Asthma Medicines

Once specific allergens have been identified, the patient must attempt to avoid these substances and clear them from the home and workplace as much as possible. A natural extension of the identification of allergy is the consideration of desensitization or immunotherapy by an allergy specialist. Allergy “shots” are given after sensitivity to specific allergens has been identified. These injections contain extremely small amounts of the allergen which is slowly increased in amount. These injections produce a “blocking antibody” that interrupts the allergy reaction. Studies of immunotherapy in asthmatics have shown a reduction in symptoms and inhibition of the late asthmatic response. The administration of immunotherapy is a gradual process, often requiring weeks or months to achieve a response. In older subjects the response to treatment may not be as pronounced as in younger patients. Extremely sensitive patients may experience generalized allergic reactions to the administration of allergens.

Recent studies have focused on fatal reactions to allergy injections. The majority of these cases were patients with severe asthma who had histories of severe asthmatic attacks that required steroids and hospitalization. These patients also appeared to be highly sensitive individuals who may have had a previous reaction to allergen injection.

Who Should Be Treated?

In patients with mild or moderate asthma who are well controlled on medication, allergy injections or immunotherapy should not be necessary. Those patients who are unstable should be considered candidates for treatment. In those allergic patients whose symptoms are more severe or who require frequent or continuous administration of corticosteroids the potential benefits of immunotherapy should be weighed against the potential for severe reactions. Once a response to immunotherapy is obtained the patient may remain on maintenance therapy for several years.

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Asthma is often divided into either an allergic or “extrinsic” type that commonly has its onset in childhood, and an adult onset or “intrinsic”type. Although there is considerable overlap between these groups, it is helpful to classify patients according to several features that distinguish them.

Extrinsic Asthma

Extrinsic patients are younger and have attacks clearly triggered by exposure to allergens such as pollens, dust, animal dander, foods, and molds. These patients often have strong family histories of relatives with allergies or asthma. Allergy treatment known as desensitization has often been helpful in these patients. For many years it has been thought that the majority of these patients “outgrew” their asthma by age thirty, but recent evidence suggests that 75 percent remain asthmatic for life. These patients may have long symptom free periods.

Intrinsic Asthma

Intrinsic group patients often develop asthma as adults, and at any age. Often the trigger for these attacks is infection with involvement of the lower respiratory tract as in bronchitis or pneumonia. Some of the most severe infections of this type are viral but they may also be bacterial. Patients in the intrinsic group usually do not have histories of allergies and produce negative allergy tests. Once the diagnosis is evident, further attacks are often triggered by less severe infections. There are fewer symptom free periods in this group and these patients usually require medication for life.

Should This Classification Be Used

Many practitioners no longer use this older classification of the types of bronchial asthma. When discussing the future outlook of the disease as well as treatment options, I find it helpful to use these two general classes of asthma to provide simple guidelines that can be followed. In the younger, highly allergic, or extrinsic asthmatic, for example, emphasis on avoidance of allergens will be extremely important.

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