Asthma

Asthma

An allergist is a doctor with special training and experience to diagnose and treat allergic diseases such as asthma. If you think you might have asthma, talk to your doctor or an allergist to see if you get an asthma diagnosis.

During a visit with an allergist, you can expect the doctor to:

  • Take a medical history that reviews whether any members of your family have asthma or allergies, such as hay fever, hives or eczema
  • Ask you about your attacks, how often they happen and what seems to trigger them
  • Perform a physical exam
  • Measure airflow entering and leaving the lungs

The doctor also may order other tests such as chest X-rays, blood tests or allergy tests.

A person with asthma should know what situations prompt an attack, such as exposure to allergens, respiratory infections and cold weather, and to avoid these situations whenever possible. If asthma attacks are severe, unpredictable or flare up more than twice a week, then asthma treatment with a long-term control medication is recommended. Long-term medications are preventive, taken daily and can achieve and maintain control of asthma symptoms.

Because inflammation of the lungs and airways plays a critical role in asthma, the most effective medications for long-term control have anti-inflammatory effects. Various forms of anti-inflammatory medication are available and should be discussed with a physician.

One of the most effective anti-inflammatory medications for controlling asthma is inhaled corticosteroids. Taken early and as directed, these medications can improve asthma control, normalize lung function, and possibly prevent irreversible injury to lung airways. Often a single dose taken daily is enough to control asthma. Other anti-inflammatory medications include cromolyn and nedocromil.

Other medications for long-term control of asthma are long acting inhaled or oral bronchodilators (beta agonists), long-acting theophylline or regular use of oral corticosteroids. Combination therapy (inhaled corticosteroid plus a long-acting beta2-agonist) is the preferred treatment for asthma when inhaled corticosteroids alone do not control the disease.

Unless directed by a physician, asthma patients should never change or discontinue preventive medications, and should always keep an adequate supply available.

For people with allergic asthma, immunotherapy (allergy vaccinations) may offer relief from symptoms prompted by allergens that act as triggers and cannot be avoided. Immunotherapy increases a patient’s tolerance to the allergens that prompt asthma symptoms. A recent treatment option called anti-IgE stops an allergic reaction before it begins, helping prevent asthma attacks by blocking the antibody that causes the reaction. The treatment is approved for patient’s ages 12 and older that have moderate-to-severe allergic asthma.

If you suspect that you have asthma, see your asthma specialist. He or she can examine you and run tests for asthma to determine if you have it.

If an asthma diagnosis is made, there are many asthma treatments available to make you feel better and improve the underlying problems that caused the asthma.

New Asthma Treatments

Over the last few years, doctors have learned many new things about allergy. This new knowledge has led to new asthma treatments and treatments for other allergic diseases.

Specific allergen immunotherapy ("Allergy Shots")

This treatment has been available since 1911. This treatment decreases sensitivity to the things to which the person is allergic. The treatment is a type of vaccination because it increases the person’s resistance to the things causing their allergies.

The allergy vaccines are made from pollens, mold spores, animal dander, dust mites or bee venom. Allergy shots are helpful for nasal allergy, asthma and bee sting allergy.

Researchers are trying to find new ways to give allergy vaccines. In the future, vaccines may be nose sprays or drops under the tongue.

Immunoglobulin E (IgE) and anti-igE

Our immune system includes cells and proteins. The proteins include antibodies and cytokines. There are many types of antibodies. Immunoglobulin E (IgE) is the type of antibody that causes allergic reactions. IgE is found in the blood and in organs. IgE binds to certain body cells. These cells include mast cells and basophils. After IgE binds to the cells, allergy particles can bind to the IgE. When this happens, the cell releases many chemicals. These chemicals cause allergy symptoms such as itching, sneezing and wheezing.

If treatment could prevent the release of the chemicals, there would be no itching, sneezing or wheezing. If IgE could be stopped from binding to the cells, the chemicals would not be released.

Omalizumab is a man-made antibody against IgE (anti-IgE). This treatment is given by injection (shots) once or twice a month. Omalizumab stops IgE from binding to the cells. In 2003, the FDA approved this treatment for teens and adults with uncontrolled asthma.

Some day, people with other allergy problems might be helped by anti-IgE injections. For example, people severely allergic to a food, a medicine, or latex rubber might be helped by injections of anti-IgE.

Cytokines and cytokine inhibitors

When the immune system is active, the cells release proteins called cytokines. The cytokines help some parts of the immune response and shut down other parts. Chemists have been making new treatments called cytokine inhibitors. These inhibitors can prevent the cytokines from causing allergy problems. The FDA has not yet approved the inhibitors. Some day, cytokine inhibitors might be used to treat asthma and other allergic diseases.

Peptide immunotherapy ("Allergy shots")

Current allergy shots (immunotherapy) are made from allergenic proteins. However, chemists can make allergy shots from peptides, which are tiny parts of allergenic proteins.

In research, peptide allergy shots have been used to treat people allergic to cats. People who were given peptide allergy shots had fewer allergy problems in their nose and lungs. In the future, the FDA may approve peptide immunotherapy.