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Which Type Of Asthma Is Associated With Allergic Reactions

How Do Allergies Affect Asthma

What Is Allergic Asthma?

If you have asthma, it’s a good idea to find out if allergies may be causing problems for you. See your health care provider, who may suggest a visit to an allergist so you can find out if you’re allergic to anything.

If you have allergies, it doesn’t mean that they’re causing your asthma symptoms. But knowing what they are lets you and your doctor start looking into the connection.

Limiting your exposure to possible allergens may be a big help in controlling your asthma. If you can’t completely limit your exposure to something you’re allergic to, your doctor may recommend medicine or allergy shots.

Medications For Allergic Asthma

Taking steps to control allergens is likely to improve your symptoms. But you may still need allergy and asthma medications to treat attacks.

Try nasal allergy medications that donât make you sleepy, saline rinses, and nasal sprays . If these donât work, use nasal steroid sprays and stronger antihistamines. If none of this helps, it may be time to talk to a doctor about allergy shots.

There are many good asthma treatments, but most require a prescription. These medications include inhaled steroids, which fight inflammation, and bronchodilators, which open up your airways. If traditional treatments donât help your allergic asthma, Xolair, an injectable medication that reduces IgE levels, may help. Also, the long-acting anticholinergic medication called tiotropium bromide may be used in addition to your regular maintenance medications to help with symptom control. This medication can be used by anyone ages 6 years and older.

SOURCES:American Academy of Asthma, Allergy, and Immunology: “What to expect at the doctor’s office,” “How to help your allergies and asthma,” “Allergic asthma information,” “Is your asthma allergic?” American Medical Association, Essential Guide to Asthma, 1998. National Heart, Lung and Blood Institute: “Asthma: How is Asthma Diagnosed?” “How is asthma treated?”Boehringer Ingelheim: “US FDA Expands Approval of Tiotropium Respimat® for Maintenance Treatment of Asthma in Children.”FDA. Prescribing Information: Spiriva Respimat.

Phenotypic Variability In Asthma

To complete the topic asthmatic allergic response, the phenotypic heterogeneity has to be taken into consideration. Indeed, apart from allergic asthma, which is the most common form, other types of asthma have been described.9,34 However, as with allergic asthma, the scientific community recognizes that IgE could be implicated in an inflammatory cascade, as well as CD4+ and CD8+ T cells, eosinophils, and mast cells. A second type of asthma is characterized by sensitivity to aspirin. It is estimated that approximately 1020% of adult asthmatics suffer from this particular type.35 Aspirin sensitization is thought to be non-IgE mediated so could be considered as a nonallergic subphenotype of asthma. A dysfunction of the eicosanoid metabolism is responsible for this type of asthma. It is estimated that 915% of all cases of asthma in adults are linked to the workplace and that up to 25% of new cases of adult asthma fall in the occupational asthma category. The two major hypotheses that could explain the induction of asthma after an effort are related to the augmentation of ventilation in the lungs. These two hypotheses are the osmotic hypothesis and the thermal hypothesis .36 These two hypotheses could better explain the phenotype rather than each one separately.

G.U. Schuster, … C.B. Stephensen, in, 2013

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Symptoms Caused By Excess Ige

When you have allergic asthma, your bronchi can become narrow and inflamed due to the rush of immune cellsand this rapidly exacerbates your asthma symptoms.

Not only do the inflammatory cells prevent air from passing through your airways, but your airways may also suddenly spasm, making it difficult for air to pass as you try to breathe.

Increased levels of IgE may contribute to symptoms of asthma, such as:

  • Wheezing
  • Shortness of breath
  • Recurrent cough

The symptoms are usually mild, but they can be quite severe and may cause serious consequences, such as a life-threatening respiratory crisis.

Clinical Impact Of Bronchiectasis In Type

Asthma Hypersensitivity Reaction Type

In T2-SA+BE patients, the median BSI was 6 . Only 6 out of 50 had a BSI score 9, indicative of clinically severe bronchiectasis. Sputum microbiological examination showed chronic Pseudomonas aeruginosa colonization in 5 patients and chronic Stenotrophomonas maltophilia colonization in 1 patient out of 50.

