Allergic Asthma: What to Know About the Common Condition

If there was such a thing as an asthma map, you’d pass right by things like stress, smoke, and extreme weather, and head straight to the intersection of allergies and asthma to find allergic asthma. That’s because (as the name implies) this type of asthma is triggered by allergens like pollen, dust mites, ragweed, pet dander, mold, even cockroaches (yes, really). Of the 25 million–plus people in the United States with asthma, around 60% of them have allergic asthma, making it the most common type of asthma, according to the Asthma & Allergy Foundation of America.

But how do you know whether the culprit behind your constant sniffling and sneezing is an allergy or allergic asthma?

“Allergies are just your immune system overreacting to something that it shouldn’t,” Panagis Galiatsatos, M.D., a lung doctor and assistant professor in the division of pulmonary and critical care medicine at Johns Hopkins School of Medicine, tells SELF. If you’re allergic to something, “you breathe it in, have a reasonable sneeze, and move on. But if it happens in the lungs, we call it atopic asthma—the official name for allergic asthma.”

With any type of asthma, the airways extending from your nose and mouth to your lungs sometimes can act erratically, according to the National Heart, Lung, and Blood Institute. In response to a trigger, they can become inflamed, causing swelling that makes the surrounding muscles tighten and restrict your intake of air. While that’s happening, your airways boost the production of mucus, and that makes breathing even more of a struggle.

If you have allergic asthma—sometimes called allergy-induced asthma—allergens are the culprit. They trigger your asthma symptoms because your immune system thinks they’re harmful. In response, it releases a substance called immunoglobulin E (or IgE). Too much IgE can trigger inflammation of the airways in your lungs. This can make it harder for you to breathe and can cause an asthma attack, according to the Asthma & Allergy Foundation of America.

Asthma can be triggered by lots of things—exercise, pollution, various irritants at work—but allergies are the most common. A 2014 study published in Annals of Allergy, Asthma & Immunology found that 75% of adults with asthma between the ages of 20 to 40 have at least one allergy.¹

Allergic asthma usually begins in childhood.² People with this particular type of asthma tend to have a family history of allergies and asthma attacks that are often preceded by hay fever, and they might also have the skin conditions urticaria³ (red, itchy welts, or hives) or eczema⁴ (red, itchy, and flaky patches of skin).

The symptoms of allergy-induced asthma are like those of any other type of asthma, so you may experience difficulty breathing, tightness in the chest, wheezing, and coughing. If you have hay fever or skin allergies, you might also experience itchy or flaky skin, a runny nose, watery eyes, or congestion, according to the American Academy of Allergy, Asthma, and Immunology.

The main difference between allergic asthma and nonallergic asthma are the triggers. While exercise, cold air, and even strong emotions such as stress can trigger nonallergic asthma, allergens, including dust mites, pet dander, pollen, and mold, are the most common culprits of allergic asthma. Cockroaches can also be a trigger, as their poop, saliva, and body parts can cause an allergic reaction in some people (so gross).

“Allergies and asthma tend to run together, so you’ll often find people with allergies who also have asthma,” Sonali Bose, M.D., associate professor of medicine, pulmonary, critical care and sleep medicine, and pediatrics at the Icahn School of Medicine at Mount Sinai, tells SELF. “But there are also a disproportionate number of people who have seasonal allergies without any asthma at all.” In fact, more than 50 million people in the U.S. are allergic to something, per the Asthma and Allergy Foundation of America.

The big giveaway that you’re dealing with nothing more than plain ol’ allergies? You have weird nose- and eye-related symptoms without any respiratory action like wheezing, asthma’s calling card. Having allergic asthma, however, means your body might pull from a grab bag of typical allergy and asthma symptoms, mixing and matching in a way that causes overlap between the two.

“Allergies can manifest in many different ways,” says Dr. Bose. “We often see upper-airway symptoms—runny nose, itchy eyes—that are the allergic response. That by itself wouldn’t make you worry about asthma. But if someone is wheezing, has chest tightness and shortness of breath, then you have to consider whether their inflammation is also involving the lower airways.” That’s because “asthma is a disease of the lower airways—particularly the small, very tiny airways we have in our lungs,” she adds. “It’s geographically separated from a lot of what we consider allergies in the nose, throat, and eyes.”

