— When Lori Feeney’s 7-year-old daughter, Allison,
suffered a minor asthma attack while playing soccer, the
mother knew her attempts at managing her daughter’s seasonal
allergies weren’t working. In fact, she didn’t even know
her daughter had asthma.
the girl was 2, Feeney had been trying to manage her daughter’s
seemingly innocuous symptoms — simple runny nose, itchy
eyes, coughing, constant clearing of her throat, congestion
and fatigue — with over-the-counter medications and nasal
sprays. She even tried a neti pot, humidifier and steam
treatments, spending $30 to $50 a month trying to alleviate
was at this point that we made an appointment with her
pediatrician to get some assistance and direction," the
Chicago mother said. "She was officially diagnosed with
asthma at that point, prescribed an inhaler and referred to an
James Sublett, an allergist-immunologist in Louisville, Ky.,
and president of the American College of Allergy, Asthma and
Immunology, said it’s common for people to have asthma and
not know it.
is estimated that as many as one of four people with asthma
have never been told they have asthma," Sublett said.
"Asthma is a chronic condition that can flare during a
seasonal exposure. Chronic or recurrent cough is the most
common symptom." People with asthma often are
misdiagnosed as having a sinus and bronchial infection, he
Centers for Disease Control and Prevention estimates that
asthma affects 25.7 million people in this country and that,
of those, 7 million are under age 18.
is a chronic inflammation of the airways of the lungs, Sublett
explained. "Symptoms are cough, intermittent wheezing,
chest tightness and shortness of breath," he noted.
"The most common triggers are allergies and viral
infections like the common cold. Air pollutants, especially
small particulates from cigarette smoke and diesel exhaust,
are also frequent triggers."
asthma is a chronic inflammatory disease, it should be managed
preventively. "An asthma ‘attack’ represents poorly
controlled asthma and should be able to be prevented with good
management," he added.
and avoiding triggers as much as possible is the first step
toward managing asthma, Sublett said. This includes keeping
pets out of the bedroom or restricting time around smokers, if
those are allergen triggers.
of lifestyle changes, those suffering from asthma have a
handful of ways to manage or treat their disease, ranging from
antihistamines to nasal steroid sprays, depending on the type
and severity of asthma.
Best-Wilson, 34, from Madison, Wis., has been managing her
asthma since she was a child, using her maintenance inhaler
(long-term medicine) daily and always carrying her rescue
inhaler (fast-acting) for emergencies. "My doctor told me
always to err on the side of caution and take a rescue inhaler
when I think I might need it," Best-Wilson said. "It’s
not always easy to tell when I’m having a true attack
because sometimes I get lightheaded instead of getting wheezy.
So I also have a peak-flow meter (measuring lung capacity)
that can help me gauge my symptoms."
is constantly looking for ways to manage her asthma better,
which is why she’s keeping close tabs on new GPS-based
technology that tracks when patients take medication while
providing location data that might reveal allergy problem
allergist recommended allergy shots to Feeney for her
daughter, she was hopeful because she didn’t want her
daughter on daily medication.
began the process of ‘desensitization injections’ the
following week," she said. The testing revealed that her
daughter was allergic to more than 30 foods in addition to
ragweed, grass, mold, tree, dust, cat and dog fur. Armed with
that information, Feeney adjusted her daughter’s diet, and
they began the process of giving the girl a
"cocktail" of her specific allergens via injections
regularly to expose her body to them in a way that she doesn’t
overreact when exposed naturally.
connection between her exposure to allergens and her asthma
difficulties is so direct, and we didn’t realize it when we
were new to the parenting game," Feeney said. "Once
her allergies were under control, her asthma issues virtually
type of "cocktail" is a form of immunotherapy, and
many patients are finding long-term success using the
treatment, eventually being able to stop altogether.
immunotherapy, small controlled amounts of specific allergens
are injected or otherwise introduced into the patient,
explained Dr. Sandra Y. Lin, associate professor, Department
of Otolaryngology-Head and Neck Surgery at Johns Hopkins
University School of Medicine. Over time this leads to greater
immune tolerance and decreased allergic symptoms.
candidates for immunotherapy are patients with proven allergic
rhinitis (or hay fever) whose seasonal pollen allergies or
reactions to other triggers like pet dander, dust mites,
cockroaches and mold, are not well controlled with medications
or desire treatment that actually changes the underlying
disease, according to Lin.
majority of patients, after being on immunotherapy, will have
significantly improved symptoms and a decreased need for
allergy medication," Lin said.
the patient arsenal is sublingual immunotherapy, approved by
the Food and Drug Administration last year. Rather than
frequent doctor’s office visits for injections, patients who
test positive for a specific allergen now can take tablets
under the tongue at home. Drops also are available, but
currently only the tablets are FDA-approved.
by the positive results patients were experiencing with
immunotherapy, Lin recently led a panel on sublingual
immunotherapy as one of several state-of-the-science
treatments for allergic rhinitis. The treatment is being
recommended in a new guideline published earlier this year by
the American Academy of Otolaryngology — Head and Neck
children may do better with sublingual forms since they tend
to not like frequent injections," Lin added. "Immunotherapy
shots or sublingual drops are available for environmental
allergies (pollens, dust mites, dander, etc). However, there
are sublingual tablets in the United States only for ragweed
and grass pollen."
everyone is a candidate for sublingual immunotherapy,
including patients with a past severe allergic reaction to
immunotherapy or who are pregnant. "Also patients taking
beta-blocker medications may not be good candidates — beta
blockers interfere with effectiveness of the medication we
give in the case of severe allergic reactions," Lin said.
benefit of immunotherapy is cost. "Some studies show that
in the long-term, immunotherapy is actually less expensive
than medications," Lin added.
shots have worked wonders for Allison," Feeney said.
"It is a commitment but so worth it for us. She started
once a week but now goes once a month."
immunotherapy wasn’t an option for Feeney at the time her
daughter began treatment, but she would prefer having her
daughter take drops at home rather than getting shots
regularly at a doctor’s office. "The most difficult
part of the injection process is committing to the regular
schedule of injections, so anything that could be less
time-consuming would be wonderful," she said. "I’m
going to be asking about sublingual immunotherapy now."
Asthma and Allergy Foundation of America has produced a list
of the Spring Allergy Capitals of 2015, naming the cities
expected to be hardest on allergy/asthma sufferers. The list
is based on data such as levels of pollen and mold, plus
availability of board-certified allergists. The top 25 are:
Jackson, Miss.; 2. Louisville, Ky.; 3. Oklahoma, City, Okla.;
4. Memphis, Tenn.; 5. Knoxville, Tenn.; 6. McAllen, Texas; 7.
Wichita, Kan.; 8. Dayton, Ohio; 9. Providence, R.I.; 10.
Richmond, Va.; 11. Little Rock, Ark.; 12. Tulsa, Okla.; 13.
Baton Rouge, La.; 14. Chattanooga, Tenn.; 15. New Orleans,
La.; 16. Columbia, S.C.; 17. Birmingham, Ala.; 18. San
Antonio, Texas; 19. Dallas, Texas; 20. Syracuse, N.Y.; 21.
Greenville, S.C.; 22. Charleston, S.C.; 23. Nashville, Tenn.;
24. Winston-Salem, N.C.; 25. St. Louis, Mo.
complete list, visit