We found a significant inverse linear relationship between BSI and ACT score , FEV1% and FEV1 mL respectively. No significant correlation was found between BSI score and duration of asthma, asthma exacerbations, FEV1/FVC%, peripheral blood eosinophil count, total IgE, Vitamin D, alpha-1 antitrypsin and FeNO.

Figure 5 Correlations between BSI, ACT , FEV1% and FEV1 mL .

Abbreviations: BSI, Bronchiectasis Severity Index ACT, Asthma Control Test FEV1, forced expiratory volume in 1 second.

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What Is Allergic Asthma

For many people, allergies play a large part in their life. Allergies can affect what you eat, products you use, and even the way you breathe. When allergies combine with a breathing condition called asthma, its called allergic asthma. A type of asthma, allergic asthma is a condition where your airways tighten when you breathe in an allergen. This can be something in the air often pollen, dander or mold spores. Allergens are also called triggers because they set off your asthma. Things that could cause you to have a reaction, might not affect other people.

When you have allergies your body creates a response to something it thinks is a threat the allergen. It fires up all of its defenses to try and fight off danger. This is done by your immune system. Your immune system typically works to protect you from disease. When your immune system thinks that theres danger, it releases a chemical called immunoglobulin E . This substance is meant to fight back and protect your body. However, high amounts of IgE can cause your airways to tighten, making it difficult to breathe.

Asthma is a disease of the lungs that causes your airways to:

  • Become swollen or irritated specifically in the airway linings.
  • Produce large amounts of mucus that is thicker than normal.
  • Narrow because the muscles around the airways tighten.

Types Of Asthma Triggers

There are 2 types of triggers that can flare up someone’s asthma:

One of the most common triggers for asthma flare-ups is exercise and physical activity. This is one trigger not to avoid if possible. Exercise is an essential part of a healthy lifestyle.

Asthma induced by exercise can usually be treated effectively with the right medicine and the right plan.

The Australian Asthma Handbook has more information about asthma triggers.

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Defining Anaphylaxis As An Aefi Based On The Brighton Collaboration Criteria

Several different definitions have been used in various committees to define anaphylaxis. According to the World Health Organization International Classification of Diseases, 11th Revision , 2019, anaphylaxis is defined as a severe, life-threatening systemic hypersensitivity reaction characterized by rapid onset with airway, breathing, or circulatory problems, and is usually associated with skin and mucosal changes. According to the WAO Anaphylaxis Guidance 2020, anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death. Severe anaphylaxis is characterized by potentially life-threatening compromise in airway, breathing, and/or circulation, and may occur without typical skin features or circulatory shocks being present. A diagnosis of anaphylaxis is made when acute onset of skin or mucosal symptoms occurred with respiratory, circulatory or gastrointestinal symptoms, or when acute onset hypotension or bronchospasm or laryngeal involvement occurred after exposure to a known or highly probable allergen for that patient.

The Sensitization Phase Of Respiratory Allergy

About Allergy Standards and the asthma & allergy friendly Certification Program

There is increasing interest in the concept that asthma may be preventable if the early events in the process, in particular those involved in initial sensitization of the immune system in atopics against airborne environmental allergens, can be circumvented or forestalled. This has led to an increase in studies focusing on the initiation of immune responses to these agents in immunologically naive humans.

Our perception of the mechanism underlying the primary allergic sensitization process has changed radically over the past few years. Following rapidly on the heels of pioneering work on Th-cell heterogeneity in the mouse, T-cell cloning studies revealed major variations in cytokine production by inhalant allergen-specific Th-memory cells within the human population, with atopics expressing a cytokine pattern similar to murine Th2 cells, or Th0 cells manifesting a mixed cytokine profile,, in contrast to the Th1-like profile typical of non-atopics. The key cytokines in the atopic response seem to be IL-4 and IL-5, which drive IgE production and eosinophilia, respectively, after allergen exposure. The central issue in relation to the aetiology of allergy is thus how these disparate cytokine production patterns become programmed into long-term immunological memory.

