WHAT TO KNOW ABOUT ASTHMA RELATED TO ALLERGIES

Asthma and allergies often occur together, and while they have much in common, they are separate conditions. For people with allergies, the same substances that trigger an allergic response may also trigger asthma. It’s common for inhaled allergens like dust mites, pollen, and pet dander to trigger asthma symptoms. Skin and food allergies also commonly trigger asthma. This type of asthma is called allergic asthma or allergy-induced asthma. It causes allergy symptoms like nasal congestion and skin rashes, both forms of inflammation, to extend to the lungs and airways, triggering the inflammation associated with asthma. While allergy and asthma symptoms are usually treated separately, some treatments are effective for both, including leukotriene modifiers, immunotherapy, and anti-immunoglobulin E (IgE) therapy.

P.S. In most cases of people with both allergies and asthma, allergies develop before asthma and become a trigger for asthma-related symptoms.

HOW IS TESTOSTERONE LINKED TO ASTHMA??

Researchers have known for a while that pre-adolescent boys have higher rates of asthma than same-age girls, but this switches during puberty so that teenage girls and women have higher rates of asthma than teenage boys and men. We also know that sex hormones affect the immune system’s response to allergens and that estrogen increases inflammation throughout the body. Since twice as many women suffer from asthma, scientists believed that estrogen was the driving factor behind the higher incidence of asthma in women. But recent research shows that testosterone suppresses the inflammatory response involved in asthma, suggesting that the male sex hormone plays a larger role in the disparity of asthma between men and women than was previously thought.

P.S. Women can better manage asthma by remembering that hormonal fluctuations affect airway inflammation and tracking their asthma symptoms throughout the month with extra awareness during ovulation and menses.

CAT SCRATCH FEVER OR CAT ALLERGY?

Cat scratch disease, which can cause a fever, is a real medical condition. Many cats carry a bacterium in their saliva, contracted from feces, fleas, or interactions with other cats. It can be transmitted to humans through a bite or scratch. The wound doesn’t heal and may form a pus-filled blister. An infected person may develop flu-like symptoms and swollen lymph nodes. A cat allergy is an immune reaction to a cat’s saliva, so anyone with a cat allergy who receives a cat scratch or bite is at risk for an allergic reaction in addition to a bacterial infection.  The two conditions are unrelated, however, since the cat-scratch disease is an infection, while a cat allergy is an immune response.

P.S. While cat scratch disease and an allergic reaction to cats may both cause flu-like symptoms, a fever is more often associated with cat scratch disease while a rash or trouble breathing is more likely caused by an allergy.

LEUKOTRIENE MODIFIERS AND  CONTROLLING ASTHMA

Leukotrienes are chemicals released by the body in certain situations, like during an allergic reaction. They can cause symptoms like coughing, airway inflammation, extra fluid and mucus, chest tightness, and trouble breathing. Leukotriene modifiers, also called leukotriene receptor antagonists (LTRAs) or leukotriene synthesis inhibitors, block either the effects or the production of leukotrienes. They are primarily used to preventatively treat breathing problems from allergies, allergic asthma, exercise-induced asthma, and chronic obstructive pulmonary disease (COPD). Patients who use these drugs take them orally as a tablet daily for best effectiveness. They should be taken every day whether or not a person is having trouble breathing because they work to prevent asthma symptoms and flair-ups, not to stop one that’s already started.

P.S. Some LTRAs have been known to  cause liver damage, so bloodwork may be required prior to starting a prescription.

THE ROLE OF GENETICS IN DEVELOPING ASTHMA

Genes have been shown to play a significant role in asthma development, and researchers have called asthma a “highly heritable condition.” Although there are many factors that contribute to asthma, and a family history of asthma does not necessarily mean that a person will have the condition, a 2014 study showed that a person’s risk of developing asthma is 70% genetic. Environmental factors also play a large role; some adult-onset asthmas like occupational asthma are not considered genetic, even if a person is genetically predisposed. Other risk factors include obesity, preexisting allergies, and smoking or exposure to second-hand smoke. Genetic susceptibility to asthma can come from an inherited gene mutation or from a single genetic variation.

P.S. A parent or sibling with asthma increases the risk of developing asthma to 25%; the risk increases to 50% if both parents have asthma. The presence of environmental factors increases the risk even more.

HOW NASAL CORTICOSTEROIDS HELP ALLEVIATE ALLERGY SYMPTOMS

Corticosteroid nasal sprays, also called steroid nasal sprays, are used to alleviate the symptoms of seasonal allergies, sinusitis, and nasal polyps (noncancerous growths inside the nose). They are available over-the-counter or as a prescription from a doctor. They work by mimicking the effects of the hormones produced by the adrenal glands. When sprayed into the nose, they reduce inflammation, causing the symptoms of an allergic reaction. Nasal corticosteroids are different from other types of nasal sprays that are used to reduce cold symptoms. Research shows that corticosteroid nasal sprays work best when they are used on a daily basis; however, they may also be used as needed, depending on your doctor’s recommendation.

P.S. If you regularly experience seasonal allergies, your doctor may recommend that you start taking a nasal corticosteroid one to two weeks before you normally start experiencing symptoms.

SUBLINGUAL IMMUNOTHERAPY FOR ALLERGIES

An allergy shot is a type of immunotherapy. Sublingual immunotherapy is a type of immunotherapy in which the patient places a tablet or liquid dose under the tongue once a day to help prevent and ultimately reduce or eliminate a reaction to a specific allergen. It works by exposing the patient to a small amount of the allergen each day to help them slowly build a tolerance safely and effectively. Putting the allergen under the tongue allows the mucus membranes in the mouth to deliver the substance directly to the bloodstream. Sublingual immunotherapy is currently used to treat seasonal allergies like hay fever and dust mite allergies, but it’s also beginning to become available for food allergens like peanuts.

P.S. Sublingual immunotherapy is less likely to cause a severe reaction and may reduce asthma symptoms in some patients.

FLU SHOTS AS A FORM OF ASTHMA PREVENTION

Having asthma doesn’t make you more likely to get the flu, but asthma patients who contract the flu virus are more likely to have severe asthma attacks that lead to hospitalizations and pneumonia. Viral respiratory infections are the leading cause of asthma attacks, and as many as 80% of them are believed to be flu-related. Additionally, a recent respiratory infection such as the flu is said to quadruple a person’s chances of having severe asthma attacks afterward. People with asthma are already at higher risk for pneumonia, and contracting the flu further increases this risk. For all these reasons, many doctors argue that getting the flu shot each year is one of the best ways to prevent complications from asthma.

P.S. One in five flu-related hospitalizations is a person with moderate to severe asthma. Doctors recommend that asthma patients start antiviral drugs within 48 hours of being exposed or developing symptoms.

WHAT TO KNOW ABOUT ASTHMA ATTACKS AND PANIC ATTACKS

Asthma attacks and panic attacks can have some very similar symptoms: shortness of breath and trouble breathing, and both can be triggered by stress. Some asthma patients wonder if they’re actually having a panic attack during an asthma attack and want to know how to tell the difference. Further, they may be concerned that the stress of an asthma attack could trigger a panic attack, or vice versa. Some key differences: the coughing and wheezing associated with asthma attacks does not occur with panic attacks, while panic attacks may cause symptoms like hyperventilation, lightheadedness, and sweating or chills, which are not associated with asthma attacks. Stress aside, common asthma triggers like allergens, environmental temperature, and exercise do not trigger panic attacks.

P.S. Asthma causes the chest to constrict, reducing oxygen flow and making it harder to breath. Panic attacks cause short, shallow breathing to increase oxygen in a fight-or-flight response.

CHRONIC SINUS INFECTIONS AND ALLERGIES

Sinusitis, otherwise known as a sinus infection, can be acute or chronic. Acute cases often follow a cold and are accompanied by a fever, but they don’t last as long. Flair ups of chronic sinusitis often follow seasonal allergies or other allergic reactions that lead to upper respiratory symptoms like sneezing and a stuffy nose. The inflammation and swelling that accompany allergic reactions can prevent the sinuses from properly draining and they become blocked, providing a place that harbors bacteria, viruses, and fungi. Chronic sinusitis symptoms can be very similar to the common cold. People with asthma and allergies are at higher risk for chronic sinus infections, as are people who are regularly exposed to air pollutants and cigarette smoke.

P.S. People who overuse allergy medications and other nasal decongestants are at higher risk for developing chronic sinus infections.

THE LINK BETWEEN ATOPIC DERMATITIS AND ALLERGIES

Atopic dermatitis (eczema) is a skin reaction, and while it’s not an allergy, people with this skin condition frequently have seasonal allergies and asthma and are more sensitive to developing additional allergies. Both conditions are caused by an inflammatory immune response. Allergies often make atopic dermatitis more severe and harder to control. What’s the connection between the two? Genes play a role in both, and children with parents who have asthma or allergies are more likely to develop atopic dermatitis. Research shows that some people with atopic dermatitis have a genetic flaw that causes fewer proteins in the skin. These proteins are part of the skin’s protective outer layer that helps keep germs and allergens out of the body.

