Triggers and treatments for allergies and asthma

Asthma is a heterogeneous disease caused by chronic airway inflammation. It is defined by a history of respiratory symptoms such as wheezing, shortness of breath, chest tightness and cough that vary over time and intensity, together with variable expiratory airflow limitation.

Are there different types? Some patients have “allergic” asthma, while others have an “irritant” asthma. Other patients do not suffer from these triggers. Patients with “allergic” asthma can have exacerbations of their respiratory symptoms when exposed to inhalant allergens that exacerbate the inflammatory process in their airway.

What are common triggers for asthma? Both allergies and irritant exposures can exacerbate asthma. Other triggers include upper respiratory tract infections, exercise or physical exertion, and exposure to cold air. The most common triggers of asthma for allergic patients include indoor and outdoor inhalant allergens — such as mold, dust mites, cats, dogs, mice, cockroaches and pollen from trees — as well as grasses and weeds. Respiratory inhaled irritants include tobacco smoke, wood smoke, strong perfumes, odors and air pollutants.

For allergen-induced asthma, what can be done?

The key is the avoidance of allergens, including pollen (trees, grasses, weeds), dust mites, mold, animal dander and cockroaches. To avoid mold and pollen, you may consider limiting your outdoor activities, closing windows of your car while driving and using air conditioning at home. Consider taking a shower to rinse off pollen and mold you may bring after being outdoors before going to bed.

To avoid dust mites, consider using physical barriers such as dust mite covers for pillows and mattresses. Avoid stuffed toys in children’s bedrooms. Carpeting can be removed and replaced with finished floors. Washing sheets and pillowcases weekly effectively reduces dust mite counts. In the case of pet dander, the most effective measure is to keep animals outside of the house. Washing cats and dogs twice weekly may be helpful. Although there is no published scientific literature confirming the existence of “hypoallergenic” breeds of cats or dogs, there may be individual animals with lower or higher levels of allergen.

What are the components of asthma management?

The four essential components of asthma management are routine monitoring of symptoms and lung function, patient education, control of trigger factors and amelioration of comorbid conditions, and pharmacologic therapy. The goals of asthma treatment are to reduce impairment from symptoms, minimize the risk of the various adverse outcomes associated with asthma (e.g., hospitalizations, loss of lung function), and minimize adverse effects from asthma medications.

Effective asthma management starts with patient education and requires a preventative approach, with regularly scheduled visits during which symptoms are assessed, pulmonary function is monitored, medications are adjusted, and ongoing education is provided. Patients should learn to monitor asthma control at home (e.g., frequency and severity of shortness of breath, cough, chest tightness and rescue inhaler use).

Environmental triggers and co-existing conditions that interfere with asthma management should be identified and addressed for each patient.

Pharmacologic therapy varies according to asthma severity and asthma control. Asthma control can be judged, irrespective of medication use, based on the current level of symptoms, lung function values and the number of exacerbations requiring oral glucocorticoids (steroids) per year. A stepwise approach to therapy is recommended, in which the dose of medication, the number of medications and/or the frequency of administration are increased as necessary and decreased when possible.

When does someone benefit from allergy shots (allergy immunotherapy)?

Allergy immunotherapy does not consist of injectable steroids. Steroid shots are not to be used regularly in the treatment of allergies since they may cause serious side effects.

In contrast, allergy immunotherapy is the treatment of injecting the natural allergens you are allergic to (pollen, mold, dust mites, cat and dog dander) to change your immunity to create a tolerance to these allergens and prevent allergy symptoms. Your allergist can prescribe allergy shots; at the beginning, they are given weekly, then eventually only once per month for a total of three to five years. Any patient that suffers from allergies while enjoying the company of their pets or while enjoying outdoor activities is a great candidate for allergy shots. Allergy shots are effective in helping you to have fewer symptoms, and also to use much less medication while enjoying your daily activities.

Dr. Gonzalo Alvarez del Real, MD, FAAAAI, FACAAI is an allergy, asthma and immunology specialist at Highland Clinic. He treats patients of all ages with allergies, from asthma and food allergy to contact dermatitis. Dr. Alvarez completed his allergy and immunology fellowship at The Cleveland Clinic Foundation in Cleveland, Ohio. He is accepting new patients and can be reached at (318) 798-4544; located at 1455 East Bert Kouns Industrial Loop, Suite 106, Shreveport. Visit https://www.highlandclinic. com/staff/gonzalo-alvarez-del-real-m-d for more information.