Between 60-80% of people with asthma also experience allergic rhinitis. The two conditions are linked by a common airway. For this reason, international guidelines recommend that asthma and allergic rhinitis should be treated together.
Medication
There is currently no cure for either hayfever or asthma, but in most cases symptoms can be controlled.
Some treatments require a prescription from a doctor but others can be purchased over the counter. Speak to your community pharmacist who can advise on the best non prescription treatment for you.
Start treatment early if you can. To help you to do this, identify when your symptoms start and what time of year is worst for you. This can help you determine what is triggering it, as different pollens and spores are active at different times of the year.
Allergic rhinitis affect 60-80% of people with asthma
Allergy Immunotherapy (AIT)
An allergy is an abnormal, altered and specific sensitivity to a particular substance or substances known as allergens. Allergic reactions take place at points of contact between and body and the outside world e.g. eyes- conjunctivitis; nose- rhinitis,sinusitis hay fever; lungs- asthma; skin- eczem, rashes; gut-diarrhoea. Allergy occurs in 15-20% of the population and is on the increase, as our lifestyle and environmental factors cause an increased number of people who have increased sensitivities to suffer allergic symptoms. In addition, studies have shown that allergy is present in up to 80% of patients with asthma. Allergy is diagnosed by a careful medical evaluation and the demonstration of positive IgE allergy antibodies using either skin or blood tests. IgE tends to be high in patients with allergies. Therefore, treatments that block its action, such as Allergen Immunotherapy (AIT), are very effective. It is well recognised that children who develop rhinitis, eczema or food allergy, have a much higher chance of developing asthma as they older. This is known as the 'allergic march'.
Allergy, as a speciality, does not exist in Ireland to a level that an effective service is provided to patients in a consistent and equitable fashion. The main reasons for this are past fears about the safety of subcutaneous AIT or 'allergy shots' in conjunction with the efficacy or short term symptomatic treatment.
Symptomatic treatment are still the choice treatments for allergic diseases, including asthma. This means that they improve symptoms control when the patient is taking the treatment, however, they do not 'get rid' of the condition, with symptoms often recurring soon after the treatment is stopped. In medical terminology, these treatments do not improve the 'natural history' of the condition. They are very effective and relatively free from serious side effects. AIT, in the form of regular injections or 'allergy shots' has been practiced widely for over a century, particularly in the USA and mainland Europe. AIT is based on the concept that the immune system can be de-sensitised to specific allergens that trigger asthma symptoms.
The practice of AIT by 'allergy shots/injections' was severely curtailed in Ireland and the UK from 1986 when a number of deaths were reported with its use in general practice, particularly in those patients who had unstable underlying asthma. The situation has changed over the past 10 years however, with strong evidence that AIT can effectively treat allergic rhinitis, make it go away for good and perhaps prevent the development of asthma in allergic children if used early enough.
AIT for the management of allergic disease had now entered a new phase. Safe, effective, oral sub-lingual preparations are becoming increasingly available for use in allergy de-sensitisation as opposed to the hitherto allergy injections. This is known as sub-lingual immunotherapy (SLIT). SLIT is now available for the treatment of allergic rhinitis in patients whose asthma is stable, in conjunction with other well-established symptomatic therapies.
Advantages of SLIT
It's a safe and effective treatment for allergic rhinitis, reducing symptoms by about 50%. Despite its safety, it is recommended that the first treatments are given under medical supervision.
Its effects persist after stopping treatment, for at least 3 years and perhaps longer. Thus SLIT may effectively 'get rid' of the condition
There is a strong likelihood that SLIT may prevent the development of asthma in patients with allergic rhinitis, particularly children from the age of 5. Thus, the earlier the treatment is started the better.
There are currently 2 licenced SLIT preparations available for grass pollen allergic rhinitis in Ireland- Grazax and Oralair. If patients have co-existing asthma, it must be recognised and treated, and their lung function test must be normal. Patients must be advised to place the tablet under their tongue for 1-2 minutes and then swallow it. Grazax (Timothy grass only) should be commenced 2-4 months before the pollen season starts in late May/ June and continued daily for a total period of three years. Oralair (5 grass mix) is commenced at the same time for a treatment period of 6 months per year for three successive yeats (If there is an effect seen after the first season)
In conclusion, the new treatment, SLIT is now viewed as a significant advance in the treatment of allergic diseases. It is very effective in the treatment of rhinitis with long-lasting benefits seen after the treatment is discontinued. Indeed, it is the only treatment that offers the possibility of reducing long-term costs and the burden of allergies by changing the natural course of the disease. The available scientific evidence would suggest that its effects on asthma are indirect, in that SLIT probably prevents the development of asthma in allergic individuals with rhinitis. Thus, this is a very important development in allergy management. The direct effects of SLIT on asthma symptoms and natural history will become clearer in the coming years.
