Asthma symptoms occur due to a combination of inflammation, bronchospasm and mucus production. They include nocturnal coughing, dyspnea, wheezing, pain, pressure and tightness in the chest and vary in type and severity from one individual to another and from episode to episode. Long asymptomatic periods are usually present between episodes, although a subset of patients may show symptoms daily. Disease manifestations in allergic asthma are triggered specifically after exposure to specific allergens, but other forms may be associated with exercise or viral infections of the upper respiratory tract. Episodes are usually mild, although occasionally symptoms may be so severe that they require urgent medical intervention and sometimes hospitalization. Recognition of indicators of severe episodes is critical for prompt and extensive treatment.

Early warning signs precede an asthma episode and are important to identify. In general, they signal a worsening of the disease or the occurrence of a severe episode. They may not be severe themselves and do not stop the patient from performing regular activities. Warning signs include shortness of breath, changes in sleeping habits, persistent nocturnal cough, post-exercise weakness and fatigue, post-exercise wheezing or coughing, changes in mood, overall tiredness and signs of allergies or an upper respiratory infection such as sore throat, sneezing, headache, coughing, congestion and runny nose. The presence of early warning signs should prompt the patient to increase medication intake to try and prevent the occurrence of possible severe episodes.

Without good recognition of early alarming signs, progression into more severe episodes can take place with serious consequences for the patient. Worsening of symptoms can affect daily functioning and habits. Manifestations include a persistent daily and nocturnal cough, rapid breathing, dyspnea, pain and pressure over the chest, muscle spasms in the chest and neck, bluish discoloration of the lips and nails, difficulty talking, anxiety or panic, paleness and sweatiness. The patients are also unable to fully exhale.

Severe episodes generally manifest with a continuous cough, a very high breathing rate, pain or pressure in the chest, inability to talk, anxiety or panic, bluish discoloration of the lips and the fingernails, spasms in the neck and chest muscles, severe wheezing and fatigue.

• Inflammation

  Electronic address: [email protected]. 2 Institute for Systemic Inflammation Research, University of Lübeck, 23562 Lübeck, Germany. 3 Institute for Systemic Inflammation Research, University of Lübeck, 23562 Lübeck, Germany. [ncbi.nlm.nih.gov]

• Nocturnal Awakening

  The main reasons for being uncontrolled according to GINA criteria were nocturnal awakenings and activity limitations in combination with daytime symptoms, an FEV 1 below 80% of predicted value, or need for SABA use. [jamanetwork.com]

  The nocturnal awakenings decreased in the intervention group and the odds of experiencing awakenings decreased in this group. [pio.uad.ac.id]

• Cough

  In cough variant asthma, coughing is the only symptom. However, severe coughing can lead to difficulty breathing and asthma attacks. This type of asthma is just as dangerous as allergic asthma. [nyallergy.com]

  […] infection such as sore throat, sneezing, headache, coughing, congestion and runny nose. [symptoma.com]

  The symptoms of allergic asthma can include: Coughing (most likely a dry cough) Wheezing Shortness of breath/rapid breathing Chest tightness Increased production of mucous A patient that has allergic asthma may describe their symptoms as feeling like [briovarx.com]

  As a result of diffuse alveolar hemorrhage, respiratory symptoms such as cough attacks, hemoptysis, dyspnea, and recurrent and refractory iron-deficiency anemia (IDA) are observed. [ncbi.nlm.nih.gov]

  Patients with asthma may have one or more of the following symptoms: Coughing. Repeated short cough that occurs most frequently during the night and early morning hours can be the first symptom. Recurring wheezing. [londonallergy.com]

• Dyspnea

  Mean dyspnea perception during allergen challenge test (PS20A) was 2.97±2.31. [lsmuni.lt]

  Attacks vary greatly from occasional periods of wheezing and slight dyspnea to severe attacks that almost cause suffocation. [medical-dictionary.thefreedictionary.com]

