“IS IT ALLERGY OR IS IT ASTHMA?”

This is one of the commonest questions patients ask. By ‘allergy’ they mean nasal and eye symptoms of allergic rhinitis and conjunctivitis. Almost everyone equates sneezing, runny nose and itchy, red and watery eyes with ‘hay fever’ or ‘sinus’. They also have some understanding that such symptoms occur because they have become allergic to certain aeroallergens such as pollens and house dust mites. They might have experienced aggravation of their symptoms on exposure to cut grass or to strong perfumes or paints. When the same aggravants trigger asthma and they are coughing and wheezing and having a difficult time breathing and they experience the tight choking sensations, recognizing the problem as an attack of asthma. They may even (falsely) assume that the sneezing and rhinorrhea cause the asthma to flare up. Ironically, they fail to recognize that the nose, eyes, the upper airway and the lower airways are all reacting identically to the same agents and that the different sets of symptoms are due the different anatomical location of the allergic reaction! It’s simply that the nose sneezes and the lungs wheeze!

Thus, one should stress that all the above symptoms are manifestations of one disease…atopy. The abnormality is in the genes and that determines what the immune system does. The various symptoms are determined by where the allergic reaction is taking place. Of course, there are non-allergic causes of “asthma”. One is the aspirin “idiosyncrasy” or hypersensitivity”. Here, along with swollen nasal turbinates and polyps, chronic sinusitis and hives, asthma is but one manifestation. An asthma-like reaction, in the absence of any eyes or nasal symptoms appears in patients with the ‘carcinoid’ tumors in the lungs. Here, the cause is large amounts of chemicals like serotonin produced by the tumor. This is not strictly asthma as there is no inflammation in the airways. By convention, when allergy is looked for but not found, typical asthma is thought to be “intrinsic”. In this case, however, response to medications is identical to the “allergic” asthma.

The importance of recognizing that in the vast majority of patients, the asthma is due to allergy is that appropriate treatment of allergy could make all the difference. For example, if environmental or food allergens are removed, along with nasal and eye symptoms of allergy, asthma also improves or even clears up completely. If unavoidable allergens such as pollens are responsible, ‘allergy immunotherapy’ (‘allergy shots’) may improve the asthma to the extent that all medications can be stopped. Studies have even shown that those patients with nasal allergies, who receive immunotherapy, they actually prevent the development of asthma later on in life.

This article was submitted by Dr. P.K. Raghuprasad and if any reader has questions, you may contact him at his email address: pkrp12@gmail.com

Disclaimer: The facts presented in this article and the views expressed are solely those of the author(s) and do not necessarily reflect the views of the Board of Directors or other members of West Texas Physicians Alliance.