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Sniffles, sneezes, and wheezes areall symptoms of allergies. Up to25% of Americans suffer from

allergies. Among the offending sub-stances that cause these allergic reac-tions are pollens, animal dander, dustmites, and molds. Asthma goes handin hand with allergies. Not only doessinus tissue become swollen orinflammed when allergens are inhaled,but in some people, lung tissue doesas well. This inflammation in thelungs can result in an asthma attack.Asthma triggered by airborne allergensoften is referred to as allergic asthma.

Allan Resnick, MD, a Chicagoallergist, explains that a complex seriesof events takes place inside the bodywhen an allergen invades. “We knowthat the immune system of an allergicperson produces a high level of anallergic antibody known as IgE,” hesays. “The IgE antibody binds to theallergen, as well as to other cells in thebody. When the IgE antibody noticesa foreign substance, such as pollen,mold, or dander, it triggers the releaseof histamine, leukotrienes, and factorsthat increase the production of a typeof white blood cell that produces aller-gic inflammation.”

When a person experiences asth-ma symptoms that seem to be trig-gered by allergies, one of the firststeps toward treatment should betesting to identify the specific aller-gens causing the problems. The twomost common allergy tests are skintesting and a radioallergosorbent(RAST) blood test. The skin testremains the gold standard because itis both reliable and economical.Once testing reveals the substancesto which a person is allergic, severalprimary methods are used to controlallergic asthma:

• Reduce (or eliminate) exposure to the specific allergens

• Initiate immunotherapy (allergy shots)

• Control symptoms with medica-tionsMany people find a combination

of all three approaches works best.

Here’s how three people have suc-cessfully used them to control theirallergy-induced asthma.

Reducing Exposureat Home

There is no place like home toavoid allergens that trigger asthma—at least that’s the philosophy of BettyHogan, a 33-year-old bookkeeperfrom Spokane, Washington. Testingrevealed she was allergic to dustmites and several pollens common toeastern Washington. This test provid-ed her with the information sheneeded to change her indoor envi-ronment in an effort to control herasthma.

Hogan uses an HEPA filter in hercentral air unit to reduce allergens inher home. When pollen counts blos-som each spring, she closes all thedoors and windows, turns on thecentral air system, and seeks comfortin her bedroom, which she refers toas her “safe room.” She has takenseveral steps to create an allergen-freezone in her master bedroom becauseshe spends the most time there. “It’swhere I sleep and spend a lot of timerelaxing in my comfortable readingchair,” she explains. “I can’t do muchabout what’s going on outside orforce my employer to install a betterheating and cooling system, but Ican do things to create an oasis inmy home.”

Because of her allergy to dustmites, Hogan encased her mattress,box springs, and pillows in plastic.(Special allergen-proof covers also areavailable and quite comfortable.) Shealso removed the wall-to-wall carpet-ing in her bedroom and got herself acomfortable vinyl reading chair.“There was one part I hated,” Hogansays, pausing for a moment. “I had toput my stuffed animal collection inplastic tubs and put them in storage. Imiss them and feel guilty, but it madea big difference.”

These home-based efforts haveproduced the desired effect. Once sheseeks refuge in her oasis, Hogan says

her allergy and asthma symptomsdiminish fairly quickly. When she hasa good night’s sleep, she feels wellenough to go out into the world andonce again take on those allergens.

According to Resnick, mold isanother common and potent allergenin the home. He suggests preventingmold and mildew from forming inbathrooms and ensuring proper venti-lation in laundry rooms, basements,and crawl spaces where dampnessoften lurks. He adds that animal dan-der is another potent indoor allergenthat people with a sensitivity shouldbe careful to avoid.

Timing is everything for thosewho want to spend time outside butare allergic to seasonal pollens. It isimportant to avoid certain times ofday when venturing outdoors duringthe pollen season. Seasonal allergysufferers should minimize outdooractivities in the early morning andnear dusk, when pollen counts tendto be highest.

Immunotherapy “I can’t even begin to count the

number of afternoons my mother andI spent at the allergist’s office,” sighsRick Shaffer, a 37-year-old financialconsultant from Wilmington, NorthCarolina. “I remember rolling up myshirt sleeve, getting several shots, anddoing my homework while waiting tomake sure there was no adverse reac-tion. It’s probably why I made suchgood grades during those years.”

A chronic childhood asthma con-dition prompted Shaffer’s parents totake him to an allergist. Extensivetesting determined he had severeallergies to dust mites, molds, grass,weeds, tree pollens, and dog dan-der—bad news for the family’s gold-en retriever, Mike, who was movedpermanently to roomier quarters inthe backyard.

