Asthma is a disease of the respiratory system caused by inflammation in the walls of the airways (bronchi), leading to obstruction and their contraction (bronchospasm). This obstruction may be permanent or intermittent, and the symptoms vary from mild, such as fatigue and coughing during laughter or exercise, to more severe, such as persistent cough, difficulty breathing, wheezing, and intense shortness of breath. Diagnosis is usually straightforward and is performed through spirometry.

Asthma is a heterogeneous disease, meaning that airway inflammation may be caused by various factors. Therefore, different asthma phenotypes are identified, such as allergic or eosinophilic asthma. When symptoms are suspected, the initial diagnostic evaluation includes spirometry to confirm the disease, followed by assessment of the asthma type, as each type requires a different therapeutic approach. In allergic asthma, it is essential to identify the responsible allergens so that treatment can be appropriately adjusted through avoidance or immunotherapy.

Allergic asthma is the most common form of asthma. It can occur at any age but is more frequent in children and young adults, with an average onset age of 15.8 years. It is often associated with a family history, elevated total IgE, and eosinophilia, although these features alone are not sufficient to distinguish it from other types of asthma. In our country, most patients have mild to moderate asthma, while a small percentage experience severe forms. Typically, exacerbations occur upon exposure to allergens, such as pollen during flowering seasons. Individuals sensitive to perennial allergens, such as dust mites or fungi, experience symptoms throughout the year or during periods of increased allergen load. Exercise-induced asthma is more common and more severe in patients with allergic asthma.

 

Allergic asthma often coexists with other conditions such as rhinitis, rhinosinusitis, and gastroesophageal reflux disease, with rhinitis being the most common comorbidity. The coexistence of these conditions has led to the concept that the upper and lower respiratory tract form a unified system (“one airway disease”). Studies show that 64% of individuals with asthma also suffer from allergic rhinitis, while 20% of individuals with allergic rhinitis also have asthma.

Diagnosis of allergic asthma includes a detailed medical history to evaluate symptoms and potential triggers. Spirometry and, if necessary, assessment of bronchial hyperresponsiveness confirm the diagnosis. If asthma is identified, allergy testing with skin prick tests or measurement of specific IgE in the blood helps identify the responsible allergens. Correlating positive findings with the patient’s symptoms is essential to confirm the allergic origin.

Treatment Treatment of allergic asthma aims to control symptoms, maintain normal activity, and prevent exacerbations or permanent damage to the respiratory system. It includes controller and reliever medications, with inhaled corticosteroids being the main option. Treatment is adjusted according to the patient’s response and is regularly reassessed. Environmental control, such as allergen avoidance or immunotherapy, plays a key role in disease management. Immunotherapy is particularly useful in cases where allergen avoidance is not possible, as it reduces sensitization to new allergens and positively affects disease progression. However, it acts as a complementary approach and does not replace pharmacological treatment.