When it comes to allergic asthma, you probably already have a hunch about what triggers your symptoms. For example, if you get wheezy every time you dog-sit, Spike is probably the culprit. Regardless of which trigger you suspect, it’s still important to see an allergist to figure out what specifically is causing your system to act up. Doctors can perform skin or blood tests to help you get to the bottom of what exactly is setting off your allergic asthma. It’s also a good idea to keep a diary of anything that makes your asthma symptoms worse. This can be a huge help in figuring out your triggers.

History is the most important tool to diagnosing allergic asthma. “A lot of it is talking to the patient and trying to understand what their symptoms have been, the environment, and their risk factors going all the way back to when they were in their mom’s uterus, believe it or not, through childhood and into adulthood,” says Dr. Bose. “A lot of those things are important for creating the foundation for diagnosis. But we also have different types of breathing tests that can be useful in diagnosing asthma.”

Those tests can include:

• A spirometry test that diagnoses asthma severity and measures how well treatment is working;
• A fractional exhaled nitric oxide test that measures how much inflammation you have in your lungs;
• Peak expiratory flow tests that measure how fast you can blow out air using maximum effort.

“If we can confirm you have allergies and you also have asthma, that helps us make the diagnosis,” says Dr. Bose.

Avoiding your triggers is key to any treatment plan. Equally key: working with your doctor to figure out how to tackle your symptoms and lower your chances of having an asthma attack if you do encounter your triggers. For example, you may be able to treat allergy symptoms with drugs like antihistamines or with regular allergy shots to build up a tolerance to the allergens that are giving you fits. Starting allergy shots at a young age might actually help prevent allergic asthma from developing in the first place.⁵ Your doctor might also recommend medications to prevent your airways from overreacting to various substances.

According to the Mayo Clinic, these medications can include:

• Long-term control medications, such as inhaled corticosteroids, which keep your airways happy on a day-to-day basis. These can also include combination inhalers;
• Quick-acting inhalers, called rescue inhalers, which can help open airways during an asthma attack. Oral corticosteroids, which are not inhalers, can also be used, if necessary;
• Leukotriene modifiers, which are pills you take, can also help ease asthma symptoms. These are considered long-acting too but work in a different way than inhalers.

“When untreated or under intense exacerbation, allergic asthma can get worse and turn into a more chronic inflammation with prolonged cough or allergic bronchitis,” says Dr. Ogden. What’s more, “breathing can worsen so significantly that someone may find themselves very short of breath requiring hospitalization and—in worst-case scenarios—in the intensive care unit.”

That does sound scary, but know that, while bronchitis is a common complication, severe complications requiring hospitalization are less common, adds Dr. Ogden. To stay safe, she says, “act quickly if you get sick or have exposure to triggers—which is part of the asthma action plan that you should go over regularly with your doctor—and be in touch with your doctor as soon as possible if things start to go downward so that you can take steps quickly.”

We’ve said it before, and we are about to say it again. One of the best ways to avoid an asthma attack is to avoid your triggers. For people with allergic asthma, that means avoiding the thing(s) that make your allergies go haywire, according to the Asthma and Allergy Foundation of America.

Depending on what incites your asthma, that can be easier said than done. For instance, if your trigger is dust mites, you can’t spend your entire life ridding your home of every speck of dust. If your airways’ worst enemy is pollen—one of the most common triggers of seasonal allergies—the solution isn’t to stay inside for months on end. In those kinds of cases, it’s about doing things like learning how to clean in a way that specifically targets dust and pollen-proofing your home so that as little makes it inside as possible.

The other MVP in your asthma toolbox is following your treatment plan by taking your long-term medications as prescribed and using your rescue medications when needed—that combo, in addition to understanding your triggers, can keep your lungs pretty happy.

Sources:

1. Annals of Allergy, Asthma, and Immunology, Characteristics of Allergic Sensitization Among Adult Asthmatics >55 Years
2. Fundamental of Toxicologic Pathology, Atopic Asthma
3. Autoantibodies, Urticaria
4. Integrative Medicine for Children, Eczema
5. The Journal of Allergy and Clinical Immunology: In Practice, Preventive Effect of Allergen Immunotherapy on Asthma and New Sensitizations

Related:

• How to Treat an Allergic Reaction to Pretty Much Anything
• COPD vs. Asthma: What’s the Difference Between These Lung Conditions?
• How to Tell If You Have Coronavirus or Allergies