Asthma affects 20 million Americans and is commonly divided into two types:

• Allergic (extrinsic) asthma
• Non-allergic (intrinsic) asthma

Antoine Azar, MD, allergist at University of Iowa Hospitals and Clinics, talks about asthma and allergies:

Does everyone with an allergy also have the risk of developing asthma?

Before I answer, I will tell you the definitions of what allergies and asthma are.

The allergies that we are talking about are environmental allergies—allergic rhinitis and allergic conjunctivitis—and are commonly referred to as hay fever. People with allergies typically have a sneezing, runny and itchy nose, as well as watery, itchy eyes. These symptoms occur when people are exposed to an allergen in the environment. An allergen is any substance, like dust mites, pet dander, mold, or pollen that trigger an allergic response.

Allergies are quite common, in fact about 20 percent of the U.S. population—one in five persons—will have allergies.

Asthma is a respiratory or breathing problem and people typically have coughing, wheezing, and shortness of breath as their main symptoms. Asthma and allergies frequently co-exist, and they go hand in hand, so everyone who has allergies is also predisposed to have asthma. Although many people with allergies do not end up developing asthma, roughly about four out of every five adults who have asthma, also have allergies. Another important relationship between asthma and allergies is that allergies are a frequent trigger of acute asthma attacks.

Who develops allergies? Are allergies genetically passed along?

That's a good question. We don't know why some people get allergies and some people do not. But we know that there's a combination of both genetic factors as well as environmental factors that predispose to allergies and asthma. So allergies and asthma certainly run in families. In other words, kids in families where one or both parents have allergies or asthma are more likely to get allergies or asthma. It's not as straightforward a relationship though, and who will end up getting allergies or asthma is not really predictable.

If a child develops an allergy and/or asthma, will it subside as they grow older?

That's interesting. Both allergies and asthma are called atopic diseases. Atopic diseases are ones where allergy plays an important role. A third atopic disease is atopic dermatitis, or eczema. This is a condition where the skin becomes dry, itchy, or crusty and turns red. Children often go through what's called the atopic march. This means that they first develop one atopic disease, and then move on to develop another. Frequently they get atopic dermatitis first, and as they grow older, they get allergic rhinitis and asthma. This being said, the course of asthma varies quite a bit among different children. Some children with asthma will continue to have persistent symptoms as they grow older, and some other kids will outgrow their asthma as they grow older.

How are allergies diagnosed?

This is a very important question. It's important to identify what a patient with allergies or asthma is allergic to. Another important thing is that once you know what a person is allergic to, to avoid exposure to the known allergens will significantly help reduce the symptoms of allergies and asthma. The best test to check for allergies is a skin test. It's a simple procedure; we do it in the office all the time. We basically place several pricks on the patient's back and/or arms and the results are immediate. A positive reaction would occur in about 20 minutes. The skin test is done for a big panel of environmental allergens; these include perennial allergens like dust mites, pet dander, mold, as well as seasonal allergens like tree pollen, grass pollen, weed pollen, and others.

How are allergies and asthma treated?

It's important to know that treatment of one condition, since they are associated with each other, one condition—once it's well treated—will improve the other as well. The first step is trying to minimize exposure to what the person is allergic to. Regarding allergies, the main treatments are oral antihistamines and nasal sprays or nasal steroids. Eye drops can also be used for people who have a lot of eye symptoms. Teatment can be tailored according to what the person's major symptoms are. As for asthma, persons can have either intermittent symptoms of asthma, or persistent symptoms. Those with intermittent symptoms only will need rescue inhalers. They will need to carry an inhaler with them to use whenever they need it, whenever they get short of breath. And those with frequent symptoms, or persistent symptoms, will need a daily medication and usually this medication is a daily inhaled steroid.

Can allergies or asthma be a life-threatening event?

Asthma is certainly life threatening. Asthma affects the ability to breathe and to maintain oxygen in the blood. It's a very serious disease, and thousands die every year in the U.S. from asthma attacks. It can also be so severe that it requires treatment in the hospital. Now this being said, it's a disease that can be well managed and well controlled on medications. Environmental allergies, on the other hand, they're not life threatening, but depending on their severity, they can interfere with sleep, they can cause fatigue, interfere with work and daily activities.

Is UI Hospitals and Clinics involved in any research with regard to allergies and asthma?

Currently we have a research project involving people who have allergies and/or asthma, specifically during the fall season, and the research involves giving people sublingual or drops under the tongue to treat their allergies. Actually, we're still enrolling patients for the coming few days.

If someone wanted to learn more or make an appointment to speak with you, how would they go about doing that?

They can call 319-356-8133 or 800-777-8442.

One more thing, one of the treatments for allergies that we can use is allergy shots or allergy immunotherapy. These are long-term treatments for allergies as well as allergic asthma, and although they are long-term, they are treatments that can lead to cure for allergic nose, allergic eyes, and allergic asthma as well.

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Antoine Azar, MD