P.S. Although allergy shots are not used to treat atopic dermatitis, the skin condition is usually best diagnosed and managed by an allergist.

ALTERNATIVE TREATMENTS FOR BETTER ASTHMA MANAGEMENT

While alternative asthma treatments should not replace medications, they can be used to support asthma management. In some cases of mild asthma, alternative treatments may be the only management needed. There is scientific evidence showing improved asthma relief and management from using different breathing techniques, acupuncture, massage therapy, and yoga. And lifestyle changes surrounding diet, exercise, and smoking have always been recommended for successful asthma treatment and management. Because stress is a major trigger for many asthma patients, different breathing techniques can help patients learn to relax, slow their breath, and breathe more deeply. Acupuncture and massage both help with relaxation, breath control, and reducing flare-ups. Yoga helps improve breath and lung function while reducing stress.

P.S. Caffeine and probiotics have both been shown to reduce asthma symptoms.

ASPIRIN-EXACERBATED RESPIRATORY DISEASE (ASPIRIN-INDUCED ASTHMA)

Around 20% of people with asthma are sensitive to aspirin and may experience increased asthma symptoms or symptoms of aspirin-exacerbated respiratory disease (AERD). About 10% of people with asthma are also living with AERD. People with this condition experience chronic asthma and nasal polyps (and may experience a range of other symptoms) after taking aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs), leading to an inflammatory reaction. Asthma can range from mild to severe, so AERD can suddenly become life-threatening when triggered by an NSAID such as aspirin. The causes of AERD are still being researched, but we know it causes a sensitivity to inflammatory substances  or those that can potentially cause inflammation like allergens and asthma triggers.

P.S. Some people with aspirin-exacerbated respiratory disease (AERD) may have a similar reaction to alcoholic beverages.

DO YOU SUSPECT A MUSTARD ALLERGY?

While a mustard allergy isn’t seen as often as many other food allergies, mustard is among the most common spice allergies. Mustard can cause your body to overreact when you eat, touch, or inhale it. Symptoms can range from gastrointestinal issues to hives, wheezing, and shortness of breath. Like any allergic reaction, a mustard allergy can lead to life-threatening anaphylaxis. Since mustard is a common condiment and culinary ingredient, it’s important to receive a diagnosis if you suspect you may have this allergy and carry an epinephrine pen at all times in case you accidentally ingest mustard. Mustard is found in pickled foods, deli meats, sausages, curries, salad dressings, sauces, snacks like chips, and much more.

P.S. A mustard allergy is usually to the mustard seed; however, canola oil (made from rapeseed) may also cause a reaction in people with a mustard allergy.

HAY FEVER IN WINTER?

Freeze-free days extend the growing season for pollen-producing plants. The number of freeze-free days has increased in all 197 U.S. cities analyzed since 1970. Of those cities, 164 have 30 to 60 or more additional freeze-free days each year. For seasonal allergy sufferers—people who experience allergic rhinitis or hay fever—this means the allergy season starts earlier in the spring or winter. In some climates, “seasonal” allergies have become year-round. Additionally, mold, fungus, pet dander, and dust mite allergies frequently cause the same symptoms as hay fever and can be more prevalent during winter. People with multiple allergies may find themselves experiencing symptoms throughout the year, with the most relief during the dry months of late summer and fall.

P.S. About 25% of adults and 20% of children suffer from symptoms of seasonal allergies.

Sue Brown

Hannah Clark

Erica Monaco

Jen Grier

Cindy Mains

COMBINATION INHALERS FOR LONG-TERM ASTHMA CONTROL

There are several types of inhaled medications that asthma patients use to manage their symptoms, classified into two groups: corticosteroids (to control and reduce inflammation) and bronchodilators (to widen airways and prevent bronchospasms). The two types of drugs can be taken separately to stop or slow an asthma attack, but combining them has a different purpose and longer-lasting effects. Combination inhalers are preventative and meant for daily use to help reduce and control symptoms long-term. When used together daily, corticosteroids and bronchodilators help control and prevent inflammation, with a goal of making asthma attacks and symptoms less frequent. Asthma patients are good candidates for combination inhalers when they have to use a rescue inhaler more than twice a week.

P.S. Rescue inhalers are used as-needed to control asthma attacks and severe symptoms. Corticosteroids are usually the next choice of treatment when a person doesn’t respond to their rescue inhaler.

DIETARY SOLUTIONS FOR ASTHMA SYMPTOMS AND PREVENTION

Asthma symptoms and attacks can be managed with the right medications, but there are some dietary changes and preventative measures you can practice at home to make those meds work better and reduce the dosage and frequency. Diet is a big one. Asthma produces an inflammatory response in the body, so eating a diet of anti-inflammatory foods and supplements will only help improve symptoms. There is research to support that asthma is linked to our gut’s microbiome, and an imbalance in beneficial gut bacteria can increase asthma symptoms. Probiotic foods and supplements can help balance the bacteria in your gut and prevent asthma attacks. Anti-inflammatory garlic has numerous health benefits and improves the taste of many dishes to boot.

P.S. If you have asthma flair ups after eating certain foods, those foods may be asthma triggers or food allergies that are making your asthma symptoms worse.

AVOIDING LATEX ALLERGIES AT HOME AND WORK

Latex is made from the sap of rubber trees. Strong and stretchy, it is used in a number of household products and toys, in addition to well-known latex products like gloves and balloons. While this allergy is somewhat uncommon, affecting one to six percent of the population, in the medical field latex allergy is much higher: Seventeen percent of healthcare workers and a whopping 38 percent of dental care workers have a latex allergy. About 17 percent of restaurant workers also develop this allergy. Many of the items we use at home daily have hidden latex that could affect someone sensitive to this allergen: bandages, shoes, toys, carpet backing, clothing, tool handles, diapers, and feminine products all have hidden latex.

P.S.  If you have a latex allergy or sensitivity, food prepared by someone wearing latex gloves can cause an immune response and allergic reaction.

SESAME ALLERGY AND HIDDEN OILS

In 2021, sesame seeds were added to the list of foods labeled as allergens on product packages. Although sesame allergy was first identified in 1950, incidents of allergic reactions to sesame seeds have been on the rise more recently. Typical symptoms include hives, rash, itching, congestion, mouth tingling, and anaphylaxis. Sesame oil, extracted from the seeds, is used in many products and recipes. People who are sensitive to this allergy may experience a rash from coming into contact with non-food products containing sesame oil, like pharmaceuticals and cosmetics. Sesame has a biochemical structure similar to other common food allergens like peanuts and some tree nuts, so these foods may cause a similar allergic reaction in people allergic to sesame.

P.S. Rye, kiwi, and poppy all share a similar biochemical structure with sesame and are more likely to cause a reaction in those allergic to sesame.

THE DANGERS OF UNCONTROLLED ASTHMA

When well-managed, asthma can improve over time and doesn’t have to limit our activities or control our lives. But when asthma goes uncontrolled or isn’t actively managed, it can have detrimental long-term consequences. Airway remodeling is a restructuring of the airways that happens when permanent scars form due to ongoing exposure to inflammation. The damaged tissue makes these patients more susceptible to lung diseases like pneumonia. It also increases heartburn and acid-reflux because the inflammation damages the esophageal sphincter. Uncontrolled asthma leads to more severe asthma attacks and more frequent emergency room visits from attacks. Sleep issues are common in people with asthma, and uncontrolled asthma can lead to both sleep disorders and chronic tiredness.

P.S. Pregnant women with uncontrolled asthma can experience serious pregnancy complications including high blood pressure, preeclampsia, premature birth, and pregnancy failure.

EFFECTS OF WILDFIRE SMOKE ON ASTHMA PATIENTS

Wildfire smoke can travel thousands of miles. Even if you live in an area far from active fires, you may still feel the effects, especially if you have asthma. Smoke contains tiny particles that enter the airways and irritate and inflame the lungs, causing coughing, wheezing, and shortness of breath. Asthma patients will notice the effects of airborne particles on their breathing much sooner than people without lung conditions. People with asthma and other lung conditions are advised to monitor air quality and stay indoors when smoke is in the air. They should run air conditioners on recirculate mode and invest in  air purifiers for rooms where they spend the most time, such as a home office and the bedroom. 

P.S. The Centers for Disease Control and Prevention recommends that asthma patients wear an N-95 mask or other mask marked as a “particulate respirator” when exposed to wildfire smoke and airborne particles.

CAN A PERSON BE ALLERGIC TO BROCCOLI??

Your kids may try to convince you that they’re allergic to broccoli and other unwanted veggies, but these allergies can be real. While fruits and vegetables are not common allergens, you can develop an allergy to any food, especially if it’s one from a family of foods you’ve never encountered before. A child with a parent who avoids certain foods may have an allergic reaction after trying a new food at a friend’s house, for example. An allergy to broccoli or other veggies produces the same symptoms as other food allergens: hives, itching, cold-like symptoms, breathing problems, and gastrointestinal issues. Some fruits and vegetables are also associated with an itchy or tingly mouth during an allergic response.

P.S. People who are allergic to several fruits or vegetables are most likely reacting to the salicylates, a natural chemical found in some fruits, veggies, and spices.

