Allergic Respiratory Disease

Allergic respiratory disease occurs when your immune system overreacts to substances you breathe in, like pollen or pet dander, causing symptoms that affect your nose, throat, and lungs. Understanding what triggers your symptoms and how to manage them can help you breathe easier and improve your quality of life.

Table of contents

• What is allergic respiratory disease?
• Symptoms
• Causes and triggers
• Risk factors
• Diagnosis
• Treatment
• Prevention and lifestyle management

What is allergic respiratory disease?

Allergic respiratory disease is a condition where your immune system overreacts to substances in the air that are normally harmless. When you breathe in these substances, called allergens, your body treats them as dangerous invaders and launches a defense response. This reaction causes swelling and irritation in your airways, leading to breathing problems and other uncomfortable symptoms^[1].

This condition is very common and can occur at any age. It includes problems like allergic rhinitis (also called hay fever), which affects your nose and sinuses, and allergic asthma, which affects your lungs and breathing passages^[3][4].

The most common form is allergic asthma, which happens when your airways tighten after breathing in an allergen. In the United States, about 25 million people have asthma, and approximately 60% of them have allergies^[6].

Medical experts now recognize that the upper and lower airways work together as one system. This means that allergic problems in your nose often go hand-in-hand with allergic problems in your lungs. This connection is known as the “united airways” concept, and it helps doctors understand why treating both conditions together works better^[4][5].

Symptoms

The symptoms of allergic respiratory disease can range from mild annoyances to serious breathing problems. What you experience depends on which part of your respiratory system is affected and how severe your allergic reaction is^[1][2].

Common symptoms affecting your nose and sinuses include sneezing, a stuffy or runny nose, and itching in your nose, mouth, eyes, or throat. You may also have watery, red, or swollen eyes, a condition called allergic conjunctivitis. Many people feel tired and may develop dark circles or puffiness under their eyes^[1][3].

When allergic respiratory disease affects your lungs, you may feel short of breath or experience chest tightness, as if something is pressing on your chest. Coughing, especially at night, is common. You might also hear a whistling sound when you breathe, called wheezing^[6].

During a severe allergic reaction, your airways can tighten significantly, making it very difficult to breathe. This is called an asthma attack. The symptoms of an allergic asthma attack are the same as other types of asthma attacks, but the difference is what causes them^[6].

Your symptoms will continue as long as you’re exposed to the allergen. Some reactions start within minutes of exposure, while others don’t begin until hours or days later. Once you’re no longer around the allergen, your symptoms should go away after a few hours^[1].

Causes and triggers

Allergic respiratory disease happens when your immune system mistakenly identifies certain proteins in the air as harmful, similar to how it would respond to a virus or bacteria. The first time you’re exposed to a substance, your body sees it as foreign and creates antibodies to it. This process is called sensitization. The next time you’re exposed to the same substance, these antibodies alert your immune system to attack, triggering your symptoms^[1].

The reaction mainly involves a type of antibody called Immunoglobulin E (IgE). When allergen-specific IgE attaches to certain immune cells, it causes the release of chemicals like histamine and leukotrienes. These chemicals produce the allergic response you feel. However, scientists have also discovered that some allergic reactions can happen through other, less understood pathways that don’t involve IgE^[4].

Many different substances can trigger allergic respiratory disease. The most common allergens in respiratory allergies are pollen, dust, mold, and hair or animal dander^[3].

Pollen is a powdery substance from trees, grass, weeds, and ragweed. Tree pollen and grass pollen are most common in the spring. Weeds and ragweed release their pollen in the fall. Hot, dry, windy days tend to have more pollen in the air, while cool, damp, rainy days wash most pollen to the ground^[6][17].

Dust mites are tiny organisms that feed on human skin. They live on soft surfaces in your home, including carpets, soft furniture, pillows, and mattresses. Both the mites themselves and their waste products are allergens^[6].

