When allergies trigger asthma

Signs of worsening asthma

• Symptoms including feeling breathless, coughing, chest tightness and/or wheezing
• Symptoms at night or early in the morning
• Finding it harder to do everyday things
• Needing your reliever inhaler more than 2-3 times a week
• Peak flow dropping below 80 per cent of your best score<

How To Reduce Risk

1. Know your triggers:

Outdoor environment

• Check Pollen Forecasts: Monitor pollen counts using resources like the Meteorological Office and plan outdoor activities accordingly.
• Keep windows closed early to mid-morning, when flowers release pollen, and in the evening, when hot air cools and falls, carrying pollen with it. Avoid drying clothes outdoors during these times.
• Avoid activities that increase pollen exposure, such as mowing grass or walking in grassy areas, particularly during early morning and evening.
• Shower, wash your hair, and change clothes after being outside to remove pollen.
• During high pollen counts, especially on windy days or after thunderstorms, try to stay indoors.
• Wear wrap-around sunglasses to protect your eyes from pollen.
• Consider applying a nasal barrier, such as petroleum jelly, around your nostrils to stop pollen entering your nose.
• Consider wearing a mask to help prevent pollen from getting into your nose and mouth.
• Gently wipe pets down with a damp cloth to remove pollen from their fur before coming indoors.

Indoor environment

• Declutter and damp wipe surfaces to remove pollen and dust build-up, including in hard-to-reach places.
• Drying clothes indoors can increase moisture in the air causing mould. Where possible, dry wet washing outside (avoiding high pollen count), or in a tumble dryer or in a well-ventilated indoor space away from bedrooms and living areas.
• Washing all bedding sheets, pillowcases, blankets and cuddly toys every week at 60 degrees will kill dust mites. Alternatively place a toy in plastic bag in the freezer for at least 12 hours once a month and then wash at manufacturer’s guidance.
• Reduce the size and number of carpets and upholstered furnishings. Ensure these are vacuumed at least twice a week.
• Be aware that vacuum cleaners can release and resuspend dust and allergens, triggering symptoms. If carpets and upholstered furnishings cannot be removed, a high-filtration vacuum cleaner, with HEPA filter or similar, can help capture the smallest particles.
• Use an extractor fan to increase ventilation when cooking and showering to prevent mould and mildew growth.
• A dehumidifier can help maintain indoor humidity between 30-50% to reduce mould growth and house dust mite reproduction. Some devices now have air purifier capabilities to remove and reduce pollen, house dust mites and mould spores.

If hay fever is not appropriately managed, it can have a significant impact on quality of life. For children and teenagers, symptoms can have a negative impact on school exams which can coincide with tree and grass pollen seasons, potentially leading to lower performance and missed school days.

2 Medication management:

Effective management of allergic rhinitis and asthma requires prevention and long-term control of symptoms.

One of the main ways to achieve symptom control is by using steroid treatments targeted at the upper airways (nose) and lower airways (chest). This will reduce inflammation and prevent symptoms occurring. A number of treatments may be needed at the same time to achieve symptom control.

Treatment of the upper airway in allergic rhinitis:

Antihistamines tablets are particularly effective against mild symptoms such as sneezing, and itchy, watery nose or eyes. They have a rapid onset of action and can be used preventively or as a rescue medicine. Non drowsy antihistamines containing cetirizine loratadine, fexofenadine, desloratadine, and levocetirizine are recommended.

In patients with more severe symptoms, intranasal steroids (anti-inflammatory medications) containing beclomethasone, fluticasone, or mometasone, are very effective at reducing reduce nasal congestion as well as itching, sneezing, and runny nose.

A steroid nasal spray should be started at least one to two weeks before the anticipated pollen season and continued daily even if symptoms improve. Please refer to the Meteorological Office website for pollen calendars. It can take up to two weeks of daily use before you may see an improvement in symptoms. Treatments may be needed all year round for the management of indoor triggers like house dust mites.

Using the correct nasal spray technique is vital to help the medication work effectively and reduce side effects.

A saline rinse (Neilmed®) or spray (Sterimar®) can help clean allergens and mucus from the nasal passages and help a steroid nasal spray to work better. For persistent eye symptoms, consider using eye drops containing sodium cromoglicate.

There are a variety of steroid nasal sprays, antihistamines, and eye drops available. Treatment should be obtained over the counter initially. A pharmacist can advise on which types of medication to use, particularly in children, and on when to speak to your GP.

Managing allergic asthma which may be seasonal only:

An inhaled steroid is the recommended treatment for the management of asthma. Latest UK asthma guidelines recommend that a reliever inhaler (containing salbutamol) should only be prescribed with a preventer inhaler and never on its own. This is because a reliever inhaler does not treat underlying inflammation which causes symptoms and may put you at risk of an asthma attack.

Inhalers are available only on prescription and may be prescribed in the following ways:

1. Two separate inhalers: a steroid inhaler used daily, plus a reliever inhaler used as needed in response to symptoms.

2. One combined steroid preventer and reliever inhaler used as needed in response to symptoms. This is referred to as anti-inflammatory reliever (AIR) therapy. AIR is recommended for people aged 12 and over with newly diagnosed or mild asthma.