  As a result of diffuse alveolar hemorrhage, respiratory symptoms such as cough attacks, hemoptysis, dyspnea, and recurrent and refractory iron-deficiency anemia (IDA) are observed. [ncbi.nlm.nih.gov]

  They include nocturnal coughing, dyspnea, wheezing, pain, pressure and tightness in the chest and vary in type and severity from one individual to another and from episode to episode. [symptoma.com]

• Chronic Cough

  Consistently, among women without allergic sensitization, significant positive associations were found between use of bleach and bronchial hyperresponsiveness, asthma like-symptoms and chronic cough. No association was observed for allergic asthma. [ncbi.nlm.nih.gov]

  Some patients with occupational asthma develop chronic inflammation and require long term treatment with medications. Cough-Variant Asthma/Chronic Cough Individuals who suffer from cough-variant asthma experience a dry, non-productive cough. [columbiaallergy.com]

  Allergic Asthma Symptoms Many of the symptoms of allergic asthma and non-allergic asthma are the same and include: Wheezing Chest tightness Shortness of breath Chronic cough Allergic asthma symptoms can be triggered by: Tobacco smoke Animal dander Dust [verywellhealth.com]

  cough over wheeze cough varlant asthma methacholine Increased sputum 초록보기 6알레르기 병력이 없는 젊은 여성에서의 집먼지 진드기 감작률 및 천식 유병률 저자 : 김희선 ( Hee Sun Kim ), 박창환 ( Chang Whan Park ), 이지수 ( Ji Soo Lee ), 조영주 ( Young Joo Cho ) 발행기관 : 대한천식알레르기학회(구 대한알레르기학회) 간행물 : 천식 및 [kiss.kstudy.com]

• Persistent Cough

  Symptoms include: Being out of breath, even when you’re not moving, and feeling exhausted and confused Persistent cough and wheezing associated with shortness of breath Anxiety because of breathing difficulty Bluish lips or fingernails Trouble walking [doctorsthatdo.osteopathic.org]

• Dry Cough

  The symptoms of allergic asthma can include: Coughing (most likely a dry cough) Wheezing Shortness of breath/rapid breathing Chest tightness Increased production of mucous A patient that has allergic asthma may describe their symptoms as feeling like [briovarx.com]

  Regardless of age, asthma symptoms can include: • Dry cough, especially at night or in response to specific “triggers” • Tightness or pressure in the chest • Wheezing — a whistling sound — when exhaling • Shortness of breath after exercise or physical [asthmaandallergies.org]

• Vomiting

  The symptoms are similar with GERD, which one vomit, regurgitation, nausea, chest or epigastrium pain, dysphagia and hematemesis. About 50% patient has allergic symptoms and more than 50% parent of the patient has allergic history. [garuda.ristekbrin.go.id]

  […] causes the immediate symptoms of allergic reactions, such as: Itchy eyes Runny nose Congestion Bronchospasm (asthma attack) Severe allergic reactions include more intense symptoms, such as: Difficulty swallowing, talking, or breathing Disorientation Vomiting [jaxallergy.com]

  Too much IgE results in typical symptoms of an allergic reaction such as: Itchy eyes Runny nose Nasal congestion Hives Symptoms of a severe allergic reaction include: Swollen tongue Difficulty talking, swallowing, or breathing Disorientation Vomiting [everydayhealth.com]

  In children 6 to less than 12 years of age with asthma: common cold symptoms, headache, fever, sore throat, pain or discomfort of your ear, abdominal pain, nausea, vomiting and nose bleeds. These are not all the possible side effects of XOLAIR. [xolair.com]

  In children 6 to less than 12 years of age with asthma : common cold symptoms, headache, fever, sore throat, pain or discomfort of your ear, abdominal pain, nausea, vomiting and nose bleeds. [gene.com]

• Chest Pain

  Symptoms of allergic asthma may include: Difficulty breathing Coughing Wheezing Chest pain Other respiratory issues It can be difficult to self-diagnose allergic asthma, because respiratory symptoms of allergic and non-allergic asthma are similar. [premierallergyohio.com]

