Allergic Asthma

What is asthma?

People with asthma have a narrowing of the airways in the lungs, which reduces the normal flow of air into and out of the lungs.  This narrowing can be reversed using medications and people with asthma can generally lead normal, active lives if they take medication as prescribed by their doctor. 

There is no cure for asthma, but it can usually be well controlled.

The most common symptoms of asthma are:

  • wheezing – a high-pitched sound coming from the chest while breathing out
  • a feeling of not being able to get enough air in, or being short of breath
  • a feeling of tightness in the chest
  • coughing

You do not have to have all these symptoms to have asthma. 

People with asthma have airways that are more sensitive to some things that may not affect other people without asthma. The things that set off your asthma or start symptoms are called triggers. 

Triggers can be non-allergic or allergic.

Non allergic triggers include colds, flu and other viruses, smoke, exercise, cold air, changes in temperature and emotion (such as being very excited/upset).

Allergic triggers (allergens) include dust mites, pollen, pets, moulds and sulfites in food/drink.

Allergic rhinitis (hay fever) and asthma

Allergic rhinitis commonly causes an itchy, runny or blocked nose, itchy or watery eyes and sneezing. Allergic rhinitis is one of the most common allergic conditions affecting 1 in 5 people whilst asthma affects about 1 in 10 people in Australia.

About 75% of people with asthma also have allergic rhinitis, and about 25% of people with allergic rhinitis also have asthma

Allergic rhinitis is caused by the body’s immune system reacting to common things in the environment such as pollen, house dust mite, moulds and animal danders (skin cells and fur).

These allergens can trigger asthma as well as allergic rhinitis symptoms. Many people with allergic rhinitis caused by grass pollen allergy can have allergic asthma in spring and summer when they also have allergic rhinitis.

How do you find out if allergy is playing a role in your asthma?

After taking your medical history, your doctor may perform skin prick tests or blood tests to look for common allergens that cause allergic rhinitis and asthma. If you have moderate or severe allergy or asthma, your doctor may refer you to a clinical immunology/allergy specialist or other specialist, such as a respiratory specialist, for testing, diagnosis and management.

It is important to determine if allergies trigger your asthma. Once something has been identified to trigger an allergic reaction, you should try to avoid, remove, or reduce exposure to it whenever possible. This may help to improve both your asthma and allergic rhinitis symptoms. Information about environmental allergen exposure minimisation can be found here.

Treatment

Allergic Asthma Management

Ensure your doctor has completed an Asthma Action Plan for you. This will provide you with information on how to treat and manage your asthma on an ongoing basis and will include instructions on what to do in case of worsening symptoms.  

  • Reliever medications are fast-acting inhalers (puffers) that reduce asthma symptoms quickly.
  • Preventer medications contain inhaled corticosteroids (ICS). They must be taken daily, even if there are no asthma symptoms. Generally, people who require reliever medication more than twice per week will be prescribed preventer medications. Some preventers are combined with other medications.
  • Oral corticosteroids are sometimes prescribed for a short time to help control asthma when it flares up.
  • Biologics/Injectables are used for patients who have uncontrolled asthma even though they are on preventative medication. If you feel you are not getting adequate control of your symptoms with your allergic rhinitis and asthma preventative medication, speak to your clinical immunology/allergy specialist or respiratory specialist about your suitability for biologics/injectables.
  • Make sure you are also taking your allergic rhinitis treatment/s, as advised by your doctor.

It is important that all nasal sprays and asthma inhalers are used correctly to ensure the medication gets to where it needs to be and works to control symptoms. An animation and infographic to help people use nasal sprays the right way has also been created by the National Allergy Strategy. Videos demonstrating the use of specific asthma inhalers and nasal sprays are available on the National Asthma Council website.

Good management of allergic rhinitis can help control allergic asthma symptoms.

Allergic Rhinitis Management

Ensure your doctor has completed an ASCIA Allergic Rhinitis Treatment Plan for you.

  • Preventer medications contain intranasal corticosteroid (INCS) sprays. They are the most effective long-term medication for allergic rhinitis. Like preventer medication for asthma, they need to be used each day to help reduce the symptoms of allergic rhinitis and possibly lessen the need for asthma medication. Some INCS sprays are combined with antihistamine sprays.
  • Reliever medications are non-sedating antihistamines (oral tablets or syrups, nasal sprays or eye drops) which give fast relief for allergic rhinitis symptoms and are safe for people with asthma.
  • Allergen immunotherapy (AIT) may be advised by a clinical immunology/allergy specialist or other specialist if symptoms persist. Immunotherapy can provide long-term relief for many people with difficult to control allergic rhinitis. AIT has also been shown to be beneficial for allergic asthma. It usually works within months but must continue for three to five years. It is available as injections given weekly to monthly or as daily drops/wafer/tablet to be placed under the tongue.
  • Make sure you are taking your asthma treatment/s, as advised by your doctor.

Click here for further information on allergic rhinitis.

Thunderstorm Asthma

Thunderstorm asthma events are believed to be triggered by an uncommon combination of high rye grass pollen levels and a certain type of thunderstorm, causing pollen grains from rye to be swept up in the wind and carried long distances. Some pollens can burst open and release tiny particles that are concentrated in the wind just before the thunderstorm. These small particles get deep into the airways and can trigger serious asthma symptoms, including severe breathing difficulty. 

The risk of thunderstorm asthma is highest in adults who are sensitive to rye grass pollen and have allergic rhinitis during spring and summer (with or without known asthma). This can occur even if you have not had asthma before.

People with poorly managed asthma have more severe thunderstorm asthma.

If you have asthma or allergic rhinitis or both, see your doctor to discuss options on how best to protect yourself during the thunderstorm season. Thunderstorm asthma typically occurs in October and November in areas where rye grass pollen is present in large numbers, such as the south-eastern part of Australia. 

Checklist for avoiding Thunderstorm Asthma

What you can do to keep safe in the months September to December if you have asthma and/or allergic rhinitis due to rye grass.

  • Carry an asthma reliever puffer with you at all times if you have known allergic asthma or allergic rhinitis caused by rye grass pollen even if you have not had asthma before. 
  • Use your recommended corticosteroid nasal spray daily to prevent and control your allergic rhinitis symptoms if you are allergic to rye grass pollen.
  • If your doctor has prescribed an asthma preventer, be sure to use it as advised. You may be advised to use preventer medication between September and December if you are going to be in an area where there is rye grass pollen.
  • Monitor the pollen levels in your area and be aware of any forecast storms. Click here for information about pollen counts in Australia.

Further information

Asthma Australia - https://asthma.org.au/

National Asthma Council - https://www.nationalasthma.org.au/

ASCIA (Australasian Society of Clinical Immunology and Allergy) -  https://www.allergy.org.au/patients/asthma-and-allergy/thunderstorm-asthma

Pollen count - https://auspollen.edu.au/

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