DOES ACUPUNCTURE HELP WITH ALLERGY SYMPTOMS?

People suffering from allergies are turning to acupuncture for alternatives to prescribed medications or to increase the effectiveness of their medications. There’s mixed research about the effectiveness of acupuncture for allergies in general, but studies show that acupuncture is more effective for allergic rhinitis, also known as hay fever, than it is for other types of allergies, like those to food or medications. An allergic reaction is an immune system response, so when acupuncture is used for allergies, the needles are targeted at the locations in the body that increase the flow of immune energy: the lungs, colon, stomach, and spleen. The needles are inserted at specific points that are part of the network of energy associated with immunity.

P.S. Stress is an allergy and asthma trigger for many people, and acupuncture helps relieve stress in addition to targeting specific issues like allergies. 

YES, YOU CAN COMPETE IN SPORTS WITH ASTHMA

Many competitive athletes have asthma, including Olympic medal winners. Asthma is the most common chronic health condition among Olympic athletes (around 16.5%). Swimmer Greg Louganis had asthma in childhood but was encouraged by doctors to remain active to increase his lung capacity. Figure skater Kristi Yamaguchi was also diagnosed with asthma as a child, and the cold air on the rink made her symptoms worse. She and her doctors created an asthma management plan that allowed her to compete. Runner Noah Lyles has lung damage from childhood asthma but is managing his asthma and competing anyway. Jackie Joyner Kersee—considered one of the greatest of all time in the long jump—won five Olympic medals after being diagnosed with asthma in college.

P.S. Amy Van Dyken was diagnosed with exercise-induced asthma in childhood and says that swimming helped her learn to manage her asthma better. She went on to win six Olympic gold medals. 

ALLERGIES VERSUS INTOLERANCES

Food allergies and food intolerances can cause similar symptoms, but one is an immune system reaction  while the other is a gastrointestinal issue. Another important difference is that an allergy can cause a life-threatening reaction that makes the airways close (anaphylaxis), but an intolerance is more of an inconvenience than a risk, albeit an uncomfortable one. A food intolerance is the result of an inability to digest food. Lactose intolerance and gluten intolerance (Celiac disease) are the most common food sensitivities with symptoms like headaches, nausea, vomiting, gas, belly cramps and pain, and diarrhea. Allergies can cause these symptoms too, but also commonly cause cold-type symptoms like itching, sneezing, hives, coughing, throat tightness, and breathing problems.

P.S. Although it causes an inflammatory reaction, Celiac disease is not a true allergy.

THE 4-4-4 RULE FOR ASTHMA

If you or someone you care about suffers from asthma, it can really pay to be aware of the 4-4-4 rule in an emergency. If someone is experiencing an asthma attack, help them sit upright and take 4 separate puffs from their quick-relief inhaler. Wait 4 minutes, and then repeat the first step (4 more inhaler puffs) if there’s no improvement. Keep them in a sitting position (lying down can make an asthma attack worse), loosen any tight clothing, and stay with the person. When someone experiences a severe asthma attack without an inhaler or other medication available, it’s best to call 911 immediately. Asthma attacks can be difficult to reverse without medical intervention.

P.S. During an asthma attack with no inhaler available, try giving the person a few sips of a beverage with caffeine. Small amounts of caffeine have been shown to reduce asthma symptoms for up to 4 hours.

SUDDEN ALLERGIES: WHAT DO THEY MEAN?

If you’ve recently had a change in your life and also suddenly developed new allergies, you have likely been exposed to an allergen for the first time. It’s common for people to develop new allergies after moving to a new climate with different plants and pollens. Allergens that are foreign to the immune systems can cause an inflammatory immune response upon first exposure. But moving to a new home or office in the same climate could cause the same response if the new dwelling has new allergens like mold or dust mites. If you suddenly develop allergies, you may have increased exposure to new allergens or ones that were already present, or your immune system may have become more vulnerable.

P.S. Lack of exposure to allergens in childhood, as well as antibiotics taken in childhood, can cause adults to suddenly develop allergies.

EPICUTANEOUS IMMUNOTHERAPY FOR ALLERGIES

Epicutaneous means “on the skin.” Epicutaneous immunotherapy (EPIT) uses immune cells in the skin to build tolerance to an allergen using a dermal patch with a microdose of that allergen. This is a newer food allergy treatment still in clinical trials, and patches are being developed to treat peanut, milk, and egg allergies. EPIT works by exposing the patient to increasing doses of the allergen over time so that they form a tolerance. The patch is worn for longer periods each day until it is worn full time and replaced daily. The dosage also increases over time. Allergy shots are a similar type of immunotherapy that slowly builds an immune system tolerance to an allergen.

P.S. When EPIT becomes fully available, it will offer an alternative form of immunotherapy in addition to allergy shots.

WHY IS ASTHMA CHRONIC AND INCURABLE?

Scientists don’t fully understand what causes asthma and why it can’t be cured. It is considered a chronic but highly treatable condition. Many people with asthma can experience minimal, infrequent symptoms with the right asthma management program. Asthma is considered under control when the patient needs fewer than three quick-relief inhaler uses per week, does not wake up in the night due to asthma, and is able to do exercise and other activities with few to no symptoms. Asthma can go into periods of remission when a person experiences no symptoms, and children with asthma may not experience symptoms as adults. There are many different types of asthma and asthma triggers that must each be managed uniquely for each patient.

P.S. Although there are products on the market that promise to get rid of asthma, there are currently no known treatments, therapies, or natural remedies that cure asthma.

POLLEN-FOOD ALLERGY SYNDROME

Also called oral food syndrome, pollen-food allergy syndrome (PFAS) happens when pollen, a common allergen, cross-reacts with allergens found in raw fruits, vegetables, and some tree nuts. The proteins of these two allergens have similar structures, and the immune system sees them as the same invader. If you have a pollen allergy and sometimes experience an itchy mouth or throat after eating produce or nuts, you may have experienced PFAS. People who have this reaction are safe to eat the same foods when they’re cooked because it changes the protein structure, and the immune system no longer identifies an allergen. For people with PFAS, the offending pollen usually comes from a plant in the birch, ragweed, or grass families.

P.S. Unlike many other allergies, children are at lower risk for developing the symptoms of pollen-food allergy syndrome because pollen allergies don’t usually develop in children under the age of three.

Leah Bell

Lori Hawley

Zoë Sariego

Zoë earned her associate’s degree in nursing at Alfred State College in 2020. She then went on to work at Duke University Hospital for 3 years while obtaining her bachelor’s degree in nursing. Her love of nursing and leadership has provided her with many opportunities to grow and learn in her profession. Her love of medical science and research led her to her current position as Clinical Research Coordinator at Smith Allergy & Asthma. In her spare time, Zoë enjoys spending time with family and friends, reading, camping, and hiking with her two dogs.

WHY ARE CAT ALLERGIES SO COMMON (OR ARE THEY)?

According to the American College of Allergy, Asthma, and Immunotherapy, cat allergies are twice as common as dog allergies. People who have asthma or other allergies are more prone to developing a cat allergy. Cats trigger a severe asthma attack in three out of ten people with asthma, and a cat allergy can lead to chronic asthma. Cat allergies are caused by proteins in a cat’s saliva, urine, and dander. Their dander is microscopic and airborne, making it prone to inhalation. Cats also carry other allergens on their fur, like dust, pollen, and litter particles. Dogs produce a similar protein, but the protein cats produce has smaller, stickier molecules that remain airborne and attach to fur and other objects longer.

P.S. Cat dander particles are smaller than particles from dust, pollen, and other animals’ dander, making them one of the easiest allergens to inhale.

DOES HAVING ALLERGIES MEAN I HAVE A WEAK IMMUNE SYSTEM?

Some scientists believe that people with allergies have immune systems that are better at identifying and eliminating cancer-causing toxins, and that allergies are a sign of a stronger immune system. In a normal immune response, the immune system reacts to harmful microbes by producing antibodies. The antibodies label the foreign microbes as dangerous, signaling the immune cells to kill the microbes. Allergens are everywhere, but most of the time our bodies don’t respond to them. Sometimes the immune system reads a harmless microbe (allergen) as a threat and produces antigens to kill the allergen, creating an unnecessary inflammatory (immune) response. The immune system becomes sensitive to the allergen and launches an even larger immune response the next time it’s exposed.

P.S. When your immune system reacts to allergens it means it is doing a good job at warding off invaders. When the invader is harmful and will make us sick, this is a healthy response.

THE TYPES AND CATAGORIES OF ASTHMA

Asthma isn’t just “asthma” anymore. There are currently seven clinically recognized types of asthma: allergic, aspirin-induced, cough-variant, exercise-induced, nighttime, steroid-resistant, and occupational. The type of asthma determines the treatment and management options. Asthma can also be classified as intermittent or persistent. The symptoms are the same at every stage, but the severity and frequency are different. The stages of asthma—intermittent, mild persistent, moderate persistent, severe persistent, and acute persistent—are also used to help determine a treatment plan. Further, inflammation plays a role in all types of asthma, so asthma inflammation is categorized into four endotypes (biological pathways of inflammation); this helps doctors understand the role that inflammation plays in each type of asthma.

