Asthma and Anaphylaxis

pdfASCIA PCC Asthma and anaphylaxis 201988.67 KB

What is asthma?

Asthma is a chronic inflammatory disease of the airways. People with asthma experience a narrowing of the airways due to inflammation in the lungs, which blocks the flow of air into and out of the lungs. Asthma is most easily recognised by the following symptoms:

  • Wheezing when breathing out.
  • Persistent coughing, especially at night.
  • Difficulty breathing and shortness of breath.
  • Tightness and heaviness in the chest.
  • Exercise induced wheezing or coughing (exercise induced asthma).

Asthma and anaphylaxis

Asthma, food allergy and high risk of anaphylaxis (severe allergic reaction) frequently occur together and asthma increases the risk of fatal anaphylaxis.

It is therefore important to manage your asthma well, as part of anaphylaxis risk management. If you are using your reliever medication frequently you should make an appointment with your GP to improve your asthma management.

You may be unsure if you are having an asthma attack or anaphylaxis, because wheezing, difficulty breathing and persistent cough can present with anaphylaxis.

It is important to note that the progression and severity of allergic reactions can be unpredictable.  Most food related allergic reactions start within 20 minutes or up to two hours after ingestion. Mild to moderate symptoms of allergy may or may not present before symptoms of anaphylaxis.

If you have asthma, have been prescribed an adrenaline (epinephrine) autoinjector and suddenly start to have difficulty breathing:

  • Sit down and do NOT stand or walk.
  • Use your adrenaline autoinjector FIRST, then use your asthma reliever medication.
  • Phone ambulance - 000 (Australia) or 111 (New Zealand).
  • Follow your ASCIA Action Plan for Anaphylaxis, then continue asthma first aid.
  • If in doubt, use your adrenaline autoinjector. 

© ASCIA 2019

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.

ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice. The content of ASCIA resources is not influenced by any commercial organisations.

For more information go to www.allergy.org.au

To donate to immunology/allergy research go to www.allergyimmunology.org.au/donate

Updated May 2019

Thunderstorm Asthma

pdfASCIA PCC Thunderstorm asthma 2019117.27 KB

It seems reasonable to think that rain would relieve allergic rhinitis (hay fever), and asthma triggered by pollen, by washing pollen out of the air. However, rain from thunderstorms can make some people's symptoms worse.

Around one in four people with allergic rhinitis also have asthma

Pollen can trigger asthma as well as allergic rhinitis symptoms, most often in spring and summer.

Grass pollen can be wind-blown for long distances

Grasses rely on wind to spread pollen grains. Pollen counts will be highest near the source, but strong winds can spread pollen grains over long distances.

Intact pollen grains are usually trapped in the upper airways and do not reach the lungs. Other allergen carrying particles can carry grass and tree pollen allergens. Unlike intact pollen, smaller particles can reach the small airways of the lungs and trigger asthma attacks.

Thunderstorms and weather changes can trigger asthma attacks

Thunderstorm asthma is triggered by massive loads of small pollen allergen particles being released into the air with fast changes in wind, temperature and humidity.

When it rains or is humid, pollen grains can absorb moisture and burst open, releasing hundreds of small pollen allergen particles that can enter the small airways of the lungs.

It is important to note that:

  • Not all thunderstorms trigger thunderstorm asthma, even on days with high pollen counts.
  • Other weather factors are involved in thunderstorm asthma.
  • It is not only people with pollen allergy who may be affected by thunderstorm asthma.
  • Other allergens such as fungal spores, massive humidity and temperature changes over a short period of time can affect some people with asthma and other respiratory diseases during a thunderstorm.

Pollen asthma can be treated effectively

If your asthma is triggered by pollens and is worse in spring and summer, see your doctor for advice. It is important to have a current asthma action plan and regularly use preventer medication to manage symptoms.

How to protect from thunderstorm asthma?

Thunderstorms are common in spring so if you have allergic rhinitis try to stay inside on high pollen days.

See your doctor to make sure that allergic rhinitis is well treated. 

If you experience symptoms of asthma such as chest tightness, wheeze, shortness of breath, or cough, see your doctor for a plan to manage asthma.

Use  preventer medication every day, particularly if high pollen counts or thunderstorms are predicted.

© ASCIA 2019

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.

ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice. The content of ASCIA resources is not influenced by any commercial organisations.

