May is Asthma and Allergy month. So what better time to discuss and learn more. How easily this can be forgotten in the winter and middle of the summer in the desert southwest. But oh, the beautiful spring and fall. How bad can it be?
“If you are allergic to a thing, it is best not to put that thing in your mouth, particularly if the thing is a cat”.
Let’s start out with the hard facts! There are no “cures” for asthma and allergies”. Did you know that 10 people a day die from asthma, and that it afflicts more than 24.5 million Americans! More than 6 million children under the age of 18 have asthma, and its more common in boys than girls. However, as adults its more common in women than men. It is the leading chronic disease in children and more common in children than adults. And it is the third-ranking cause of hospitalization among children younger than 15. However, the episodes have declined in children from all races and ethnicities from 2001 through 2016. What are the cost: $81.9 billion (which includes medical cost, loss of work and school days). And in 2013 it accounted for more than 13.8 million missed school days.
And allergies, oh those nasal congesting, eye watering, itchy nose, post nasal drainage, “DRIVE ME CRAZY” symptoms! There are more than 50 million Americans with allergies. This includes pollen, contact (latex…) and food. And the rate of allergies is increasing. However, the symptoms are not always “classic”. Many people present with recurrent sinus and/or ear infections, dizziness, hearing loss (from eustachian tube dysfunction), conjunctivitis, eczema, chronic post nasal drainage… And the list goes on. Allergies are often overlooked in these settings. We often want to treat the symptom/finding, and not the underlying cause. Allergies are the 6th leading cause of chronic illness in the US, and annual cost exceeds $18 billion for environmental allergies while food allergies cost around $25 billion dollar each year.
So, let’s start by briefly discussing what is asthma. Asthma is a chronic condition that causes inflammation and narrowing of the bronchial tubes (passages that allow air to enter and leave the lungs). Triggers of asthma include allergies (pollens, molds, perennials (dust mites, cockroach, pet dander…)), irritants in the air (smoke from cigarettes, pollution, wood fires, charcoal grills…), respiratory illnesses (cold, flu…), exercise, weather, medicines (such as aspirin or NSAID’s), sulfites in food, hormonal changes (menstrual cycle) or even reflux. For those that have not had an asthmatic attack, it can seem like a 6-ton elephant is sitting on your chest. Not a pleasant feeling!
Why do the topics of allergies and asthma come up together? Well, as noted above allergies can trigger asthma. And the better you address your allergy symptoms, the better control you can have of your asthmatic symptoms. Not to mention sinus/ear symptoms and infections, chronic post nasal drainage… So what causes allergies? Simplified, allergies are the result of your immune systems response to exposure to antigens (say Palo Verde, Bermuda grass…). You have 5 types of antibodies. IgE is the type that causes allergies. Once it binds to an antigen it then binds to a mast cell. Long story short, the mast cell “blows up” releasing many inflammatory mediators (including histamine) which result in your symptoms. There is much more to it, but this is the simplified “500-foot view”.
So, the treatment of allergies during this time of year is important for some individuals not just because of the annoyance of allergies but because of the potential sequala (asthma exacerbations, sinus or ear infections…). The mainstay of therapy in this day and age are 1) avoidance (not likely successful unless it is just one or very few allergens), 2) pharmacotherapy (topical nasal steroids, antihistamines, topical nasal antihistamines, leukotriene blockers (Singulair) and something call mast cell stabilizers), or 3) immunotherapy (either sublingual (below the tongue) or subcutaneous (“shots”). Which treatment plan(s) is/are best for you may vary. Treatment for asthma has also improved. Options include inhaled steroids, Singulair and “rescue” (albuterol) inhalers. If you are using a rescue inhaler multiple times per week you should see a healthcare provider. This is not the appropriate way to manage your asthma.
This is an abbreviated look at really complex issues. But the big picture should be, start enjoying the spring and fall! We here at Urgent Specialists, and our associated specialists, can help in the management of your allergies and asthma (and those associated complications) when needed.