P.S. Uncontrolled asthma is not a type or category of asthma, but rather a term for asthma that is either not being managed properly or not being treated at all. What seems like severe asthma may be uncontrolled asthma instead.

WHY PREDNISONE IS USED FOR SHORT-TERM ASTHMA RELIEF

Prednisone is commonly used to treat asthma attacks, also called acute asthma exacerbations, which cause a person to have severe difficulty breathing. Prednisone is a corticosteroid, and doctors use these medications to stop the inflammatory response so that the person’s airways relax and widen, allowing them to breathe more easily. Prednisone is made to mimic the body’s own hormonal response. It is a short-acting drug meant to treat acute attacks, not a long-term asthma solution. Prednisone can have many side effects when taken on a regular basis, but those are limited when it is used on an as-needed basis for emergencies. Better long-term solutions include combining medications like beta-2 agonists with biologics.

P.S. Using a rescue inhaler more than twice a week, having asthma that regularly disrupts sleep, or asthma attacks that require hospitalization are signs that you need to adjust your asthma treatment plan.

CAN A PERSON BE ALLERGIC TO THEIR OWN SWEAT?

Most people associate hives with an allergic reaction. Sometimes hives appear in response to heat, sweat, or raised body temperature. Cholinergic urticaria (CU, also called heat hives) is a reaction to an increase in body temperature that causes patches of red skin with hives. It is not understood exactly what causes this reaction, but some doctors believe it may be an allergic response to sweat. People with CU may notice hives caused by sweat from working out, anxiety, or hot temperatures. People with eczema, asthma, and other allergies like hay fever are more likely to experience hives caused by CU. CU hives tend to show up about six minutes after exposure, and the skin may appear swollen, blotchy, or flushed. 

P.S. Some people can have a life-threatening version of cholinergic urticaria that causes full-body hives, angioedema, bronchospasms, and very low blood pressure.

WHAT’S THE DIFFERENCE BETWEEN A FISH AND A SHELLFISH ALLERGY?

Seafood allergies can be confusing, especially when fish and shellfish don’t contain the same allergens and “shellfish” actually includes two types of edible sea creatures (mollusks and crustaceans). Some people with a shellfish allergy are only allergic to one type. Fish allergies are usually caused by a type of calcium-binding protein, while the muscle proteins in shellfish are usually the source of shellfish allergies. However, there are several other allergens in both fish and shellfish, which explains why some people are allergic to all types of seafood and others are only allergic to fish or one group of shellfish. For some people, the allergy-causing proteins in seafood can initiate a reaction through touch or inhaling the fumes as it cooks.

P.S. Seafood allergies are the most frequently reported allergy by adults and are also one of the most common allergies in children. A person can develop a shellfish allergy at any stage of life.

SILENT CHEST: SIMILAR, BUT NOT THE SAME AS SILENT ASTHMA

Asthma is normally associated with coughing, wheezing, and difficulty breathing. Silent asthma is a form of asthma that does not exhibit audible symptoms, and it is often a sign of the most severe types of asthma (like fatal asthma and status asthmaticus). Silent chest is used to describe one type of severe asthma that does not produce audible symptoms. If a prolonged asthma attack is followed by the symptoms of silent asthma—or accompanied by loss of consciousness or cyanosis—the condition is called silent chest, and it is considered a life-threatening emergency. A person with silent asthma may not experience silent chest, while a person with other forms of asthma can have an episode of silent chest.

P.S. Cyanosis happens when blood has extremely low oxygen levels. It causes blue, purple, or grayish discoloration of the skin, lips, and nails and may occur as a result of silent chest.

BREATHING EXERCISES TO STOP OR PREVENT AN ASTHMA ATTACK

Breathing exercises can help anyone experiencing trouble breathing, increased heartrate, or anxiety, especially when they all happen at once. People with asthma can benefit from learning breathing techniques that can help them slow, stop, or prevent an asthma attack. Breathing exercises help retrain your breathing by increasing the strength of respiratory muscles and improving ribcage flexibility. They reduce asthma symptoms by improving lung function and overall lung health. Breathing exercises can’t prevent airways from narrowing, but they can help you control your breathing. And better breathing control reduces the likelihood and frequency of asthma attacks. Stress and anxiety can trigger asthma and vice versa. Intentional breathing decreases stress and anxiety and helps prevent asthma triggered by emotions.

P.S. Breathing and relaxation exercises that help improve asthma include diaphragmatic breathing, nasal breathing, alternate-nostril breathing, purse-lipped breathing, yoga breathing, and meditation.

WHAT HAPPENS DURING ANAPHYLAXIS?

Anaphylaxis is a severe, life-threatening allergic reaction that causes difficulty breathing and other serious symptoms throughout the body. If you or someone you’re with is having an anaphylactic reaction, you may see or experience trouble breathing, facial swelling, rapid heartbeat, hives, vomiting, and fainting. These symptoms can come on very quickly, either immediately after contact with an allergen or within a couple of hours. What causes this powerful response? An anaphylactic reaction makes the immune system release a flood of chemicals known as histamines to attack the invading allergen—much more than a normal allergic response. The sudden release makes the body go into shock, causing symptoms like rapidly narrowing airways and a sudden drop in heartrate.

P.S. Anaphylaxis requires an epinephrine injection and can be fatal if not treated immediately, often requiring a trip to the emergency room.

WHAT TO KNOW BEFORE STARTING ALLERGY SHOTS

Allergy shots are a form of immunotherapy used to decrease the severity of allergy symptoms for certain allergies. They do not cure allergies but can help ease symptoms and reduce medicine use. The shots are given in two phases. During the build-up phase, small doses are given in increasing amounts for a period of six to ten  months, as the body adjusts to the allergens. Once an effective therapeutic dose is achieved, the maintenance phase begins, and injections are given about once every three to four weeks over a period of three to five years or longer. Although local reactions to allergy shots are common (such as redness and swelling at the injection site), serious reactions are rare.

P.S. Some studies have shown that allergy shots may stop asthma from developing in children with nasal allergies.

WHAT DOES SMOKING DO TO ASTHMA PATIENTS?

There are numerous harmful effects of tobacco smoke on smokers with asthma and people with asthma who are subjected to second-hand smoke. Smoke is a major trigger for many asthma patients. People who smoke have more sensitive airways and a higher risk of triggering asthma. Smoking leads to increasing asthma symptoms, more frequent and severe attacks, poorer asthma control and medication effectiveness, and lower activity levels. The same is true for asthma patients who inhale second-hand smoke. Tobacco smoke damages the lungs’ cilia—the tiny hairs responsible for sweeping the lungs clean. Loss of cilia causes mucus and toxic substances to collect in the lungs, increasing risk of infection. It also damages the airways and air sacs inside the lungs.

P.S. Smoking during pregnancy harms the development of the baby’s lungs and puts them at higher risk for asthma after birth.

HOW DO BIOLOGICS WORK TO REDUCE ASTHMA SYMPTOMS?

Many asthma patients are able to manage their symptoms through a combination of daily oral or inhaled corticosteroids, as-needed use of a quick-relief inhaler, and avoiding their asthma triggers. But this regimen doesn’t work for everyone. Some people with moderate-to-severe asthma find success using a group of medications called “biologics.” Biologics are made by modifying the cells of a living organism so that they target specific molecules in humans. Biologics for asthma target antibodies, inflammatory molecules, or cell receptors to disrupt the pathways leading to inflammation and asthma symptoms. Biologics improve lung function in some patients with severe asthma. Other benefits include fewer asthma symptoms and acute attacks, lower doses of other medications, and fewer missed work or school days.

P.S. Most biologics are given via injection at a doctor’s office every two to eight weeks and may eventually be administered at home.

WHAT CAUSES ALLERGIES AND WHY DO I HAVE THEM?

The immune system produces an antibody called Immunoglobulin E (IgE) to protect against allergens. IgE tells the immune cells to produce chemicals to fight foreign invaders (the allergens). The immune system develops immunological memories to respond faster to foreign invaders. People with allergies have higher IgE levels that increase immunological memory and cause an overreaction to allergens that causes allergy symptoms. Allergies can develop at any age, and genetics are a big factor. A child who has one parent with allergies has a 30 to 50% chance of developing them, which increases to 60 to 80% if both parents have allergies. Exposure to new allergens and changes in the immune system also play a large role in allergy development.  

P.S. Immunological memory is what makes vaccines work the way they do, by creating a faster response to a harmful, foreign substance (a virus).

WHAT TO KNOW ABOUT TREE NUT ALLERGIES

Allergies to nuts that grow on trees are some of the most common food allergies among both children and adults. The six most common tree nut allergens are walnut, pecan, cashew, chestnut, pistachio, and hazelnut. However, U.S. labeling requirements necessitate the labeling of 18 different tree nuts on food packages. Many people who are allergic to one tree nut have an allergy to at least one other. Tree nuts are known to cause higher numbers of anaphylaxis (life-threatening reactions) than many other allergens because they contain higher numbers of proteins that bind to the antibodies in the immune system that cause allergic reactions. People with this allergy should always carry an epinephrine pen (an injection that reverses allergic reactions).