For more information go to www.allergy.org.au

To donate to immunology/allergy research go to www.allergyimmunology.org.au/donate

Updated May 2019

Asthma and Allergy

Asthma Issues: Sport, Travel and Pregnancy

pdfASCIA PCC Asthma Issues sport travel pregnancy 2019224.67 KB 

Many people with asthma can have breathing difficulty when playing sport. Some people may be concerned about the use of asthma medications when pregnant or travelling.

Exercise asthma can be controlled

Many people with asthma will have symptoms provoked by vigorous exercise. This appears to be due to reflex airway narrowing caused by drying of the airways. It is important to consider whether asthma is well-controlled at other times. For example, a person needing their reliever medication more than twice per week or with peak flow readings less than expected may benefit from regular preventer medication. This may help prevent or manage exercise-induced asthma.

Plan ahead to reduce exercise-induced asthma

The following approaches may help reduce symptoms that occur despite good asthma control at other times:

  • Choose your exercise. For example, swimming is less likely to provoke asthma attacks, because warm and moist air is being inhaled. Cycling and running are more likely to provoke symptoms.
  • Do warm-up exercises for at least 15-20 minutes before vigorous exercise.
  • Wear a mask or balaclava to reduce heat and moisture loss, particularly in winter.
  • Use prescribed medicines, including:
    • Short acting relievers and preventer medications protect for two to three hours if taken just before exercise. 
    • Longer-acting symptom controllers are active for up to 12 hours.
    • Leukotriene antagonists are also effective if taken regularly.

Elite athletes can also suffer from asthma

Even elite athletes can suffer from asthma. They tend to control it with warm-up exercises and careful use of medication. Some asthma medications are approved for use in athletes participating in competitive sport, although many sporting bodies require a doctor's letter confirming that the athlete has asthma.

Some medications must be declared

Some medications such as inhaled corticosteroid puffers (inhalers) and leukotriene antagonists are approved as long as they are declared. Oral corticosteroids must be declared and are not allowed within six weeks of competition.

As regulations change it is important to checkwhich medications are currently banned substances. Athletes competing at state or higher levels of competition should contact their national sporting organisation to obtain additional information. 

Contact the Australian Sports Anti-Doping Authority (ASADA) www.asada.gov.au or Drug Free Sport New Zealand www.drugfreesport.org.nz for current information.

Asthma should be controlled during pregnancy

Some increased shortness of breath during pregnancy is normal, as the baby takes up space in the body, which affects breathing space. Asthma does not normally worsen during pregnancy. However, if it does worsen, it is important to treat asthma. Uncontrolled asthma is a much greater risk to the baby than any theoretical risk of medication.

There is little evidence that the medications used to treat asthma harm the developing baby in any way, if taken according to the directions.

Flying with asthma

Pressurised aircraft have an oxygen pressure around 80 % of normal. This poses no problem to people with controlled asthma. As a rule of thumb, people able to walk 100 metres or climb one flight of stairs without getting puffed should experience no problems. Those experiencing shortness of breath at rest should seek medical advice before flying.

Be prepared when travelling

Travellers are often exposed to new infections or high levels of allergens while away from home. This may worsen asthma and increase the need for medication. It is therefore important to:

  • Take enough medications, for expected needs, and more in case increased doses are required.
  • Carry medications in hand luggage to ensure easy access.
  • Check if travel insurance will cover pre-existent ailments.

With planning, people with asthma can travel, play sport and lead active lives.

© ASCIA 2019

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.

ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice. The content of ASCIA resources is not influenced by any commercial organisations.

For more information go to www.allergy.org.au

To donate to immunology/allergy research go to www.allergyimmunology.org.au/donate

Updated May 2019

Asthma and Allergy

pdfASCIA PCC Asthma and allergy 201983.73 KB

Allergy plays an important role in asthma, as one of the major factors associated with the cause and persistence of asthma.  Around 80% of people with asthma have positive allergy test results.

Allergy and asthma are very common

Allergy is very common in Australia and New Zealand, affecting around 20% of people. Asthma is also common, affecting around 10% of people.   Globally, the prevalence of allergy is continuing to increase, particularly in developed countries, such as Australia and New Zealand.

What is allergy?

