There are lots of ways to manage allergic asthma. But you might need more than standard treatments. That could leave you wondering: Why are my symptoms so hard to control?
“Unfortunately, I don’t have a great answer for that,” says Farheen Mirza, an allergist and immunologist at Northwestern Medicine Central DuPage Hospital in Illinois. “But some people are highly allergic.”
When you breathe in an allergen, your immune system sends out a lot of immunoglobulin E (IgE). That molecule triggers inflammation in your airways. Some people with allergic asthma might have an IgE of 30. But your IgE can go as high as the hundreds.
“I think those people find it much harder to control their allergic asthma,” Mirza says.
Treatment can help you breathe easier no matter how serious your symptoms are. Talk to your allergist to find a plan that works for you. You might need lifestyle changes, medication, or new therapies. Here are some strategies that might help.
The best way to ward off allergic asthma attacks is to keep allergens out of your airways. That’s easier said than done. But talk to your doctor to see if there’s something more you can do to lessen your exposure to indoor and outdoor triggers. You might need to make some tough choices, like rehoming a family pet.
“I have a handful of kids who have very severe asthma who are severely allergic to pets,” says Kirsten Kloepfer, MD, associate professor of pediatrics at Indiana University School of Medicine. “That’s when I say there’s not really an option here. You can’t isolate this animal. You’ve got to get it out of the house.”
Ask your allergist if there are certain chores or activities you or your child should skip.
For instance, you should probably get someone else to mow your lawn if you’re allergic to grass. And when it comes to outdoor mold, “we try to tell kids not to jump into piles of leaves,” Kloepfer says. “Because that can be triggering.”
Find the Right Medication
Go over all of your choices with your doctor. Make sure you’ve tried every basic asthma treatment. Mirza says she starts people with corticosteroid inhalers or montelukast (Singulair). That’s a drug that blocks leukotriene, another molecule that causes airway inflammation.
“If that doesn’t work, the next step would be adding different types of inhalers or increasing the dose of medication,” Mirza says. "Instead of (only) using a steroid inhaler, we might do a combination inhaler or add something different to it.”
You might also need antihistamines, steroid nasal sprays, or anticholinergic drugs. Your doctor can tailor a plan that fits your symptoms.
Try Allergy Immunotherapy
This is another way to lessen inflammation caused by asthma. Think of it like a vaccine against allergies.
Your doctor puts a little bit of allergen into your body. This is usually done through a series of allergy shots. You’ll get them weekly or monthly for 3 to 5 years. Less often, you can take a liquid or pill that goes under your tongue.
You’ll get a higher dose each time you get treatment. Over time, your immune system can become more tolerant of whatever you’re allergic to. Immunotherapy doesn’t work for everyone. But experts agree it can make a big difference in symptoms for some people.
“I’ve had (people) where they go to their sister or friend’s house who has a cat. And every time they break out into an asthma attack,” Mirza says. “But after they go through allergy shots, they don’t have those issues anymore.”
Try Biologic Therapy
These drugs target your allergy-causing antibodies. They stop molecules from causing inflammation that trigger your asthma symptoms. Your doctor might suggest this therapy if you keep having serious asthma symptoms despite maxing out your meds and making lifestyle changes.
Kloepfer says biologics have been “a game-changer” for the kids she treats. Some had such severe allergic asthma that they were intubated or went into cardiac arrest. And they were in and out of the hospital so much that she and her colleagues knew them by name.
Now that they’re on biologics, she only sees them every 3 to 6 months. When they do come in for their checkup, she says they’re a whole lot happier.
“It’s like they come bouncing in the office because they can finally do things they’ve never been able to do before.”
For one girl, biologics have given her the chance to ride her bicycle for the first time. Other kids picked up new activities they never liked before.
“A boy we saw this summer said he never realized that the reason he didn’t like swimming was because he couldn’t go under the water and hold his breath,” Kloepfer says. “He’s 15 now, and he basically swam all summer.”
Finding the Right Biologic
There are five kinds of biologics approved for hard-to-control asthma. Your doctor can run some tests to find the one that’s right for you. Omalizumab (Xolair) is the most common choice for allergic asthma. It’s approved for people aged 6 and up. It’s a shot you get every 2 or 4 weeks.
Mirza always checks to see if people with allergic asthma also have high eosinophils. Those are a kind of white blood cell that can cause inflammation in your airways.
If you have eosinophilic asthma, your doctor might suggest other biologics, such as:
- Benralizumab (Fasenra)
- Dupilumab (Dupixent)
- Mepolizumab (Nucala)
- Reslizumab (Cinqair)
Tell your doctor if you have other health conditions. They might be able to treat more than one medical problem at a time. For example, omalizumab could treat hives plus allergic asthma, Mirza says. While dupilumab would be a good fit for someone who also has eczema or nasal polyps.
Go over all the pros and cons of biologics with your doctor. Ask them about side effects and how long your child will need to be on treatment. Though, Kloepfer says, kids with allergic asthma “do so much better that their parents don’t want them to come off.”
Farheen Mirza, MD, allergy & immunology, Northwestern Medicine Regional Medical Group in Illinois.
Kirsten Kloepfer, MD, associate professor of pediatrics, Indiana University School of Medicine; pediatrics, allergy & immunology; Riley Allergy & Asthma (Indiana University Health).
Cleveland Clinic: “Allergic Asthma.”
Mayo Clinic Laboratories: “immunoglobulin E (IgE), Serum.”
American College of Allergy, Asthma & Immunology: “Medication,” “Allergy Immunotherapy,” “Allergy Shots (Immunotherapy).”
Annals of Allergy, Asthma & Immunology: “Asthma biologics: Comparing trial designs, patient cohorts and study results.”