P.S. Peanuts, another common allergen, are legumes that grow underground and are not related to tree nuts.

TAKE THE ASTHMA LIFE QUALITY TEST

An asthma life quality (LQ) test helps people determine how well their asthma is managed and if better management can improve their quality of life. These tests ask about trouble breathing while performing routine tasks like chores, how often you catch a cold, and how well your current asthma medications are working. An LQ test is meant to show how well your asthma symptoms are controlled and how you can work with your doctor to reduce them. Do you avoid exercise because of breathing problems? Are you able to regularly take deep breaths? Do you cough frequently? Considering these questions can help you see the areas of life that asthma is affecting the most and how to improve them.

P.S. Find an asthma life quality (LQ) test online and bring the results to your next appointment with the doctor managing your asthma treatment plan.

MILD, MODERATE, AND SEVERE ASTHMA

Two sets of guidelines are used to classify asthma severity: the Global Initiative for Asthma (GINA) and the National Asthma Education and Prevention Program (NAEPP). The NAEPP classifies asthma as intermittent or persistent, and further categorizes persistent asthma as mild, moderate, or severe. Intermittent asthma is characterized by infrequent, short flare-ups. Mild asthma does not cause problems on a daily basis and can be managed with low-dose, inhaled medications as needed. Moderate asthma causes lower lung function and symptoms on most days that can still be well managed with a combination of oral and inhaled medications as needed. Severe asthma is chronic, difficult to control with common medications, and may require alternative therapies like LAMA (long-acting muscarinic antagonists) and biologics.

P.S. People with intermittent asthma often have higher lung function and their symptoms don’t affect daily activities.

KISSING ALLERGY?

Can a person be allergic to kissing? According to the American College of Allergy, Asthma, and Immunology, kissing someone who has  eaten a food or medicine you are allergic to can cause an allergic reaction in addition to giving you germs from a contagion. Even hours after a food allergen is ingested, or after the person has brushed their teeth, their saliva can continue to secrete the allergen that their body has absorbed. In severe cases, an allergic person must avoid kissing someone who has eaten their allergen for 16 to 24 hours before it is safe. If you have a serious food allergy that may lead to anaphylaxis, discuss it with any new partner before eating or kissing.

P.S. With mild to moderate allergies, experts advise waiting four hours and thoroughly brushing your teeth before kissing someone who is allergic to something you ate.

WHAT IS A DUST MITE ANYWAY?

Is dust a living, breathing creature, or is it, well…just dust? The dust we find in our homes is a combination of dead skin cells, dirt, pollen, clothing fibers, tiny plastic particles, dead insect remains, and dust mites. House dust mites are microscopic arachnids (spider family) that thrive in warm, humid environments and feed on our dead skin cells. Thankfully, they don’t live on our bodies, but they do end up in our sheets, clothing, and upholstery. Although tiny, dust mites are not airborne but settle on fibers and dust that become their nest. Unfortunately, dust mites are an allergen for many people, causing typical allergy symptoms when inhaled, such as sneezing, itching, watery eyes, and swollen nasal passages.

P.S. People with a dust mite allergy are reacting to the proteins inhaled from dust mite feces, urine, and decaying body parts. 

DIFFERENT TYPES OF AIRWAY INFLAMMATION

In the past, asthma was a general diagnosis referring to chronic airway inflammation, but today we know that there are different subgroups of asthma classified according to the type of airway inflammation. Eosinophilic asthma was initially the only kind of asthma, named for the rise in eosinophils—a type of white blood cell—that happens in response to an allergen. Over time, however,  doctors realized that nearly 50 percent of asthma cases were caused by something else. Some asthma patients have elevated neutrophil (another kind of white blood cell) levels in their airways and have neutrophilic asthma, triggered by airborne pollutants, viruses, and bacteria. And many asthmatics have a combination of these two types, called mixed neutrophilia and eosinophilia inflammation.

P.S. A newer asthma subgroup called non-inflammatory (or paucigranulocytic) asthma is characterized by normal levels of eosinophils and neutrophils.  It is not as well understood as other subgroups.

HOW GLUCOCORTICOIDS WORK TO TREAT ASTHMA

Glucocorticoids are a type of steroid commonly prescribed to manage asthma. They are medications used to reduce the immune system’s inflammatory response. Your body makes its own glucocorticoids to control inflammation and the way your cells process fats and sugars. Normally, inflammation is your immune system’s response to infection or injury. It causes your body to produce hormones and extra white blood cells that help your body heal. Sometimes this immune response is too strong and can hurt your body, such as when asthma triggers airway inflammation that hinders breathing. Prednisone and dexamethasone are two glucocorticoids commonly used to treat asthma and allergies. These drugs mimic the effects of the hormone cortisol, which the body uses to reduce inflammation.

P.S. Many asthma patients do not respond to glucocorticoids but often see positive results from non-steroidal oral medications and biologics, which use living cells to target inflammatory response.

IS ECZEMA AN ALLERGIC REACTION?

Eczema actually refers to a group of skin conditions that cause dry, itchy skin, and many of those conditions are caused by allergies. Atopic dermatitis (often caused by food and environmental allergens) is the most common type, affecting almost 90 percent of eczema sufferers. Contact dermatitis (a reaction to something that touches the skin) is the second most common type. Dry skin is the foremost cause of eczema, and heat or hot weather that dries skin can trigger eczema flare-ups. When eczema results from an allergen combined with another trigger like dry skin, flare-ups can be severe. Regardless of the cause, the best treatment for eczema is moisturizing the skin and avoiding any known triggers like allergens.

P.S. Eczema is more common in children than adults. Many children overcome the condition, but some experience flare-ups in adulthood.

COMMON FOOD ALLERGENS: EGGS

Eggs don’t have the reputation that peanut allergies do, but egg allergies are quite common and can be just as dangerous if you have a reaction. Egg allergies in adults are less usual, and while they affect about two percent of children, as many as 70 percent of them outgrow the allergy during childhood. The most frequent symptoms are a rash and/or stomach pains shortly after eating (or touching) eggs. Other common symptoms include nausea and vomiting, wheezing and difficulty breathing, watery and itchy eyes, and less often, anaphylaxis. Because eggs are a common ingredient in many processed foods, people with this allergy must become excellentlabel readers. Eggs are one of eight allergens that must follow legal labeling requirements.

P.S. People who are allergic to eggs from chickens may experience an allergic reaction to eggs from other birds such as duck, quail, goose, and turkey eggs.

VIRAL-INDUCED ASTHMA

Many factors can trigger asthma, including exercise, cold air, mold, allergens, and airborne irritants. However, viral infections are actually the most common asthma trigger. As many as 95 percent of children and 80 percent of adults with asthma have flare-ups caused by viral infections. These viruses include the ones we face every day: colds, the flu, RSV, and COVID-19. Many researchers suspect that viral-induced asthma (or viral asthma) is so common because chronic asthma damages the airways and makes them more susceptible to infection. Symptoms are similar to a regular asthma attack, but also include cold or flu-like symptoms. Viral asthma often lasts longer than typical asthma attacks, as the body must fight the infection to recover.

P.S. Scientists are still unsure whether viral infections cause asthma or simply make it worse.

BRONCHIAL TRIGGER TESTS FOR ASTHMA DIAGNOSIS

There are three kinds of “provocation” or trigger tests that measure breathing to diagnose asthma: the irritant challenge, the exercise challenge, and the methacholine challenge. Before and after each test, lung function is measured with a spirometer. The irritant challenge exposes you to a substance suspected of triggering asthma. The exercise challenge monitors changes in heartrate and oxygen levels while you run on a treadmill. The methacholine challenge uses the drug to constrict the airways and induce an asthmatic response. People with asthma respond to a low dose of methacholine, while non-asthma people respond to higher doses. If you have asthma symptoms but the lower dose doesn’t trigger a response, you may have a different lung condition.

P.S. Methacholine is in a class of drugs called cholinergic receptor agonists. It uses muscarinic receptors in the lungs to induce bronchoconstriction (tightening of the airways).

THE ANTS AND THE BEES

Honeybees, bumblebees, hornets, wasps, and yellow jackets are all similar flying insects that sting and can cause a venomous allergic reaction. The only other stinging insect known to cause an allergic reaction is the fire ant. Black and red fire ants can sting repeatedly and almost always cause a non-allergic reaction in their victims. A non-allergic reaction creates an itchy hive or bump at the sting site, which usually disappears within 60 minutes. Then the bump becomes a blister within 8 to 24 hours, which can become infected if scratched or broken. An allergic reaction to the sting is more concerning.  In addition to itching and swelling, it can cause intense abdominal pain, vomiting, and difficulty breathing and swallowing.

P.S. Fire ants usually attack in groups and produce multiple stings that can make an allergic reaction more severe. They clamp down on your skin with mandibles that make it difficult to simply brush them away.