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Incidence And Risk Factors

Determining the true incidence of sulfonamide allergies is challenging, as allergy history is often self-reported by patients. A retrospective review of electronic medical records from patients receiving care in San Diego County through Kaiser Permanente aimed to determine the incidence and prevalence of self-reported antimicrobial allergies . The study evaluated 411,543 patients who had at least one outpatient visit during 2007. Antimicrobial allergy rates were calculated by determining the number of patients reported as having an allergy to the antimicrobial they were prescribed in 2007 divided by the sum of all patients who received that antimicrobial during 2007. The antimicrobial allergy rates were then stratified by gender to account for differences in incidence reporting. Sulfa allergy incidence among males and females was found to be 2.23 percent and 3.42 percent , respectively. Additionally, sulfa antimicrobials were associated with the highest incidence rates of antimicrobial allergies for both males and females compared to penicillin, cephalosporin, fluoroquinolone, tetracycline, and macrolide antimicrobials .

How Is Allergic Asthma Treated

Inhaled corticosteroids can control symptoms for many people with allergic asthma.3 Corticosteroids quiet the signals from the Th2 cells and reduce inflammation.1

For adults and children older than five years who still have symptoms while taking an inhaled corticosteroid, a higher dose of inhaled corticosteroids or a second medication may be needed.5 The second medication is often a long-acting beta-agonist or a leukotriene agonist.

Some people with severe allergic asthma do not respond well to corticosteroids.7 For adults, health care providers may recommend the addition of a medication that blocks IgE.5,7

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Serum Specific Ige Allergy Tests

Serum specific IgE allergy tests are blood tests that detect specific IgE antibodies. These antibodies are made by your bodys immune system against allergens .

These skin and blood tests are not conclusive in determining asthma triggers. Just because your skin and blood react to an allergen, doesn’t mean your lungs will too. Think of these tests as a helpful ingredient for your doctor to use to assess your overall health and asthma and allergy needs.

Allergy tests can however help define the substances you are allergic to and enable a precision approach to managing that trigger.

Tests such as these should only ever be performed under the guidance of a doctor or allergy specialist.

Background: Type 2 Immune Response

Asthma Hypersensitivity Reaction Type

Traditionally, type 2-immunity is triggered by allergens or parasitic infection and characterized by the differentiation of naïve T CD4+ cells towards Th2 effector cells, which is typically associated with IgE production, eosinophilia and mast cell activation. The keystone cytokines in type 2 immune response include interleukin 4, IL-5, IL-9, and IL-13 . IL-4 is crucial for the differentiation of naïve Th0 cells to Th2 cells, which in turn induce isotype switching to IgE production. Specific IgE antibodies bind to their high affinity receptors FceRI on the surface of basophils or mast cells, leading to the sensitization of those cells. IL-5 and IL-9 are responsible for the activation and recruitment of eosinophils and mast cells, while IL-13 induces goblet cell hyperplasia, mucus hyper-secretion and airway hyper-responsiveness . Nevertheless, the initiation of immune response is believed to be triggered by the innate immune cells located at the epithelium of the skin, lung, or gut. Injured epithelial cells produce master regulatory cytokines, including thymic stromal lymphopoietin , IL-25 and IL-33. Subsequently, those cytokines stimulate Th2 cells and type 2 innate lymphoid cells to produce Th2 cytokines. Furthermore, IL-33 and TSLP could directly activate mast cells, while TSLP stimulates dendritic cells to induce a Th2-like process.

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Clinical Asthma And Airways Hyperresponsiveness

The term asthma describes a heterogeneous collection of clinical phenotypes as opposed to a single condition. A notable example is the distinction between the manifestation of the disease in children compared with adults. The point prevalence of asthma is actually greatest in young children, but up to half of these cease wheezing by adolescence. The most common trigger of asthma exacerbations in children is virus infections, whereas infections account for only a minority of adult exacerbations. It is noteworthy, however, that children with the most severe asthma have symptoms which begin in early life, are likely to be clearly atopic, and do not tend to lose their symptoms in adolescence.

The key feature of persistent asthma is the development of the state of airways hyperresponsiveness . In the context of atopic asthma this equates to an exaggerated bronchoconstrictor response not only to allergens to which the subjects are sensitized, but also to a range of non-specific stimuli, including agents as diverse as cold air and methacholine.

