More than 50 million people in the United States suffer from asthma and allergies. Fortunately, today there are many effective medications available to treat these conditions. The following information is intended to help asthma and allergy sufferers better understand the most commonly used types of medications.

Anti-inflammatory agents

Inflammation is an important part of allergic diseases and can affect the skin as in eczema; the nose as in allergic rhinitis; the conjunctiva of the eyes or the bronchial tubes as in asthma. There are three classes of medications that are used as anti-inflammatory agents to treat allergies and asthma:

Mast Cell Stabilizers: these are non-steroidal medications that reduce inflammation by preventing the release of inflammatory chemicals.

• They include cromolyn, nedocromil and lodoxamide and are available in various forms to treat allergic disease.

Corticosteroids [also known as "steroids"]: are effective anti-inflamammatory medications. These medications are very different from the anabolic steroids that are misused by some athletes to increase their performance.

• Corticosteroids are available in topical creams or ointments, nasal sprays, inhalers, pills and by injection.
• Corticosteroid use needs to be supervised by a physician.
• Minor side effects from using corticosteroid inhalers can include hoarseness and thrush (a fungal infection of the mouth and throat). Both are less likely with rinsing, gargling and spitting with water after use.
• Long-term use of inhaled corticosteroids in children could potentially result in reduced growth velocity; however in most situations the benefit of having the asthma controlled is greater than the potential for a side effect.
• Oral corticosteroids generally have more side effects than inhaled or topical agents.
• Short-term use (up to several weeks) of oral corticosteroids is usually not a problem for an otherwise healthy person.
• Side effects of short-term use include slight weight gain, increased appetite, menstrual irregularities, cramps, heartburn or indigestion. These side effects will go away shortly after stopping the corticosteroids.
• Long-term use (months to years) of oral corticosteroids is associated with ulcers, weight gain, cataracts, weakened bones and thinner skin, high blood pressure, elevated blood sugar, easy bruising and decreased growth in children.
• Corticosteroids, when taken properly, are a very effective method of treatment for asthma and allergies.
• Oral corticosteroids are usually considered as short-term medications for asthma flare-ups, marked nasal congestion, and at times for skin conditions such as poison ivy.
• Inhaled corticosteroids are considered the most effective medications for long-term control over persistent asthma.
• Please see the Tip brochure in this series for more information on the use of inhaled medications for asthma.

Anti-leukotrienes

• Many of the cells involved in causing airway inflammation are known to produce potent chemicals within the body called leukotrienes (lu-ko-try-eens).
• Leukotrienes are responsible for increasing inflammation within the body-causing contraction of the airway muscle and increasing leakage of fluid from blood vessels in the airways.
• Currently we have several oral anti-leukotriene medications available to help fight allergic inflammation.
• These drugs are primarily used to help gain control over persistent asthma.
• One is also approved to treat allergic rhinitis.
• These medications are available only in tablet form which some people prefer.

Bronchodilators

There are several classes of bronchodilators available to treat asthma.

Beta-agonist bronchodilators relax the muscle of the bronchial tubes.

• Short-acting beta-agonist bronchodilators are used as quick-relief medications. These are available as inhalations, liquids, injectables and pills. (Albuterol is the classic example.)
• Long-acting beta-agonists bronchodilators are used for long-term control of asthma. (Salmeterol and formoterol are two examples.)
• Side effects of this class include nervousness, increased heart rate, restlessness, insomnia and, rarely, headaches.

Theophylline has been used for over 30 years to treat asthma.

• These are available as tablets, capsules or intravenously.
• Their blood levels need to be monitored.
• Side effects can include headaches, elevated heart rate and stomach upset.

Anticholinergics are available in inhaled form.

• These can be used alone or combined with the beta-agonist bronchodilators.
• Ipratropium is used for asthma treatment as a quick-relief medication.
• Cough and headache can be side effects.

Omalizumab

Omalizumab was approved in 2003 as a new class of therapy, known as anti-IgE, for patients with moderate to severe persistent allergic asthma. IgE is an antibody that we all have and it is responsible for causing allergic problems in some people. It may reduce allergic reactions by causing free IgE to disappear from the body so that the IgE cannot attach to pollen (and other substances that are present).

Its use should be limited to those patients with moderate to severe persistent allergic asthma who: 1) are inadequately controlled with appropriate combination therapy; 2) have complications due to inhaled or oral steroid use; 3) have increased urgent care, emergency department or inpatient service needs due to asthma exacerbations; 4) have significant problems with activities of daily living; or 5) have problems taking regular medication prescribed to treat asthma. Omalizumab should be administered every two to four weeks by injection based on body weight and total serum IgE levels.

To treat your allergy and asthma symptoms, your allergist/immunologist will prescribe the medications that are best for you and your specific symptoms. If you have side effects from any medications, be sure to contact your doctor.

Your allergist/immunologist can provide you with more information on asthma and allergy medications.

Tips to Remember are created by the Public Education Committee of the American Academy of Allergy, Asthma and Immunology. This brochure was updated in 2003.