  Tell your healthcare provider right away if you have rash; chest pain; shortness of breath; or a feeling of pins and needles or numbness of your arms or legs. Fever, muscle aches, and rash. [xolair.com]

  Drug-related adverse events included anaphylactoid reactions (n = 4), headache (n = 2) and chest pains (n = 1). CONCLUSION: Australian patients with severe allergic asthma report a high disease burden and have extensive comorbidity. [ncbi.nlm.nih.gov]

  This may be experienced as coughing and wheezing, as mentioned above, but can also cause chest pains, shortness of breath, and being unable to breathe. [healthguidance.org]

• Fracture

  The most common side effects of XOLAIR: In adults and children 12 years of age and older with asthma: pain especially in your arms and legs, dizziness, feeling tired, skin rash, bone fractures, and pain or discomfort of your ears. [xolair.com]

  […] patients ≥12 years of age, the most commonly observed adverse reactions (≥1% more frequent in XOLAIR-treated patients) from 4 placebo-controlled asthma studies were: arthralgia (8%), pain (general) (7%), leg pain (4%), fatigue (3%), dizziness (3%), fracture [xolairhcp.com]

  The most common side effects of Xolair: In adults and children 12 years of age and older with asthma : pain especially in the arms and legs, dizziness, feeling tired, skin rash, bone fractures and pain or discomfort of the ears. [gene.com]

• Eczema

  Eczema Eczema, or atopic dermatitis, is chronic skin inflammation that is sometimes made worse by exposure to foods or environmental allergens, particularly in children. [primaryimmune.org]

  They analysed associations between maternal intake of free sugar (sugar that is added to foods or naturally present in honey, syrups, and fruit juice) during pregnancy and asthma diagnoses, wheezing, hay fever, eczema, atopy, serum total IgE, and lung [bmj.com]

  Also known as eczema, atopic dermatitis refers to a red, itchy rash commonly found on the cheeks in infants and in the creases of the elbows and knees in older children and adults. [livestrong.com]

  Our dedicated, friendly staff of physicians and nurses are well experienced in the diagnosis, treatment and care of pediatric and adult patients with allergic diseases such as asthma, hay fever, hives, sinusitis, food allergies, eczema and primary immune [mcw.edu]

  The team found no association with eczema or hay fever. [sciencedaily.com]

• Dermatitis

  However, the same might not apply to atopic dermatitis, which is often the first manifestation of atopy. [ncbi.nlm.nih.gov]

  Types of allergic rashes someone with allergic asthma might experience include atopic dermatitis, atopic urticaria and allergic contact dermatitis. [livestrong.com]

  AbstrakEosinofilik esofagitis merupakan gangguan dimana terjadi infiltrasi eosinofil pada mukosa superfisial esophagus yang berhubungan dengan alergi makanan dan kondisi atopi seperti asma, dermatitis atopi, rhinitis alergika dan sering bersamaan dengan [garuda.ristekbrin.go.id]

• Insomnia

  […] shoulders, back, arms or neck) • Arthritis • Blood sugar elevation • Memory problems, cognitive dysfunction, confusion, amnesia • Nerve pain, peripheral neuropathy, leg cramps • Digestive upset, nausea, constipation, diarrhea, flatulence • Headache • Insomnia [pio.uad.ac.id]

Improvement of symptoms in asthma subsequent to the intake of anti-asthmatic medication can suggest the diagnosis but is not sufficient to fully establish it. In general, diagnosis in older patients requires the performance of pulmonary function tests whereas a demonstrated response to empiric treatment is sufficient in children. Pulmonary function tests usually show reversible obstruction but are not frequently performed in children younger than 4 because of the difficulty in establishing cooperation with the child and the absence of standardized measurements.

A ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) that is less than 70% defines respiratory obstruction. Nonetheless, other clinicians have advised the use of different standards [5] [6]. Patients of young age tend to have elevated forced vital capacity, which might decrease the ratio of FEV1/FVC without necessarily signifying an obstruction. On the other hand, reversible obstruction can be demonstrated after the administration of a beta 2 agonist inhaler. In such a case, the FEV1 improves by a mean 12% in asthmatic patients and the forced vital capacity can increase by up to 200 milliliters [7]. An absence of an immediate response requires a two to three-week administration of corticosteroids either orally or intranasally. The appropriate dose is generally 20 milligrams twice-daily for an average patient. Reversible obstruction is not unique to asthma and may also be exhibited in chronic obstructive pulmonary disease. FEV1 levels are also useful in assessing the risk of annual exacerbations. A diagnosis of asthma can be further suggested by peak expiratory air flow, although the latter depends greatly on effort and, thus, is not usually used alone. Peak expiratory air flow is suggestive of asthma when there's a variation of 20% between high and low values.

A number of blood tests can be performed in the workup of asthma. Skin testing is very useful when allergic asthma is suspected. These tests assess for the presence of IgE antibodies that are specific for particular allergens. They are needed when advising patients in avoiding certain environments and when guiding medical therapy. In place of skin testing, blood testing can be performed when there is extensive skin disease, when antihistamine and TCA drugs cannot be stopped, and in the presence of any contraindication for skin tests. Skin testing, however, has higher sensitivity and specificity, and is more affordable. Assessment of eosinophils in the sputum and the serum may also help in guiding therapy, although they are not required for diagnosis. Recent evidence suggests, however, that there is no correlation between response to early and late bronchoconstriction and levels of eosinophils 7 and 24 hours after bronchoprovocation [8]. Although levels of exhaled nitric oxide are functionally significant, no clinical benefit for their use has been demonstrated. They correlate well with inflammation of the airways and are reduced by corticosteroid therapy but clinical studies have shown that their use results in the administration of higher doses of corticosteroids without an associated clinical improvement [9]. Other potential testing modalities that can be employed in the future include exhaled breath condensate and exhale breath temperature. Brain natural peptide can also help in ruling out heart failure as a cause for the symptoms.

Bronchoprovocation tests are useful in excluding the diagnosis of asthma. They are performed after the administration of histamine or methacholine or after exercise and hyperventilation. Methacholine is the most frequently used drug in these tests. A positive test is suggested by a decrease of 20% of FEV1 after the administration of 8 milligrams per ml of methacholine. It is important to note that the drug should be avoided in pregnant women because it can precipitate an asthma attack and because it is classified as a type C Drug, with considerable risks on the fetus.

Imaging tests can be used to exclude other causes. Chest x-rays for example can rule out pneumonia, heart failure and large legions in the airways. They are also performed in cases where symptoms do not respond to therapy, when an adult patient has new onset asthma, or when physical exam reveals unilateral or focal wheezing. On the other hand, a CT scan is recommended when there is suspicion for acute sinusitis since approximately 65% of patients with asthma have sinusitis at the same time. A chest CT scan can also aid in excluding infection, interstitial lung disease, bronchiectasis and bronchiolitis. Finally, a high suspicion in heart failure should prompt the physician to perform an EKG.

• Reversible Airway Obstruction

  It is characterized by chronic airway inflammation, reversible airway obstruction, airway hyper-responsiveness, and ultimately airway tissue remodeling. [biomodels.com]

  Abstract Allergic asthma, caused by inhaled allergens such as house dust mite or grass pollen, is characterized by reversible airway obstruction, associated with an eosinophilic inflammation of the airways, as well as airway hyper responsiveness and remodeling [ncbi.nlm.nih.gov]

  Asthma is a clinical syndrome of chronic airway inflammation characterized by recurrent, reversible, airway obstruction. Airway inflammation also leads to airway hyperreactivity, which causes airways to narrow in response to various stimuli. [medicinenet.com]

Treatment is targeted at improving symptoms, enhancing quality of life, decreasing the inflammation that may result in permanent changes to the airways, and minimizing hospitalization and urgent medical treatment. Severe asthma, according to the National Heart, Lung and Blood Institute, is suggested by a peak airflow rate and FEV1 that are less than 40% of predicted values. On the other hand, values that are greater than 70% of what is predicted signal a possibility for discharging the patient from the emergency treatment [10].

