20 Questions About Allergy-Triggered Asthma
A: Heredity is the main risk factor. Eighty-seven percent of people with allergies have some background of allergic disease in a family member.
Q: What allergens trigger allergic asthma?
A: Animal dander, dust mites, pollen, and mold spores. Cockroach pieces can also be a problem in parts of the country where these insects thrive.
Q: I'm allergic to my dog, but I can't bear to part with him. What can I do?
A: It would be best to keep the dog out of the house, but if that's not possible, keep him out of the bedroom. If you have forced-air heat, consider putting cheesecloth over the bedroom registers to block allergens. Wash your hands after petting and playing with the dog. And you may want to think about allergy shots.
Q: If I'm allergic to dust mites, do I really have to wash sheets in hot water or is warm water enough?
A: Dust mite allergies are best controlled by putting special mite-proof covers on mattresses and pillows, and by washing bedding in the hottest water available at least once a week. Water should be at least 130 to 140 degrees Fahrenheit, and the hotter it is, the more dust mites it will kill.
Q: What medications are used to treat allergic asthma?
A: The same medications are used to treat allergic and non-allergic asthma. There really aren't any studies of medications specifically for allergic asthma.
The backbone of therapy should be inhaled corticosteroids to treat inflammation. If that's not enough to control symptoms, a long-acting beta agonist or a leukotriene modifier, like Singulair, may be prescribed. Anyone with asthma should keep a short-acting beta agonist on hand for emergencies, but this should be used no more than once or twice a week, and less frequently if possible. Medications like Allegra can help keep seasonal allergy symptoms under control. Xolair (omalizumab) is a new drug that works by tying up the antibodies that cause allergies, but is only used in patients with severe disease because of its cost.
Q: Do people with allergic asthma need to take medications year-round, or is it OK just to take them during allergy season?
A: If asthma is clearly allergen-induced, it can be safe to have a drug holiday for a period of time. For example, a person with seasonal allergies who doesn't have non-allergic asthma probably won't need to take medication once pollen season is over. I will usually test pulmonary function outside of their allergy season to determine if a patient with seasonal allergic asthma may have non-allergic asthma as well.
Q: If someone feels fine, do they need to be taking their medications?
A: It depends, and it's something patients must discuss with their allergist or primary care physician. Some people need to take inhaled steroids regularly to keep their asthma under control, while others may have allergen-free periods when this isn't necessary. Just feeling good isn't a good reason to skip medication, because the lungs may still be inflamed.
Q: Is it possible to overuse a bronchodilator inhaler?
A: Yes it is. Bronchodilator inhalers are only for 'rescue' use, when a person truly needs help breathing.
Q: If so, how often is too often?
A: Anything more than twice a week, unless the inhaler is being used for exercise-related symptom prevention, is too much. Patients who need to use it more than twice a week need to reassess their asthma control therapy. Using bronchodilator inhalers several times a day increases mortality risk. Bronchodilators open the airways by relaxing the muscles around them, and overly frequent use can make it more difficult for these muscles to relax on their own. The lungs basically lock up.
Q: Are there some interesting new allergic asthma treatments on the horizon?
A: Drugs that block interleukins or inhibit the action of prostaglandins look promising. But I don't see anything ahead that will revolutionize the treatment over what we have now.
Q: Is there such thing as a 'hypoallergenic' cat or dog?
A: Not really. Dogs that may have a less allergy-provoking type of dander will still bring in dust, pollen, and mold from outdoors, and I still don't believe there are hypoallergenic cats. What we promote is frequent bathing of all types of animals.