During Shaffer’s 5-year course ofallergy immunotherapy (also knownas desensitization or allergy shots),the frequency of these injections wastapered slowly from twice a week to

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once a week, then biweekly,and then monthly. He alsofaithfully continued a dailyregimen of oral and inhaledasthma medications. But asthe shots became less fre-quent, so did his number ofasthma attacks.

“I was able to play varsitybasketball and baseball inhigh school,” says Shaffer. “Iwas finished with the shotswhen I was 17. By the time Iwent to college, my asthmamedications had been tapered toalmost nothing. Today, the only timeI have asthma flare-ups is afterintense exertion. I am convincedthose shots made a big difference inmy asthma.”

He could be right. People whoreceive immunotherapy often areable to build enough tolerance toallergens to prevent allergic symp-toms. It is well established that thistreatment can reduce the severity ofallergic rhinitis, and scientific evi-dence that it may help to controlallergic asthma is increasing.

Resnick explains that immuno-therapy is a type of inoculation verysimilar to vaccines for measles, polio,and chicken pox. The injection con-tains a very small amount of theoffending substance. In the case ofimmunotherapy, the body’s immunesystem gradually becomes desensi-tized to the substance so that expo-sure to it in the environment nolonger triggers an allergic response.

Medication TherapyInhaled corticosteroids are anti-

inflammatory medications that are amainstay of preventive asthma treat-ment. Daily use of an inhaled corti-costeroid inhibits airway inflamma-tion associated with the asthmaticresponse after the body is challengedby an allergen.1

For many people with asthma,combining a long-term bronchodila-tor and an inhaled corticosteroidcontrols asthma by reducing airway

inflammation and increasing lungfunction, Resnick explains. Newmedications also making asthmatreatment even more effective. “A rel-atively new group of drugs, known asleukotriene modifiers, has shownadded anti-inflammatory benefit forasthma and allergic rhinitis,” he says.

Quite a lot of research is beingdone in the field of asthma and aller-gy, with some promising new treat-ments in the pipeline.

April Stillings, 42, a computerprogrammer from Des Moines, Iowa,has battled chronic allergies andasthma all her life. Allergy testingrevealed allergies “to just abouteverything,” but the primary culpritswere dust mites, cat dander, andplant pollens.

“When I was a child, my parentswrapped just about everything weowned in plastic, and I slept with aair purifier next to my bed,” sherecalls. “I wasn’t even allowed to setfoot in a house where a cat lived.”

Five years of allergy shots duringher teens and a lifetime of trying toavoid allergens were not enough toeliminate her need for medicationsto control her allergy and asthmasymptoms. In addition to a nasalcorticosteroid spray and a once-a-dayprescription antihistamine, she useslong- and short-term bronchodilatorsand an inhaled corticosteroid.

“In the year that I’ve been usingmy current medications, my asthmahas not been the persistent problemit has been in the past,” says

Stillings. “I’ve been able tocut way down on the use ofmy rescue inhaler.”

For Stillings, living withallergic asthma means beingcareful to reduce her expo-sure to known allergens andbeing diligent about takingher prescribed medications.As a result of her efforts, sheis able to run 10 miles aweek and enjoy her favoritesummer activity—hikingtrips to Minnesota and

northern Wisconsin.“I still have good days and bad

days,” she explains, “but not lettingmy allergies and asthma get the bestof me is what I stay focused on.”

Allergic asthma can be a difficultcondition to manage. The substancesthat act as allergens are numerousand varied, and many are difficult toavoid in daily life. For most peoplethere is no simple solution but rathera combination of approaches thatworks best. Vigilant avoidance ofallergens, when possible, is a greatstart in an effort to feel better. Then,working closely with knowledgeablehealth care providers, people withallergic asthma may find otherapproaches helpful, such as medica-tion therapy and even immunothera-py when appropriate. These toolsmay be the key to taking control ofallergic asthma.

Reference1. Wong CS, Wahedna I, Pavord ID,

Tattersfield AE. Effect of regular terbu-taline and budesonide on bronchialreactivity to allergen change. Am JRespir Crit Care Med 1994;150:1268-73.

Gregory Alford is a freelance writerand author of a weekly health columnfor the Belvidere Daily Republican inBelvidere, Illinois.

Reprint orders: Mosby, Inc., 11830 WestlineIndustrial Dr., St. Louis, MO 63146-3318;phone (314) 453-4350; reprint no.78/1/116700doi:10.1067/mas.2001.116700