wheals will appear on the affected skin area after about 20 minutes (allergic reaction).

Blood test

A blood test gives the physician further indications as to whether an allergy is present. Three values are determined:

• Total IgE: elevated values indicate an allergy.
• Specific IgE: indicates against which specific allergen the IgE antibodies are directed.
• Eosinophils/ECP: certain white blood cells, which are usually more frequent in allergic diseases