Asthma exacerbations require treatment with many agents. These include supplemental oxygen, oral or intravenous corticosteroid therapy, nebulized beta agonist or anticholinergic medication and intravenous fluids. The goal for oxygen therapy is to induce PaO2 and arterial oxygen saturation to surpass 60 mmHg and 90%, respectively. Patients may also require breathing support either invasively or non-invasively. Studies have shown no benefit for antibiotics except when patient suffer from concomitant pneumonia. Other potential treatments are magnesium sulfate and heliox. The latter is a mixture of helium and oxygen [11] [12].

Prognosis of allergic asthma improves considerably when the patient manages to avoid the allergen. It will also depend on the severity of the allergy. Patient with mild allergic reactions are less likely to exhibit severe asthmatic symptoms.

The causative factors responsible for asthma can be divided into allergic and non-allergic. Possible allergens are dust mites, food, seasonal pollen, mold spores and animal allergens [1] [2] [3].
Allergens alone cannot account for the development of asthma. Genetic factors are also thought to play a critical role. They may predispose to the disease and influence response to therapy. In fact, genetic variation in the Arg-Arg beta adrenergic receptors is associated with the response to inhaled beta-adrenergic drugs.

The epidemiology of asthma is extremely complex. Genetic variation is thought to play a very important role and may influence incidence rates within certain racial and ethnic subpopulations. Nonetheless, confounding variables such as culture, overall environment, social and economic status, and geography are difficult to factor in [4].

The pathophysiological mechanisms underlying asthma are diverse. Mucous metaplasia and bronchoconstriction are characteristic of the disease, and are mediated by the release of inflammatory cytokines such as IL 25 and IL 33. These, in turn, activate specialized cells like mast cells, basophils and type 2 lymphocytes. Genetic variations in alleles that code for cytokines like IL33 have been also identified and are thought to be associated with the disease.

Environmental control can play a very significant role in preventing the development of asthma, as evidenced by randomized control studies. Preventive measures include remediation of allergens, especially those of cats, cockroaches, mouse, dog and mold. On the other hand, vitamin supplementation, especially vitamin A and D, can improve the immune system and potentially decrease the risk for asthma development. Drugs that have also shown promise include Palivizumab, a monoclonal antibody that is normally used against respiratory syncytial virus. The drug has been shown to reduce morbidity in preterm infants for up to 78%. Other Studies have reported that prophylaxis with Palivizumab may decrease recurrent wheezes from 10 to 50% in the first year of life. Nonetheless, more studies need to be performed to directly access the role of Palivizumab in the prevention of asthma.

Allergic asthma is a medical condition in which allergens trigger an asthmatic reaction. Both genetic and environmental factors are thought to underlie the disorder. Early intervention in regards to a multitude of allergens such as dust mites, pollen, cockroaches, dogs and cats can help in limiting or preventing the development of the disease. Patients usually present with symptoms typical of asthma after exposure to particular substances. These include wheezing, nocturnal cough, chest tightness or pain and difficulty breathing. Symptoms can vary from mild to severe, requiring urgent medical intervention. Diagnosis is established with pulmonary function tests and allergic skin testing. Treatment is based on allergen avoidance as well as symptomatic treatment.

Allergic asthma is a medical condition that describes asthmatic symptoms after exposure to allergens. The causative factors responsible for the condition are diverse and involve both a genetic predisposition and environmental triggers. Patients present with a range of symptoms that include nocturnal cough, dyspnea, chest pain and pressure, wheezing, and difficulty talking. Episodes can be mild but also severe and might require urgent medical care. Diagnosis is established with testing that assesses respiratory functioning and sensitivity to specific allergens. Treatment includes inhaled medication that relieve obstruction in the respiratory tract, as well as oral or intravenous corticosteroids and oxygen supplementation in medical emergency. Prognosis improves if the patient is able to avoid the allergen but also depends on the severity of the allergic reaction.

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