Mold is typically found in places that hold moisture, like basements. Outdoors, mold is found during warm or humid days, after mulching, or after rainfall. Mold produces spores that get into the air and can trigger your symptoms^[6].

Allergies to pets or animals can come from their fur, urine, saliva, or from pet dander, which are flakes of skin that animals shed^[6].

Cockroaches can be found in many homes and older buildings. Their waste products, saliva, and other body parts can trigger asthma symptoms^[6].

The amount of allergen in the air can affect whether symptoms develop or not. The clinical expression of allergic respiratory disease is closely associated with the period of environmental exposure to the allergen^[5].

Risk factors

You’re more likely to develop allergic respiratory disease if you have certain characteristics or live in particular conditions.

Family history plays a significant role. If you have a biological parent with allergies, you’re more likely to have allergies yourself. The chance is even higher if your mother has allergies. Hay fever and allergies often run in families^[1][17].

Having other allergic conditions increases your risk. If you already have one type of allergy, you’re more likely to develop respiratory allergies. People with conditions like asthma or eczema, which are part of a group called atopic conditions, are at higher risk^[1][3].

Children are more likely to experience respiratory allergies than adults, although some children grow out of them as they get older^[3].

Some experts believe that repeated exposure to a particular substance may increase the likelihood of a respiratory allergy developing, though the general causes of allergies are not completely understood^[3].

Diagnosis

A healthcare provider can diagnose allergic respiratory disease by asking detailed questions about your symptoms and examining you. They will want to know whether your symptoms change depending on the time of day or season, and whether exposure to pets or other allergens affects you^[1][17].

During your first visit, a doctor who specializes in lung problems (pneumologist) will note your symptoms, how often they occur, and the moments and circumstances in which they appear. The doctor will also perform a spirometry test, which is a simple test that measures how well your lungs are working^[8].

To identify which allergens are responsible for your symptoms, your provider can perform allergy testing. The most common method is a skin test. This involves placing a drop of the allergen on your arm and then pushing it beneath the surface of your skin using a fine needle. If you’re allergic to that substance, you’ll develop a raised bump called a hive at the test area within minutes^[1][10].

If the skin test suggests you don’t have an allergy but your doctor still suspects one, you may need a different type of skin test called an intradermal skin test. In this test, your healthcare provider injects a small amount of allergen into the outer layer of your skin^[10].

Blood tests are another option for diagnosing allergies. These tests measure the amount of IgE antibodies that your blood makes in response to specific allergens. This test is known as specific IgE (sIgE) blood testing, and it’s sometimes called a RAST or ImmunoCAP test. Your blood sample is sent to a laboratory to find out if you’re sensitive to suspected allergens^[10][17].

If asthma is suspected, additional tests may be needed. If a breathing test shows your airways are blocked, a bronchodilatation test can be done immediately to see if medication opens them up. If your breathing test is normal, you may need to return for a bronchial provocation test using histamine. This test, carried out under medical supervision, can either rule out or confirm asthma with near certainty^[8].

Treatment

The treatment of allergic respiratory disease involves several approaches, from avoiding allergens to taking medications and, in some cases, receiving immunotherapy.

Avoiding things you’re allergic to is your best option for managing symptoms. However, this can be difficult since it’s hard to avoid certain allergens completely^[1][3].

Intranasal corticosteroids are the most effective treatment for allergic respiratory disease and should be first-line therapy for mild to moderate disease. These are medications you spray into your nose. They work by reducing swelling and irritation in your nasal passages. The effects can begin in less than 30 minutes, and they work best when used continuously^[4][13].

Antihistamines work well for treating allergy symptoms. They block the effects of histamine, one of the chemicals your body releases during an allergic reaction. Many antihistamines can be bought without a prescription. Some antihistamines, especially older ones called first-generation antihistamines, can cause sleepiness. You should not drive or operate machinery after taking this type of medicine. Newer antihistamines, called second-generation antihistamines, cause less sedation, with the exception of cetirizine. These medications can be taken by mouth or used as nasal sprays or eye drops^[1][13].