Allergy occurs when the immune system in a person reacts to allergens which are substances in the environment that do not cause problems for most people.  This reaction leads to inflammation (redness and swelling) that causes allergic conditions, which can affect different parts of the body, such as:

  • Allergic rhinitis (hay fever) which affects the nose and eyes.
  • Eczema or urticaria (hives) which affect the skin.
  • Anaphylaxis (the most severe allergic reaction) which can affect the whole body.
  • Asthma which affects the lungs.

Allergens are mostly found in house dust mites, pollen, pets, moulds, some antibiotic medicines, insect stings or bites, latex (natural rubber) and foods. 

What is asthma?

People with asthma experience a narrowing of the airways in the lungs, which obstructs the flow of air into and out of the lungs.  This narrowing can be reversed using medications and people with asthma can therefore lead normal, active lives if they take regular preventer medication. 

Asthma is most easily recognised by the following symptoms:

  • Wheezing when breathing out.
  • Persistent irritable cough, especially at night.
  • Difficulty in breathing and shortness of breath.
  • Tightness and heaviness in the chest.
  • Wheezing or coughing with exercise (exercise induced asthma).

Triggers for asthma include allergens, infections, exercise, cold air, changes in temperature and cigarette smoke.

There may, however, be other causes for these symptoms, so you should always see your doctor for advice. 

How does allergy play a role in asthma?

There are two main ways in which allergy plays an important role in asthma:

  • Allergy itself can produce the allergic inflammation in the airways.
  • Exposure to one or more allergens can trigger an asthma attack.

Pollen can directly trigger asthma

Some people with moderate or severe allergic rhinitis believe that their allergic rhinitis turns into asthma or that it makes them tight in the chest or wheeze. However, pollen can directly trigger asthma as well as allergic rhinitis. Small particles of allergens can penetrate deep into the airways of the lung. Thunderstorms can also contribute to this:

  • When pollen granules come into contact with water, starch granules are released that are small enough to be breathed into the airways, causing allergic rhinitis and asthma in some people.
  • If you wheeze mostly during spring and/or summer, see your doctor for appropriate advice.

How do you find out if allergy is playing a role in your asthma?

After taking your medical history, your doctor may perform skin prick tests or blood tests for allergen specific IgE to demonstrate the presence of antibodies to one or several allergens. These tests are medically and scientifically proven.  Your doctor may decide to refer you to a clinical immunology/allergy specialist for testing, particularly in the case of suspected severe allergies, including those to foods, medicines or insects.

Effective management of asthma involves control of allergy

It is essential to determine if allergies are an important factor in your asthma. 

Once a certain substances has been identified to cause an allergic reaction, you should try to avoid, remove or minimise exposure to it whenever possible. This will improve your asthma symptoms.

Asthma and allergy treatments

If you have asthma and untreated allergic rhinitis (hay fever), it can be more difficult to control asthma symptoms. Treatment options for allergic rhinitis include:

  • Intranasal corticosteroid sprays are the most effective long term medication for allergic rhinitis (hay fever). Like preventer medication for asthma they need to be used each day to be effective, in controlling asthma and lessening the need for asthma medication.
  • Non-sedating antihistamines are used to treat allergic rhinitis (hay fever) symptoms and are safe for people with asthma.
  • Combination medications containing an antihistamine and intranasal corticosteroid nasal spray are available and offer the combined advantages of both medications.
  • Allergen immunotherapy is a long term treatment which alters the immune system's response to allergens and has been shown to improve asthma control in some people. It involves the administration of gradually increasing amounts of allergen extracts which are usually injected or givensublingual (under the tongue).

Medication which can cause problems for people with asthma include aspirin, nonsteroidal anti-inflammatory medicines and beta blockers.  Some natural treatments such as Echinacea and royal jelly can cause life threatening allergic reactions (anaphylaxis) in some people with asthma.  It is important to advise your pharmacist and doctor of any medications or ‘natural' treatments you are taking.

 

People with asthma should have a regularly reviewed asthma action plan, developed in consultation with their doctor, including asthma medications (preventers and relievers), and how these may need to be increased or decreased.

 
© ASCIA 2019

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.

ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice. The content of ASCIA resources is not influenced by any commercial organisations.

For more information go to www.allergy.org.au

To donate to immunology/allergy research go to www.allergyimmunology.org.au/donate

Updated May 2019

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ASCIA is the peak professional body of clinical immunology and allergy in Australia and New Zealand
ASCIA promotes and advances the study and knowledge of allergy and other immune diseases

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