Overview
Allergic asthma is a chronic inflammatory disorder of the airways characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and underlying allergic inflammation 2.Diagnosis
History of recurrent wheezing, breathlessness, chest tightness, and coughing, especially at night or after exercise 2.
Positive skin prick tests or specific IgE levels to common allergens 2.
Spirometry showing reversible airflow obstruction (increased FEV1 after bronchodilator administration) 2.
Peak expiratory flow variability >20% over 24 hours 2.Management
First-line treatments:
- Inhaled corticosteroids (ICS) as the cornerstone therapy 2.
- Short-acting beta-agonists (SABAs) for quick relief of symptoms 2.
Adjunctive treatments:
- Long-acting beta-agonists (LABAs) combined with ICS for persistent symptoms 2.
- Leukotriene receptor antagonists (e.g., montelukast) for additional control 2.
Allergen Specific Immunotherapy (ASI):
- Considered for patients with persistent symptoms despite optimal pharmacotherapy 12.
- Subcutaneous injections of allergen extracts can reduce symptoms of allergic asthma and rhinitis 1.Special Populations
Pediatrics: Immunotherapy may prevent the development of allergic asthma in children with allergic rhinitis 2 (Evidence: Moderate).
Comorbidities: Specific caution advised with ASI due to rare but severe adverse reactions like multi-organ failure 1 (Evidence: Weak).Key Recommendations
Initiate treatment with inhaled corticosteroids for persistent allergic asthma symptoms (Evidence: Strong) 2.
Consider allergen specific immunotherapy in patients with persistent symptoms despite optimal pharmacotherapy, weighing benefits against rare severe adverse events (Evidence: Moderate) 12.
Evaluate and consider early immunotherapy in children with allergic rhinitis to potentially prevent progression to asthma (Evidence: Moderate) 2.References
1 Sana A, Ben Salem C, Ahmed K, Abdelbeki A, Jihed S, Imene BS et al.. Allergen specific immunotherapy induced multi-organ failure. The Pan African medical journal 2013. link
2 . Immunotherapy: new guidelines suggest a 'window' for prevention. Disease management advisor 2003. link