WHEAT ALLERGY VERSUS GLUTEN INTOLERANCE

A wheat allergy versus a wheat or gluten intolerance can be an important distinction. An intolerance can make a person feel uncomfortable or sick, while an allergy can be life-threatening. Luckily, most wheat allergies are mild. Wheat allergy and gluten intolerance symptoms have both similarities and distinct differences. Wheat allergies cause hives, sneezing, a stuffy or runny nose, headaches, asthma, and, less commonly, anaphylaxis. But one set of wheat allergy symptoms—nausea, vomiting, stomach cramps, indigestion, and diarrhea—is similar to those caused by gluten intolerance. An allergist can determine whether or not an allergy is present with a simple skin prick or blood test. Wheat allergies are most common in children and are often outgrown at a young age.

P.S. Gluten intolerance is not an allergy. Celiac disease—a type of gluten intolerance—causes an immune response leading to severe gastrointestinal issues, but this is not the same as the immune response to an allergen, which causes the body to produce histamines.

DERMATOGRAPHIC ALLERGIC REACTIONS

Dermatographia, or “skin writing” as it’s commonly called, is an allergic reaction in response to the skin being scratched, rubbed, or pricked. It is actually quite common and not usually dangerous. People with this condition get welts or hives within about 5 to 7 minutes of the skin being scratched or irritated. Symptoms usually disappear within 15 to 30 minutes and commonly include swelling, inflammation, welts, itching, and raised red lines where the skin was scratched. Exercise, stress, and heat or cold exposure can make symptoms worse. For sensitive people, the reactions can be triggered by things like clothing, bedsheets, or leaning against a hard surface. Dermatographia is more common in kids and teens and may be acute or chronic.

P.S. Dermatographia is called skin writing because people with this condition can use a sharp object like a fingernail to scratch words into their skin that appear as raised welts.

RULING OUT COPD WITH AN ASTHMA DIAGNOSIS

Asthma and chronic obstructive pulmonary disorder (COPD) are both lung diseases that make breathing more difficult. It’s common for a patient with one disease to have symptoms of the other, and sometimes people have both conditions, called asthma-COPD overlap. This makes both conditions more difficult to diagnose. One difference is that asthma can improve, and symptoms may come and go, while COPD symptoms are constant and worsen over time. Asthma attacks cause chest tightness and wheezing, while COPD causes a cough with phlegm. Spirometry tests, bronchodilators, and trigger tests are used to help diagnose asthma. If COPD is also suspected, chest X-rays and arterial blood tests can be used to diagnose, rule out, or look for asthma-COPD overlap.

P.S. Asthma-COPD overlap is more common in people who had childhood asthma. It is common to have COPD without asthma and vice versa.

WHY IS ASTHMA WORSE AT NIGHT?

There’s no consensus on what makes asthma get worse at night, but it happens to as many as three-quarters of asthma patients. Lung function is lower at night because our muscles relax while we sleep. This causes our airways to narrow, making breathing more difficult. Hormonal changes occur at night too, like lower cortisol levels, which have been shown to increase airway obstruction in some studies. Other factors can have an effect too: your sleeping position, exposure to allergens in the evening or at night, poorly controlled daytime asthma, and sleeping in a cold or air-conditioned room. Other conditions that can increase nighttime asthma symptoms include sleep apnea, sinusitis, and acid reflux. Allergic rhinitis can increase nighttime symptoms by 50 percent.

P.S. Nocturnal asthma is a condition that causes severe asthma symptoms before and during sleep.

MONTHLY RASHES MAY INDICATE A PROGESTERONE ALLERGY

Also called autoimmune progesterone dermatitis, progesterone hypersensitivity (PH) is a condition that causes an allergic skin reaction near the end of the menstrual cycle, when progesterone levels spike. Common symptoms include rashes, hives, eczema, swelling, itching, and flaking skin, while more severe reactions can include open sores and anaphylaxis. PH is an allergic reaction to a woman’s own progesterone. Symptoms appear three to ten days before a woman’s period begins and clear up during the first days of her period. One theory about the cause of PH is that women who have taken hormonal contraceptives or progesterone supplements can develop a sensitivity to progesterone, which causes a monthly reaction. Pregnancy also causes elevated progesterone levels that may trigger the condition.

P.S. Allergic reactions to estrogen can happen, but they are not as common as allergic reactions from progesterone hypersensitivity.

DAIRY ALLERGY OR LACTOSE INTOLERANCE?

Lactose intolerance is not the same as a milk or dairy allergy. Lactose intolerance is the body’s inability to digest the sugars present in many dairy products. An allergic reaction to dairy is an immune response or immune system overreaction to the proteins found in dairy products. There are two types of dairy allergies: immunoglobulin E (IgE)-mediated and non-IgE-mediated. IgE is the type of antibody released in response to an allergen. An IgE-mediated response happens immediately. A non-IgE-mediated response involves other parts of the immune system besides IgE and takes longer for symptoms to appear, often as nausea, vomiting, and diarrhea. Since these are some of the same symptoms caused by lactose intolerance, the two conditions are often confused.

P.S. A cow’s milk allergy is the most common food allergy in infants and young children.

MEDICATION-INDUCED ASTHMA

If you’ve recently been diagnosed with asthma, check with the doctor managing your asthma before taking any over-the-counter medications or new prescription medications. Certain prescription and non-prescription drugs are known to cause asthma symptoms and flare-ups. Two types of common household medications, aspirin and NSAIDs, cause asthma symptoms more often than other types of drugs, and some doctors recommend that asthma patients avoid them altogether. Beta-blockers and ACE inhibitors—two groups of drugs used to treat heart conditions and high blood pressure—can affect asthma too. Common symptoms include a runny nose, coughing, wheezing, and shortness of breath. Prescription narcotics don’t often cause asthma flare-ups but can lead to complications with breathing if an asthma attack happens while taking them.

P.S. Asthma patients with nasal polyps are at higher risk of an asthmatic reaction when taking aspirin and NSAIDs.

ORAL IMMUNOTHERAPY FOR FOOD ALLERGIES

Oral immunotherapy (OIT) exposes people with food allergies to problem foods in small but increasing amounts to help the immune system begin to recognize the foods as safe. Allergies make the immune system overreact to allergens and release histamines, causing allergy symptoms. OIT takes place in a clinical setting where reactions can be monitored and controlled. A patient will ingest doses of the targeted allergen in amounts so small they won’t cause a reaction. Over time, these doses are increased to raise the threshold for allergic reactions to that substance. OIT does not cure people of allergies, and people who receive successful OIT treatments will still need to carry an epinephrine pen and limit their intake of the offending food.

P.S. Oral immunotherapy may be more effective with certain food allergens. The current recommendation for people with food allergies is to avoid the allergen and carry an epinephrine pen.

HOW OBESITY EFFECTS ASTHMA

The CDC reports that 38 percent of adults in the United States are obese, defined as a BMI of 30 or higher. People in this category, especially women, have a much higher risk of developing asthma. The reasons for this are not entirely understood, but studies show that inflammatory substances in fat tissue can affect the lungs and may also affect asthma. Obese asthma patients have more symptoms and use more medications than lower-weight patients. They also don’t respond as well to asthma medications. People who have both obesity and asthma also have more additional medical conditions that affect asthma, especially obstructive sleep apnea. Obese asthma patients have difficulties exercising, but daily walks can improve both weight and lung capacity.

P.S. Obese asthma patients are advised to eat a diet low in fat due to the role that fat tissue plays in inflammation.

SPIROMETRY TESTS FOR ASTHMA DIAGNOSIS

A spirometry test is one of the most common ways to diagnose asthma. It can be done in minutes in a doctor’s office. It measures how much air you can inhale and exhale, and how fast you can exhale. The test can tell if you have asthma or how well you’re managing asthma is you’ve already been diagnosed. If a spirometry test shows reduced lung function, you may be given a bronchodilator (inhaler) to see if the medication improves lung function when you take the test a second time. During future visits a spirometer can be used to monitor your asthma and the effectiveness of your treatments and medications. It is a safe test that rarely causes side effects.

P.S. Spirometry tests are used to diagnose chronic obstructive pulmonary disorder (COPD) and other lung issues, in addition to asthma.

WHAT TO KNOW ABOUT SHELLFISH ALLERGIES

Shellfish allergies are common and can include allergies to some or all shellfish. An itchy rash and a stuffy nose are the most common reactions, but serious shellfish allergies can be life-threatening. Symptoms appear quickly, usually within a few minutes to an hour. There are two classes of shellfish: crustaceans (shrimp, lobster, crab) and mollusks (squid, clams, scallops). A person may be allergic to crustaceans and not mollusks, or vice versa, and crustacean allergies are more common. Fish allergies are a different type of seafood allergy, so those with shellfish allergies may still be able to enjoy some food from the sea. Shellfish allergies are more common in adults and women, while childhood shellfish allergies are more common in boys.

P.S. Glucosamine, commonly used to treat arthritis, comes from shellfish skeletons and should be avoided by people with a shellfish allergy. Chondroitin is a safe alternative.

ARE ALLERGY SHOTS THE ANSWER?

