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Hay fever with asthma

Last edited: 4/22/2026

Overview

Hay fever with asthma, also known as allergic rhinitis coexisting with asthma, involves symptoms of both allergic rhinitis (such as sneezing, nasal congestion, and itching) and asthma (like wheezing and shortness of breath), often triggered by similar allergens 1.

Diagnosis

  • Symptom Assessment: Presence of allergic rhinitis symptoms (sneezing, nasal congestion, itching) alongside asthma symptoms (wheezing, breathlessness) 1.
  • Allergy Testing: Skin prick tests or specific IgE blood tests to identify specific allergens 1.
  • Pulmonary Function Tests: Spirometry to assess airway obstruction and reversibility 1.
  • History and Physical Exam: Detailed history focusing on allergen exposure and physical examination for signs of both conditions 1.

    • Management

  • First-Line Treatments:
    • - Inhaled Corticosteroids: For asthma control (e.g., fluticasone, budesonide) 1. - Antihistamines: For allergic rhinitis (e.g., second-generation antihistamines like cetirizine) 1.
  • Adjunctive Treatments:
    • - Leukotriene Receptor Antagonists: For additional asthma control (e.g., montelukast) 1. - Nasal Corticosteroids: For rhinitis symptoms (e.g., fluticasone nasal spray) 1. - Allergen Immunotherapy: Consider for long-term management if specific allergens are identified 1.

    Special Populations

  • Pregnancy: Close monitoring and individualized treatment plans; avoid systemic corticosteroids; consider intranasal corticosteroids for rhinitis 1.
  • Pediatrics: Use age-appropriate formulations; prioritize non-sedating antihistamines; monitor growth and development 1.
  • Elderly: Consider polypharmacy risks; focus on non-sedating antihistamines and inhaled corticosteroids; regular reassessment of symptoms and medication efficacy 1.
  • Comorbidities: Tailor treatment to manage coexisting conditions; coordinate care with pulmonologists and allergists as needed 1.

    • Key Recommendations

  • Integrate Asthma and Rhinitis Management: Use inhaled corticosteroids for asthma control and antihistamines for allergic rhinitis concurrently (Evidence: Moderate) 1.
  • Utilize Allergy Testing: Perform specific IgE testing or skin prick tests to identify allergens for targeted therapy (Evidence: Moderate) 1.
  • Consider Allergen Immunotherapy: For patients with persistent symptoms despite pharmacotherapy, consider allergen immunotherapy (Evidence: Expert opinion) 1.

    • References

    1 Lynöe N, Svensson T. Doctors' attitudes towards empirical data--a comparative study. Scandinavian journal of social medicine 1997. link

    Original source

    1. [1]
      Doctors' attitudes towards empirical data--a comparative study. — Lynöe N, Svensson T Scandinavian journal of social medicine (1997)
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