9 Medicines for Asthma and Allergies

Inhalant allergies, such as those to dust mites, pollen, cockroaches, or cat dander, may be a major contributor to asthma symptoms. (Half of those who suffer from asthma have allergic asthma, per the NLM.)

If you suffer from allergic asthma, the first approach is to avoid the allergen that is triggering your symptoms. However, this isn’t always practical or effective.

Medication can help with it. If you suffer from asthma, these are some of the most commonly prescribed medications for treating the condition.

Inhaled Corticosteroids

Inhaled corticosteroids are considered a cornerstone of asthma treatment, including allergic asthma.

"These medications are widely recognized as the gold standard for asthma therapy as they effectively inhibit the inflammatory response in the lungs," explained Dr. Mitchell H. Grayson, an associate professor at the Medical College of Wisconsin in Milwaukee.

Inhaled corticosteroids, often referred to as "controller" medications, are designed to be used regularly to maintain long-term control of asthma symptoms. Unlike "quick-relief" medications, they may take a few days to exert their full effect and are not intended for immediate symptom relief or short-term use.

Leukotriene Receptor Antagonists

Singulair (montelukast sodium) is another type of "controller" medication that is effective in treating both allergic and non-allergic asthma. It works by inhibiting a chemical released by the immune system that triggers inflammation. Dr. Jill Poole, an associate professor at the University of Nebraska Medical Center, explained that these medications are available in pill form and generally have few side effects.

One advantage of Singulair and similar drugs is their ease of administration. However, their effect is usually mild. Dr. Mitchell H. Grayson noted that they can be particularly useful for individuals with mild persistent or mild intermittent asthma.

In 2020, the U.S. Food and Drug Administration (FDA) required a boxed warning about serious behavior and mood-related changes associated with montelukast (Singulair and generics). The FDA determined that this warning was necessary after a thorough review of available information and expert consultations. The boxed warning serves to raise awareness about potential risks associated with the medication.

Short-acting Beta Agonists

Rescue medications, such as albuterol and Maxair (pirbuterol), are essential for individuals with asthma to quickly alleviate symptoms. These bronchodilators work by relaxing the airways and can provide relief within minutes.

Dr. Jill Poole emphasizes the importance of carrying a rescue inhaler at all times for individuals with asthma. However, it’s crucial to use these medications sparingly. They should only be used as needed, typically no more than 1-2 times a week.

One effective way to use a quick-relief inhaler is to take it proactively before a triggering event, such as exercise. By doing so, it can prevent the bronchoconstriction that would typically occur without medication. Dr. Mitchell H. Grayson suggests that individuals with exercise-induced asthma can use their inhaler approximately 20 minutes before engaging in physical activity to prevent any breathing difficulties.

Long-acting Beta Agonists (LABAs)

For individuals who require frequent use of rescue medications, switching to long-acting beta agonists (LABAs) may be necessary. These medications can provide relief for 12 hours or more, offering extended asthma control. Dr. Jill Poole recommends considering products like Advair (fluticasone and salmeterol combination) and Symbicort (formoterol and budesonide combination).

It’s important to note that using a combination formulation of a beta agonist and a steroid is crucial, as long-acting beta agonists alone can potentially worsen asthma symptoms. The combination of a beta agonist and a steroid provides a more comprehensive treatment approach.

While Advair received a black box warning from the FDA in 2003, the FDA removed this warning in December 2017 after reviewing clinical trials. The FDA found that using LABAs in combination with inhaled corticosteroids does not lead to significantly more serious asthma-related side effects compared to treatment with corticosteroids alone.

Antihistamines

Antihistamines are medications that block the chemical histamine, which plays a key role in allergic reactions. They can be beneficial for individuals with asthma who also have an allergy component, according to Dr. Jill Poole. Antihistamines are often used in combination with inhaled corticosteroids or Singulair to help reduce inflammation in the nose and lungs.

These medications are readily available over-the-counter, affordable, and generally have few side effects. They work quickly, which can be helpful if you’re about to be exposed to an allergen, such as visiting a friend with a cat, as mentioned by Dr. Mitchell Grayson. It’s important to note that antihistamines should not be used chronically and should be used as needed for acute allergic symptoms.

Omalizumab (Xolair)

Xolair is a medication specifically designed for allergic asthma. It works by binding to immunoglobulin E (IgE), which is an antibody produced in response to allergens. This medication is not effective for non-allergic asthma, which is triggered by factors such as exercise or cold air.

Due to its cost, Xolair is typically prescribed for more severe cases, especially for individuals who frequently require emergency room visits. It is administered via injection and carries a boxed warning about the risk of anaphylaxis, a severe allergic reaction that can be life-threatening. Healthcare providers closely monitor patients for any signs of anaphylaxis after administering the injections.

Allergy Shots

Allergy shots, also known as immunotherapy, can be beneficial for individuals with mild-to-moderate allergic asthma. The process involves undergoing a skin test to identify specific allergens that trigger your symptoms. Once the allergens are identified, you receive regular injections containing small amounts of the allergen, typically on a weekly basis initially. After four to six months, maintenance shots are administered at longer intervals, usually every three to four weeks. The goal is to gradually desensitize your body to the allergen over time. However, it’s important to note that the full desensitization process may take up to five years.

It’s worth mentioning that the effectiveness of allergy shots for conditions other than hay fever is not well-established. While they have shown positive results for hay fever, their efficacy for allergic asthma and other conditions is less clear, as mentioned by Dr. Grayson. Consulting with an allergist or immunologist can help determine if allergy shots are a suitable treatment option for your specific situation.

Oral Corticosteroids

Oral corticosteroids, such as prednisone, are typically reserved for the short-term treatment of severe asthma attacks. They are a stronger form of corticosteroids and can provide quick relief when symptoms are not adequately controlled with controller medications. However, oral steroids are associated with potential side effects when used for extended periods.

If you are experiencing persistent symptoms despite using controller medications, your healthcare provider may prescribe a short course of oral steroids for approximately four to five days to help improve your condition. It’s important to note that oral steroids take several hours to take effect and should be used under medical supervision due to their potential side effects. Regular monitoring and close follow-up with your healthcare provider are crucial when using oral steroids.

Theophylline

Theophylline is a bronchodilator medication that has been historically used to relieve asthma symptoms, particularly nighttime coughing. It is available in pill form, which can be convenient for some patients. However, it is important to note that theophylline has potential side effects, including gastrointestinal issues like diarrhea and, in rare cases, neurological problems if the dosage becomes too high.

Due to its potential side effects and the availability of newer and more effective asthma medications, the use of theophylline has declined in recent years. Regular blood tests are required to monitor the drug’s levels in the body and ensure it is within the therapeutic range. Overall, theophylline is not commonly prescribed for asthma management nowadays, and alternative medications are usually preferred. It is important to discuss with your healthcare provider about the most appropriate treatment options for your asthma.