There are plenty of over-the-counter and prescription medications available for treating allergies. Each person reacts differently to both allergens and allergy treatments, so it’s important to work with your doctor to create the best treatment plan. Allergy testing can diagnose your specific allergies so they can be targeted in your treatment plan. Allergy shots are a form of immunotherapy that can reduce—and in some cases eliminate—reactions to environmental allergens. Allergy shots reduce allergy symptoms over time by exposing your immune system to small amounts of the problem allergens, much like a vaccine. Many people respond better to allergy shots than medications and can find long-term management and relief, sometimes with just one or two courses of shots.

P.S. Vitamin C is a natural antihistamine that can help reduce allergy symptoms.

BETA-AGONISTS AND CORTICOSTERIODS FOR ASTHMA

Beta2-agonists are a group of inhaled bronchodilators (airway opening) drugs used to treat asthma. Short-acting beta-agonists (SABA) are used for quick relief or to prevent exercise-induced asthma. SABAs are meant to be taken as needed but should not be used more than a few times a week. Long-acting beta-agonists (LABA) are intended for daily use to relax the muscles in the airways and make breathing easier. To treat asthma, LABAs must be taken in combination with a corticosteroid (anti-inflammatory drug). But inhaled corticosteroids (ICS) may be able to treat asthma symptoms alone, without the addition of a LABA. If asthma can’t be controlled with an ICS, the next step is taking a combination of LABA and ICS.

P.S. Beta2-agonists are powerful anti-inflammatories that address asthma symptoms, but they do not address the inflammation at the root of asthma attacks.

EXTRINSIC ASTHMA OR INTRINSIC ASTHMA?

Extrinsic and intrinsic asthma are also called allergic and nonallergic asthma. Extrinsic or allergic asthma is triggered by an allergen, while intrinsic or nonallergic asthma is triggered by something other than an allergy. Because the symptoms of both kinds of asthma are similar, the two conditions can be difficult to decipher, and you may need to examine potential triggers to tell the difference. When asthma symptoms mimic seasonal allergies or you’re already experiencing allergy symptoms, it usually indicates extrinsic asthma. Asthma symptoms that accompany or follow an upper respiratory virus or infection, oral infections, or exercise are usually caused by intrinsic asthma. It is possible to have both intrinsic and extrinsic asthma and seasonal allergies all at the same time.

P.S. Age can point to whether asthma is extrinsic (usually develops during childhood) or intrinsic (usually develops in middle age or later).  

WHAT CAUSES A ROACH ALLERGY?

Insects like bees inject venom when they sting, which can cause an immune response that leads to an allergic reaction. But what makes an insect like a cockroach a common allergen? An immune response to the proteins in the saliva, feces, and shedding body parts of cockroaches can all trigger an allergic reaction when disturbed, much like dust mites. Symptoms of a cockroach allergy mimic those of seasonal allergies, but a cockroach allergy can extend long beyond allergy season. A simple skin test can confirm whether your allergy symptoms are caused by roaches. Medications and allergy shots can improve symptoms, but the best defense is to remove roaches from living spaces and roach-proof your home.  

P.S. Regular housecleaning, keeping food sealed, fixing leaks, and limiting piles of items like laundry and magazines are an effective start to a roach-free home.

ALLERGIC DERMATITIS FROM NICKEL

Allergic reactions to nickel are a type of allergic contact dermatitis, which causes an itchy rash in response to a normally harmless substance. Regular or prolonged exposure to nickel can cause the allergy to develop, but like many allergies, the actual cause is unknown. In addition to coins and jewelry, nickel is found in eyeglass frames, zippers, belt buckles, cosmetics, detergents, and electronic devices like cell phones and laptops. Most reactions occur only where the nickel touched the body. Reactions can occur hours to days after exposure and may last anywhere from two to four weeks. In addition to a red, bumpy rash, a nickel allergy can cause severe itchiness, dry patches that resemble a burn, and fluid-filled blisters.

P.S. People with extremely sensitive nickel allergies may have reactions to foods containing higher amounts of nickel, such as canned foods, soy products, peas, cocoa, clams, and cashews.

USING A PEAK FLOW METER TO TRACK ASTHMA

A peak flow meter is an easy-to-use handheld device that measures airflow in and out of the lungs. You can use a peak flow meter any time to see when you might have an asthma flareup. A peak flow meter is so sensitive it can tell that your airways are narrowing hours or even days before symptoms begin. By regularly measuring your airways, you can tell when an asthma attack is coming and preventively use asthma medications to limit or avoid symptoms or a serious episode. Tracking your asthma symptoms can also help you and your doctor see whether your medications are working, when to adjust medications and other treatments, and how to identify your asthma triggers.

P.S. A peak flow meter can measure changes in the airways more accurately than listening with a stethoscope.

ARE ASTHMA AND SLEEP APNEA CONNECTED?

Asthma and obstructive sleep apnea (OSA) are both respiratory disorders that affect breathing. Asthma causes airway narrowing and inflammation, while OSA causes upper airway obstruction. The two conditions are related and affect one another. People with asthma are at higher risk of developing OSA, and OSA increases asthma symptoms when a person has both conditions. During OSA, the muscles at the back of the throat relax and block air from moving to the lungs, causing a pause in breathing for several seconds. One connection between OSA and asthma is that OSA may cause asthma-like symptoms such as airway inflammation and narrowing, making asthma symptoms worse and increasing flareups. Asthma also makes OSA worse by restricting airways and breathing capacity.

P.S. Risk factors that are common for both asthma and obstructive sleep apnea include obesity, rhinitis (allergic reaction), GERD (gastroesophageal reflux disease), and family history.

CAN EXTREME HEAT CAUSE ALLERGIC REACTIONS?

Heat waves and hot weather can cause several heat-related symptoms and reactions in our bodies. We normally associate hives (also called urticaria) with an allergic reaction, but extreme heat or elevated skin temperature can also cause the body to release the same histamine that causes an allergic reaction like hives. Histamine dilates blood vessels and causes swelling to help your immune system fight invasions. Heat hives (also called cholinergic urticaria) are caused by a rise in body temperature that tells the body to release histamine. Heat hives are more common if you have an allergic reaction to sweat, clogged sweat ducts, or even lack of sweating, which can occur when the body becomes dehydrated from heat exposure.

P.S. A heat rash is not the same as hives caused by heat. Heat rash occurs due to blocked sweat ducts, while heat hives are an allergic reaction to a rise in skin temperature.

Source: healthline.com (Allergy 9-3-23 HT)

FENO TESTS FOR ASTHMA

Asthma makes breathing more difficult, and it also has symptoms similar to several other respiratory conditions. Some people have both asthma and another respiratory issue. If you’ve not yet been diagnosed with asthma, a FeNO test can help determine what’s causing your symptoms and either confirm or rule out asthma. FeNO stands for fractional exhaled nitric oxide, and it’s used to measure the amount of nitric oxide in your breath, which helps doctors determine if and how much your airways are inflamed. If you’ve already been diagnosed with asthma, tracking FeNO levels can help determine what kind of asthma you have and whether your medications are working or need adjusting. The test is quick, non-invasive, and results are available immediately.

P.S. A FeNO test can tell if you are a good candidate for using corticosteroids to manage asthma. It can also show your doctor if you’ve been using your medications correctly.

Source: aafa.org (Allergy 9-3-23 HT)

ARE BEE STINGS AND HONEY ALLERGIES RELATED?

Honey allergies are extremely rare, but people who are allergic to bee stings or pollen may find themselves reacting to honey. A bee sting allergy is an immune response to bee venom. An allergic reaction to honey is usually a reaction to something in the honey rather than the honey itself. Pollen is a common allergen, and honeybees are avid pollinators. People with severe pollen allergies may have reactions to honey or beeswax. Unprocessed honey is more likely to contain pollen and other bee components like bee venom sacs. Studies show that people with pollen allergies have reactions on varying levels from different types of pollen. Honey is likely to contain several types of pollen due to cross-pollination from bees.

P.S. If you experience an allergic reaction to a bee sting, you are at a higher risk for a reaction to honey, which may contain small amounts of bee venom.

Source: beeawareallergy.com (Allergy 9-3-23 HT)

WHAT TO KNOW ABOUT SOY ALLERGIES

Although adults can develop a soy allergy, it is most common in infants and young children. Many children will outgrow a soy allergy as they get older. Soy reactions can cause a laundry list of symptoms, but the most concerning are trouble breathing and throat swelling, which can lead to anaphylaxis (a life-threatening allergic reaction). More often, soy will cause common allergy symptoms like itchiness, coughing, and hives. It can also cause stomach issues including nausea, cramps, indigestion, vomiting, and diarrhea, which may indicate a soy intolerance rather than an allergy. Of course, avoiding soy if you’re allergic is the best way to prevent a reaction. Since soy is an ingredient in many food products, reading labels becomes essential.

P.S. Non-food items containing soy can also cause an allergic reaction, such as candles, crayons, makeup, and cleaning products.

Source: my.clevelandclinic.org (Allergy 9-3-23 HT)

DO YOU HAVE NOCTURNAL ASTHMA?

