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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Adult and Senior Health Allergic asthma

Allergic asthma

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80- 90% of all asthma sufferers have allergic asthma. Allergic asthma is triggered by allergens that are capable of causing an allergic reaction.

 

Common Allergens in Allergic

  • Pollens from grass, weeds, and trees

  • Mold spores and mold fragments

  • Animal danders (hair, skin and feathers) and saliva

  • Dust mite feces

  • Cockroach feces

  • Food allergens: food preservatives like potassium bisulphate and sodium benzoate.

  • Other food allergens are egg, milk, peanut, sesame and others.

 Other triggering agents in asthma

  • Smokes from fire place, candles, fireworks, and incense sticks.

  • Tobacco smoke

  • Air pollution

  • Cold air

  • Strong chemical odors and perfumes

  • Dusty work places

 Pathology in allergic asthma

  • Following exposure to allergens, allergic reaction sets up in airways.

  • There is a complex interaction btw mast cells, IgE, esinophils, T- lymphocytes, macrophages and dendritic cells.

  • These cells release many mediators like Leukotriene C4, interferons and cytokines.

  • These mediators cause constriction and spasm of bronchial airways, edema of bronchial walls and mucus plugging the airways.

  • Long term changes in airways referred to as airway modeling, can lead to fibrosis and irreversible airway obstruction in some of the patients.CC

 Clinical signs and symptoms

  • Cough with expectoration

  • Wheezing

  • Shortness of breathe

  • Chest pain and tightening

  • Rapid breathing

 Severity of asthma

 

Intermittent

Mild persistent

Moderate persistent

Severe persistent

Day time symptoms

Daytime symptoms 2 or fewer times/week

Daytime symptoms >2 per week. but not daily

Daily symptoms

Symptoms through the day

Night time awakening

Night time awakenings 2 or fewer times/month

Night time awakenings 3-4 times per month

More than 1/week

7 times/week

Use of beta agonist

2 or fewer times/month

>2 times per month, but not daily

Daily use

Several times per day

Interference in normal activity

None

Minor limitation

Some limitation

Extremely limited

Lung function tests

FEV1 >80%

FEV1/FVC ratio normal

FEV1 >80%

FEV1/FVC ratio normal

FEV1 >60% but <80% predicted, FEV1/FVC ratio reduced 5% 

FEV1 <60% predicted, FEV1/FVC ratio reduced more than 5%

Exacerbations requiring of systemic corticosteroids

One per year at most

2 or more exacerbations per year

2 or more exacerbation per year

2 or more exacerbations per year

Recommended therapy

Step 1- Short acting beta agonists

Step 2- Low dose steroid inhalers, or Cromolyn, Leukotriene inhibitors, Theophylline

Step 3- Low dose oral corticosteroids + low-dose inhaled corticosteroids + long-acting beta-agonist

Step 4- Low dose oral corticosteroids + low-dose inhaled corticosteroids + long-acting beta-agonist+ Leukotriene receptor antagonist, Theophylline, or zileuton. To consider anti-IgE therapy Omalizumab in allergic patients.

 

To consider allergic immunotherapy in allergic patients

Tests and diagnosis

  • Serum IgE levels

  • Absolute esinophils

  • Sputum examination

  • Chest radiography

  • Chest CT scan

  • Echocardiogram

  • Pulmonary function test

 Treatment

 Pharmacotherapy

Corticosteroids

Bronchodilators

  • Short acting beta agonists: Salbutamol, Albuterol

  • Long acting beta agonists: Salmetrol, Formoterol

  • Methyl Xanthine: Theophylline, Deriphylline

  • Anticholinergics: Ipratropium and Tiotropium bromide

Leukotriene-modifying agents

  • Zakirlukast, Motelukast, and Zileuton

Mast cell stabilizing agents

  • Sodium chromoglycate, Nedocromil and Ketotinfen

 Monoclonal antibodies

Omalizumab

  • DNA derived human IgG monoclonal antibody that binds selectively to human IgE receptor on surface of mast cells and basophils.

  • It down regulates the mediators of allergic response in asthma.

  • Indicated in moderate to severe persistent asthma.

 Environmental control

Allergen avoidance- A multifaceted approach is necessary, as individual interventions are rarely successful.

Allergen immunotherapy

Allergen immunotherapy should be considered in those the specific allergens have a proven relationship to symptoms.