Decongestants can help relieve a stuffy nose. However, you should not use nasal decongestant sprays for more than a few days, as they can make your congestion worse if used for too long^[1].

Other medications include intranasal cromolyn, which can help prevent allergic reactions but is less effective than intranasal corticosteroids and needs to be used several times a day. Intranasal anticholinergics can help with a runny nose. Leukotriene receptor antagonists are medications taken by mouth that can help with some allergy symptoms^[13].

For people with asthma, treatment depends on the type and severity of asthma. Medications may include bronchodilators (which open up your airways), corticosteroids, and newer medications called biologics that target specific parts of the immune response^[8].

Immunotherapy is a treatment that can modify how your immune system responds to allergens. It works by gradually exposing your body to increasing amounts of the allergen, helping your immune system become less sensitive over time. This treatment often involves taking tablets that melt on your tongue or using drops. Immunotherapy is effective but relatively long and costly. It should be considered in patients who don’t respond well enough to usual treatments^[5][8][13].

The treatment approach for allergic respiratory disease is based on a comprehensive assessment of both upper and lower airway symptoms. Aeroallergens are largely responsible for the clinical features and severity of the disease, so treatment plans must take allergen exposure into account^[5].

If you have severe allergies that cause life-threatening reactions, you may need to carry emergency medication. In some cases, allergic reactions can lead to anaphylaxis, a life-threatening condition that causes severe airway swelling and low blood pressure. This requires immediate emergency treatment^[1][2].

Prevention and lifestyle management

While you can’t always prevent allergic respiratory disease, you can take steps to reduce your exposure to allergens and manage your symptoms more effectively.

The best way to manage a respiratory allergy is to avoid the allergen entirely. However, this can be challenging as it’s often hard to completely avoid particular triggers^[3].

To limit your exposure to triggers, check daily pollen counts and air quality before heading outside. When exposure levels are high, consider wearing sunglasses and a mask to minimize contact with allergens. Once you return home, change and wash your clothes right away to keep allergens from spreading indoors^[19].

Stay indoors during peak pollen times, which are usually highest in the early morning and on windy days. Keep your windows closed and use air conditioning to cool your home instead of opening windows, which can let pollen inside^[13].

After spending time outdoors, shower and change your clothes to remove pollen from your body^[13].

A clean home helps reduce allergens that collect on floors, furniture, and bedding. Vacuum and dust regularly, and wash your sheets weekly in hot water to remove dust mites, pollen, and other potential allergens. Clean one room at a time, since cleaning can stir up allergens. Having a “safe room” gives you a break while the dust settles^[19].

Use high-efficiency particulate air filters (HEPA) in your home. HEPA filters with a minimum efficiency reporting value (MERV) of 8 or higher can trap tiny allergen particles. Change the filter as instructed to ensure continuous protection^[13][19].

Nasal saline irrigation can help remove mucus from your nose and may be beneficial in treating symptoms of chronic runny nose. You can buy a saline solution at a drug store or make one at home using distilled or boiled then cooled water, salt, and a pinch of baking soda^[13][17].

While there’s no special diet for people with respiratory allergies, eating more fruits and vegetables is good for your immune system. Fruits and vegetables contain substances that support immune health and may reduce inflammation. Try to eat three to five servings of fruits and vegetables a day^[19].

Research shows that some interventions do not effectively prevent allergic respiratory disease. Studies have not found any benefit to using mite-proof covers on mattresses and pillows, despite dust mite allergies being common. Similarly, there is no documented effectiveness in the prevention of allergic rhinitis through breastfeeding, delayed exposure to solid foods in infancy, or the use of air filtration systems^[13].

Your allergies and symptoms can change over time. Regular check-ins with your doctor allow them to adjust your treatment plan and provide the latest options for relief^[19].