Figure 2: Transverse sections of the central airway from a subject with chronic asthma.

What Are Common Allergens That Can Trigger Allergic Asthma

Allergens can be found all around you. These can be in your indoor and outdoor environments. When you have allergic asthma, inhaling these allergens can set off your symptoms. Its important to know what can trigger your asthma so that you can control your condition.

Possible allergens that can trigger allergic asthma can include:

  • Dander: This is skin flakes and its usually from pets. Hair is often grouped with dander as a common allergen.
  • Pollen: A powdery substances, pollen comes from plants. The most common types of pollen that trigger allergic asthma are grass and weeds.
  • Mold: Typically found in places that hold moisture , mold produces spores that get into the air and can trigger your asthma.
  • Dust mites: Very small and shaped like spiders, dust mites live in the soft surfaces of your home . They eat skin flakes that you naturally shed all of the time. Both the mites themselves and their feces are allergens.
  • Cockroaches: These pests can be found in many homes and other buildings. Your asthma can be triggered by the feces, saliva and other body parts of the cockroaches.

Some people suffer from seasonal allergies. These are allergies that flare up at a certain time of year. This is often connected to spring because of the blooming of many plants. During this time of year, there is more pollen in the air than other seasons .

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Vaccination And The Risk Of Atopy And Asthma

Head, Division of Allergy and Clinical ImmunologyEmek Medical CenterAfu and Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifa, Israel

Reviewed by: Gailen D. Marshall, Jr., MD, PhD, Division of Allergy and Clinical Immunology, University of Texas Medical School at Houston

Vaccines are of major importance in controlling the spread of infectious diseases, but the use of some vaccines was linked to allergic and autoimmune phenomena in healthy and often in certain high-risk populations. Immediate systemic allergic reactions after vaccination with commonly used vaccines are extremely rare to a degree where it can be argued that there is any association at all between the vaccines and the allergic reactions that were reported .

It has been feared that vaccinations in infancy and childhood can increase the risk for development of asthma and allergic diseases. The concern has been particularly raised in regard to some of the currently available non-replicating infant vaccines that may not mimic a natural infection-mediated immune response that may protect against the development of allergic diseases and asthma. However, there has been no epidemiologic evidence that infant vaccinations with diphtheria, pertussis, tetanus , measles, mumps, rubella and bacillus Calmate-Guerin vaccines in infancy are associated with the development of allergic diseases .

Influenza vaccine

Bacillus Calmette-Guerin

Diphtheria, Tetanus, acellular Pertussis vaccine

Key Issues

How Do Allergies Make Asthma Worse

Are Allergies and Asthma Related?

Lots of people with asthma find it gets worse when they’re around allergens . Common allergens include dust mites, mold, pollen, and animal dander.

If you have allergies, your immune system reacts to an allergen like it’s an unwanted invader. To fight it off, the immune system produces an antibody called immunoglobulin E .

When the IgE combines with the allergen, it starts a process to release substances designed to protect the body. One of these is histamine. Histamine causes allergic reactions that can affect the eyes, nose, throat, skin, and lungs.

When the airways in the lungs are affected, it can bring on symptoms of asthma .

The body remembers this reaction. Each time the allergen comes into contact with the body, the same thing can happen. Because of that, allergies can make it difficult for some people to keep their asthma under control.

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Best Treatments For Allergic Asthma

Did you know allergies affect approximately 60% of the over 25 million people in the US with asthma? This number makes it the most common type of asthma out there. Allergic asthma refers to asthma that gets triggered as a result of an allergic reaction. The allergic reaction is often due to airborne allergens, like pet dander, dust, mold, pollen, and more.

Allergic asthma is a chronic disease. Therefore, there is a need for consistent management. One of the ways to do so is to take precautions in exposing yourself to allergy triggers. If you are allergic to something, avoid exposure to reduce the chances of an allergic asthma attack. There are also many medications that can help treat allergic asthma. These medications work to reduce airway inflammation caused by the allergic reaction. Here are some ways you can treat allergic asthma:

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