3. One combined steroid preventer and reliever inhaler used daily as a fixed dose, plus extra doses used as needed in response to symptoms. This is referred to as maintenance and reliever therapy (MART). MART is recommended for people aged 12 and over whose symptoms are not controlled on AIR.

Inhaled steroids are available in different devices including as Metered Dose Inhalers (MDI), Dry Powder Inhalers (DPI), and Breath Activated Inhalers (BAI). It is important to find the device that you can effectively use. Any changes to your treatment should be made in collaboration with a healthcare professional.

Cost saving tip: If you live in England and need more than three prescription items in three months, or 11 items in 12 months, an NHS Prescription Prepayment Certificate could save you money. Alternatively buy generic brands if purchasing over the counter.

If you live in England and need more than three prescription items in three months, or 11 items in 12 months, an NHS Prescription Prepayment Certificate
could save you money.

Alternatively buy generic brands if purchasing over the counter.

Reducing medication side effects:

It is important that nasal and inhaled steroids are administered correctly into the nose and lungs to reduce side effects. Common side effects of inhaled steroids include hoarse voice and oral thrush. Some people may experience nasal irritation, bleeding and an unpleasant taste when using a nasal steroid.

Side effects can be reduced by:

Using your devices correctly to ensure that medication is delivered to the correct area.
If you are prescribed a metered dose inhaler (press and spray device) it is recommended that you use a spacer for targeted delivery.

How to use a nasal spray
https://www.asthmaandlung.org.uk/living-with/inhaler-videos/nasal-spray

How to use your inhaler
https://www.asthmaandlung.org.uk/living-with/inhaler-videos

Rinse your mouth and gargle with water after using your inhaler.
Aim for the lowest dose of treatment needed to keep your symptoms under control, as guided by a healthcare professional .

It is estimated that between 35-50 per cent of people with a food allergy also have asthma.

Food allergy and asthma

Around 6 per cent of the UK adult population (approximately 2.4 million people) and between 5 and 8 per cent of children have a clinically confirmed food allergy.2

Food allergy and asthma often co-exist. An estimated 4–8 per cent of children with asthma have food allergies, with acute chest symptoms present in up to 50 per cent of food allergy reactions.3 Having both food allergies and asthma increases your risk of anaphylaxis and life-threatening asthma.

Therefore both food allergy avoidance and good asthma control are essential.

Know the signs and how to treat

Recognise the signs of anaphylaxis:

Airway – swelling in the throat, tongue or upper airways. (Tightening of the throat, hoarse voice, difficulty swallowing).

Breathing – Sudden onset wheezing, breathing difficulty, noisy breathing.

Circulation – Dizziness, feeling faint, sudden sleepiness, tiredness, confusion, pale clammy skin, loss of consciousness. In babies and young children this may look like the sudden onset of paleness and floppiness and loss of consciousness (unresponsive).

The treatment for anaphylaxis is with adrenaline auto-injectors (AAIs). You should be prescribed two AAIs and carry these at all times. They come in different strengths for children and adults. Do not delay use: if in doubt, give. Immediately call 999 stating anaphylaxis (“ana-fill-axis”). Use your second AAI if symptoms haven’t improved after 5 minutes.

There are two brands of AAIs currently available: EpiPen and Jext. Correct technique can be viewed on the EpiPen and Jext patient websites (links below). Sign up for free expiry alert reminders to ensure your devices remain in-date.

EpiPen: https://www.epipen.co.uk/en-GB/patients
Jext: https://patients.jext.co.uk/

For a mild/moderate reaction hives (raised, red itchy rash), itchy/tingling lips, mouth or tongue, swollen lips, face, or eyelids, abdominal pain or vomiting, take non-sedating antihistamine(s). Take a second dose if you have vomited or symptoms have not improved after 30 minutes. Be prepared to use your AAIs.

Personalised Action Plans

In anaphylaxis, symptoms occur quickly after exposure to a food allergen, whilst the signs and symptoms of worsening asthma can often be identified in the days leading up to an asthma attack.

All people with allergies and asthma should have a personalised action plan. These should be completed together with a healthcare professional.

An allergy action plan provides guidance on how to identify and treat mild, moderate and severe allergy reactions. Plans are available for both AAI devices depending on which you have been prescribed.

An asthma action plan can help you to identify worsening chest symptoms at an earlier stage. This can provide a window of opportunity to intervene and keep you well.

Actions plans should include specific allergy and asthma triggers. Each person with asthma should have an annual asthma review. This is a routine check-up with a healthcare professional to review symptoms, management, and ensure your asthma action plan remains accurate.

Tips

1. Carry two AAIs and know when and how to use.
2. Use non drowsy antihistamine tablets for a mild allergic reaction.
3. To keep asthma in control take your inhaled steroid as prescribed. This may also be your rescue inhaler if prescribed an AIR or MART regime.
4. Know your food allergy and asthma triggers – try to avoid.
5. Tell all staff about your food allergy if you are eating out.
6. The 14 regulated allergens will be highlighted on food ingredients labels. Please review carefully.
7. Share your personalised action plans with your child’s school, your family and friends so they know how to help in an emergency.