The article discusses the connection between allergic asthma and allergies, highlighting the immune system's overreaction to common allergens as the trigger for asthma symptoms. It focuses on the importance of accurate diagnosis, comprehensive treatment, and patient education for managing allergic asthma.

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Asthma and allergies

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 mould 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.

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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 sensitisation tests (eg, specific IgE or skin prick tests). 

Typical asthma symptoms include,

• Wheezing
• Breathlessness
• Chest tightness
• Coughing

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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 personalised treatment plans that include allergen avoidance strategies and immunotherapy options.

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Treatment approaches

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. 

Recognising triggers

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

Asthma control

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

Immunotherapy

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

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Patient education and management

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

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Disclaimer: This story is contributed by Payel Gupta and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.