Managing your sleep is an important part of managing asthma. Losing sleep increases asthma symptoms, causes inflammation in the body, and reduces lung function, all of which can make asthma worse. Asthma tends to flare up at night, and it’s common for asthma patients to be woken up by asthma symptoms more than once a week. Poorly controlled asthma also places you at higher risk for nighttime asthma. To improve your sleep and your asthma symptoms, it’s important to remove all allergens from your bedroom, which are common asthma triggers for many patients. Other tips for improving sleep include adhering to a sleep schedule, creating a bedtime routine that promotes sleep, and following a regular schedule during the day.

P.S. Acid reflux is commonly associated with nocturnal asthma, affecting around 80% of asthma patients.

Source: sleepfoundation.org (Allergy 9-3-23 HT)

YOUR ASTHMA TREATMENT ACTION PLAN

Inhaled, oral, and intravenous medications are the most common ways to treat asthma. Treatment also involves identifying asthma triggers and avoiding them or removing them from your immediate environment. Once your doctor has prescribed medications to control asthma, it’s time to work with them to create an asthma treatment action plan. This can allow you to increase or decrease your medication doses based on your changing symptoms. You can also create a list of your triggers and how you will take measures to avoid them. Your doctor may also want you to track your asthma symptoms with a peak flow meter, which can help monitor how effectively your medications are controlling your asthma.

P.S. Lung function tests can be done before and after trying an asthma medication to measure improvement in lung function on the medication.

Source: webmd.com (Allergy 9-3-23 HT)

WHAT IS EXERCISE-INDUCED ANAPHYLAXIS?

Exercise-induced anaphylaxis is an allergic reaction that occurs during physical activity. While vigorous exercise is more likely to cause the reaction, it can also be triggered by lighter forms of exercise like yard work. Physical activity is not fully to blame for the reaction, as other factors like weather, food, and medications can be contributing factors. Food-dependent exercise-induced anaphylaxis occurs during exercise after eating certain foods like peanuts, shellfish, corn, tomatoes, and wheat. Medications like aspirin and anti-inflammatories can also trigger the reaction. Hormonal fluctuations, high humidity, and extreme temperatures have also been identified as triggers. Symptoms are like other allergic reactions and range from hives to difficulty breathing, cardiac or respiratory arrest, and anaphylaxis, a life-threatening allergic reaction.

P.S. An epinephrine auto-injection can slow the effects of exercise-induced anaphylaxis. If you have a known allergy, carry an EpiPen and cell phone with you when you exercise.

CAN A PERSON BE ALLERGIC TO THE WEATHER?

Cold urticaria is an allergic reaction to cold temperatures. Urticaria is the medical term for hives, and the condition often causes an itchy rash. However,  it’s not only the weather that is to blame. Enjoying an icy beverage, icing an injury, and jumping into a cold body of water can all trigger cold urticaria. Acquired cold urticaria occurs in people with no family history of the condition. It tends to be immediate and less severe. Symptoms appear within a few minutes of exposure and usually clear up within minutes. Familiar cold urticaria is hereditary, affecting people with a family history of the condition. Symptoms may appear 30 minutes to 48 hours after exposure and can last for a few days.

P.S. Cold urticaria itself is not contagious, but it is sometimes associated with infections and viruses that may be passed to another person.

HOW TO SPOT A LATEX ALLERGY

Latex is made from natural rubber derived from the rubber tree plant, and its milky sap can cause an allergic reaction in some people. Repeated exposure to latex products can result in a person developing a latex allergy. Those at high risk include healthcare workers and other occupational workers who use latex gloves, spina bifida patients, and people who have undergone multiple surgeries. Latex allergy symptoms range from mild to severe and can lead to anaphylaxis. Symptoms may include skin irritations like hives and itchiness; cold-like symptoms like a runny nose, sneezing, itchy eyes, and a sore throat; and asthma-related symptoms like trouble breathing. Symptoms may arrive in seconds or over several hours, and the reaction usually progresses quickly.

P.S. A suspected latex allergy  can be confirmed with an allergy skin test or blood test.

SILENT ASTHMA

Wheezing and coughing are the hallmarks of asthma symptoms, but sometimes these audible symptoms aren’t present during an asthma flare-up. Other symptoms like chest tightness, shortness of breath, difficulty speaking, and distress may still occur, but without wheezing and coughing. Asthma without audible symptoms is sometimes referred to as “silent asthma.” Silent asthma can make asthma more difficult to diagnose, especially since asthma symptoms can vary widely depending on the severity of the flare-up. And not all asthma patients experience the same suite of symptoms and may not have wheezing and coughing with every incidence of asthma. If you have difficulty breathing but lack wheezing and coughing, especially after a common asthma trigger, you may be experiencing silent asthma.

P.S. If asthma presents without wheezing or coughing and you previously experienced these symptoms, or these symptoms are lacking after a prolonged asthma attack, you may be experiencing a life-threatening condition called silent chest. 

ASTHMA AND ALLERGIES AS DISABILITIES

The Americans with Disabilities Act (ADA) gives people with disabilities the right to inclusion and allows them to ask for changes that allow them to participate in the same work and activities that people without disabilities enjoy. Under the law, public places and spaces must be accessible and accommodating to people with disabilities. Asthma and allergies are both recognized disabilities under the ADA  because they can limit major life activities like breathing and eating, which affects other major activities like working or attending school. In 2008, the definition of “disabled” was expanded to include conditions that don’t always produce symptoms, like asthma and allergies. The ADA now also protects people who use a medication to control their condition.

P.S. The Americans with Disabilities Act prohibits retaliation against people with a disability who exercise their rights. You can file a complaint with the Department of Justice if you feel you have been treated unfairly.

RED MEAT REACTIONS

Alpha-gal syndrome is a type of allergy that causes people to have an allergic reaction to red meat and other products that come from mammals. The culprit is a bite from the lone star tick, which transfers the sugar molecule known as alpha-gal into the body. In some people it triggers an immune system response in the form of an allergic reaction. Reactions to red meats like beef, pork, and lamb can range from mild to severe. Other foods like dairy products and gelatin can cause similar reactions in those who are affected by alpha-gal syndrome. While the lone star tick used to be found in the southeastern United States, deer have been carrying the tick farther north and west.

P.S. There is no treatment for alpha-gal syndrome, so people with the disease must avoid the animal products that cause a reaction. Taking measures to avoid tick bites can help prevent the disease.

INTRADERMAL SKIN TESTING

There are several tests available for determining whether a person has an allergy. Blood tests and three different skin tests are all options. Intradermal skin testing is one type of skin test that may be used when a person tests negative for an allergy using other methods, but the doctor still believes the patient has a specific allergy. They are also used to test for allergies to substances like bee venom, penicillin, and medications. While a skin prick test merely scratches the skin, an intradermal skin test goes deeper by injecting the allergen into the skin and can produce more reliable results. While false negatives are rare with skin tests, false positives are more common and often require additional testing.

P.S. If you have been taking antihistamines for your suspected allergies, you may need to discontinue their use a few days prior to an allergy test.

CAN FOOD ADDITIVES TRIGGER ASTHMA?

Some people with asthma may experience allergic reactions to certain food additives, which can trigger asthma symptoms. With the exception of sulfites, food additives are not listed on food labels, but they can be spotted in ingredient lists if you know what to look for. Sulfites are both added and naturally occurring in products like wine and dried fruits, and a warning is required on food labels when they are above a certain concentration. Food colorings can cause allergic reactions that trigger asthma, and both carmine and yellow number five are known food allergens. Monosodium glutamate (MSG) is used as a flavor enhancer in a range of foods and is thought to trigger asthma symptoms in higher concentrations.

P.S. While not an additive, salicylates are found in aspirin and are naturally occurring in foods like beer, coffee, honey, and tomato paste. Salicylates may increase symptoms in some asthma patients.

Denise Hiser-Ruddick

Denise earned her master’s degree Nursing in 2009 from SUNY Upstate Medical University and became certified as a Family Nurse Practitioner.  She further advanced her education by obtaining her Doctorate degree from SUNY Upstate Medical University in 2015. She has had many roles as a Nurse Practitioner working with newborns, reproductive health, and asthma and allergy.  Her practice focuses on evidence based- care, implementing cutting edge research when developing patient care in collaboration with her team at Smith Allergy and Asthma. In her spare time she enjoys, traveling, knitting and spending time with her family.

Lynn Chamberlin

Christina Meade

Christina graduated in 2019 from the BT BOCES nursing program. She has worked in nursing homes as a CNA for 10 years before completing becoming an LPN. She grew up in Western New York and has 8 children.  Christina enjoys spending time with her husband and children, billiards with friends, and trips to buffalo to attend Buffalo Bills games with her family.

Shari Johnson

Shari received her LPN degree from SUNY Broome in 1999 while working as a Medical Assistant on NT 4 at UHS Wilson Hospital.   After a year at UHS, she began working at Broome OB/GYN where she was responsible for patient care, scheduling surgeries and procedures as well as assisting the Physician with procedures.   In 2009, she began working in Allergy and Asthma with Dr. Asha Gupta.  She took on many roles throughout her years with Dr Gupta.    Upon Dr. Gupta’s retirement in 2022, Shari transitioned to Smith Allergy & Asthma as a full time LPN.    Outside of work she enjoys spending time with her family especially her Grandchildren.