PATIENT EDUCATION

Asthma is a chronic inflammatory disorder of the airways in which susceptible individuals experience recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. The inflammation causes hyperactivity/hyper responsiveness of the airway to a variety of stimuli (triggers). The response to these stimuli is airflow obstruction, which is at least partially reversible, either spontaneously or with treatment. In addition, there is a further increase in inflammation and bronchial hyper responsiveness.

Asthma is the most common chronic disease of childhood and is increasing in prevalence. It is potentially fatal, and is the 3rd leading cause of preventable hospitalizations in the U.S. It remains under diagnosed and undertreated, possibly because signs and symptoms vary widely from patient to patient, as well as within each patient over time. Typical symptoms of asthma include wheezing, cough, chest congestion, chest tightness, and shortness of breath. Symptoms may be worse at night, or during or just after exercise.

Asthma is diagnosed by taking a detailed history, physical examination and lung function testing. Asthma can then be classified as mild intermittent, mild persistent, moderate persistent, or severe. Allergy testing may be performed to help identify triggers or if there is a positive family history of allergies.

Levels of Asthma Severity (before or without treatment) Mild Intermittent: Symptoms occur < 2 times a week and are brief (few hours or days). Nighttime symptoms < 2 times a month. Mild Persistent: Symptoms > 2 times a week but < 1 time a day and may affect activity. Nighttime symptoms > 2 time a month. Moderate Persistent: Daily symptoms which affect activity. Nighttime symptoms > 1 time a week.
Severe Persistent: Continual symptoms, limited physical activity, and frequent exacerbations. Nighttime symptoms occur frequently.

• The recent onset of frequent, moderate to severe headaches, associated with other symptoms such as nausea or vomiting.
• Frequent headaches which occur on a daily or weekly basis.
• Headaches which make it impossible for you to think, do your work, go to school, or enjoy life.
• Headaches which respond only to a great deal of over-the-counter medication such as aspirin and Tylenol-type products.
• Headaches with fever that last more than a day or two.

• To describe how severe the pain is
• Where it is strongest
• How you obtain relief
• If other symptoms accompany your headaches

A physical examination will reveal the causes of some headaches. If necessary, your doctor will order laboratory tests, X-rays, and brain-wave tests. Often these tests are ordered after consultation with a neurologist, a physician who specializes in nerve and brain problems. Most people who come to an allergist for evaluation and treatment of their headaches have been seen by other physicians. If you have not had such a preliminary evaluation, it may be worthwhile to visit your primary care physician first to rule out other causes of your headaches. One hint that allergy may play a role in your headaches is if you have other allergies such as hay fever.

What kinds of headaches have been shown to be caused by allergies?
Two types of headaches clearly can be caused by allergies – sinus headaches and migraines. Another unusual headache called cluster headache is possibly related to allergic disease

What are the symptoms of sinus headache?
The four groups of sinus cavities in the head are hollow air spaces, with openings into the nose for the exchange of air and mucus. They’re located inside each cheek-bone, behind the eyes, behind the bridge of the nose and in the forehead. Secretions from the sinus cavities normally drain into the nose. Sinus headaches and pain occur when the sinuses are swollen and their openings into the nasal passages are obstructed, stopping normal drainage and causing pressure to build up. Often the pain is localized over the affected sinus. For example, if the maxillary sinus in the cheeks is obstructed, your cheeks may be tender to the touch and pain may radiate to your jaw and teeth. Sinus pain can be dull to intense, often begins in the morning and becomes less intense after you move from a lying-down to an upright position. Antihistamines/decongestants help relieve the pain. If the area over a sinus becomes tender and you have a fever, the obstructed sinus may be infected. More intensive treatment, including antibiotics, is then required.

What about migraines?
Migraine headaches vary from very intense and disabling to mild. Migraines tend to be throbbing, usually one-sided headaches, which often are aggravated by sunlight and are frequently accompanied by nausea. There are two general types of migraine: classic and common (plus many variations). Classic migraine attacks tend to be severe and of long duration. They are preceded by aura, a sensation that signals the start of a headache. The aura may be funny smell, partial vision loss, or a strange sound. Common migraine is more prevalent than classic migraine. Attacks are generally milder and shorter. There is no aura. However, because the attacks may occur more frequently, common migraine also can be quite disabling.

What is the role of allergy in these types of headaches?
Sinus headaches develop because of swollen sinus membranes. Allergic reactions to airborne pollens, dust, animal danders, molds, as well as foods can lead to sinus obstruction. Treatment of the underlying allergic cause of sinus pain will result in long-term relief. Medications used to treat allergies include antihistamines, decongestants, intranasal steroids and cromolyn. In some cases, immunotherapy or “allergy shots”, may be recommended. When possible, of course, avoid the allergen if your allergy is caused by an avoidable substance – such as food or an animal. A large number of recent scientific studies have described the importance of food allergy in migraine attacks. Some migraine sufferers will benefit from a careful evaluation of food allergy as a cause of their headaches. Some migraines are provoked by food additives or naturally occurring food chemicals such as monosodium glutamate (often added to Chinese food and packed foods), tyramine (found in many cheeses), phenylethylamine (found in chocolate) or alcohol. The artificial sweetener aspartame and the preservative metabisulfite also may cause migraine. Often, only a few foods trigger migraines and, by limiting or avoiding their use, you can experience complete or marked relief without medication.
If you have more questions, your allergist will be happy to answer them.