Managing asthma and food allergies or celiac disease.
Morgan Howard, 13, checks the weather forecast each morning to see if the levels of pollens and mold—triggers for her asthma—will curtail the time she spends outdoors. Her daily routine also includes making sure she doesn’t leave the house without her asthma inhaler and two epinephrine auto-injectors.
The food-allergic teen must scrupulously steer clear of fish, shellfish, peanuts and tree nuts to avoid the risk of an allergic reaction. She must also be in tune with the weather in her hometown of Elkridge, Maryland, because high pollen counts, heat, humidity, mold or the onset of a cold could mean breathing difficulty.
“As a typical teen, she’s still learning respon-sibility every day and, ultimately, learning the
true importance of taking care of her health in managing both conditions,” says Tia Mason Howard, Morgan’s mom and founder of the blog The Allergy Mamas.
Vigilance is woven into each day for people navigating life with both asthma and food allergies.
Research has shown that children like Morgan who have food allergies are more than twice as likely to have asthma than children without food allergies.
The Centers for Disease Control and Prevention (CDC) found in a 2007 survey that 29 percent of children with food allergy also had asthma, whereas 12 percent of children without food allergy had asthma. A 2016 review of medical records from the Children’s Hospital of Philadelphia clinical network found that 35 percent of children with food allergies also had asthma.
Asthma and Food Allergy Connection & Risk
Asthma and food allergies are part of a group of atopic diseases that also includes allergic rhinitis (hay fever) and atopic dermatitis (eczema). The conditions share the development of immunoglobulin E (IgE) antibodies against allergens that the patient’s immune system considers a threat, says Todd Rambasek, MD, an allergist at Northern Ohio Medical Specialists.
For example, with allergic asthma (the most common type of asthma), an allergen such as pollen triggers the release of IgE antibodies, which can cause swelling of the airways in the lungs. With a food allergy, the ingestion of an allergen such as egg causes IgE antibodies to trigger a reaction.
A predisposition to develop T helper 2 (Th2) cells, which produce immune responses and promote allergic airway inflammation, is common in these patients, says Rambasek.
More than 26 million Americans have asthma, according to CDC, and up to 15 million Americans have food allergies. The combination of asthma and food allergies can put patients at a higher risk for severe or fatal food allergy reactions.
A study examining fatalities from food-induced anaphylactic reactions found that the majority of the children had asthma, and the main cause of their severe reactions was respiratory symptoms, according to a 2001 report in the Journal of Allergy and Clinical Immunology.
The increased risk highlights the need to keep asthma well controlled, as the risk for a severe outcome is especially heightened for patients whose asthma is poorly controlled, Rambasek says. It’s important to manage asthma symptoms and have regular doctor visits including lung function tests, he says.
Because breathing difficulty can be among anaphylaxis symptoms—which also can include hives, swelling, itchy mouth, itchy throat, nausea or vomiting—having both conditions can make it hard to decipher between an asthma flare-up and an allergic reaction.
Last summer, Morgan had a serious asthma flare-up that required a trip to the emergency room. Her mom suspected that heat had triggered Morgan’s asthma, but she was uncertain of the cause because Morgan had eaten in the same timeframe. A doctor administered epinephrine, in addition to other protocols, as a precaution.
“There’s a constant uneasiness knowing there’s a greater risk for a fatal food allergy reaction due to asthma,” Tia Mason Howard says.
Severe food allergy reactions usually involve two or more body systems, and symptoms usually come on quickly after eating the food to which you’re allergic, says Tanya Bumgardner, spokesperson for the Asthma and Allergy Foundation of America (AAFA).
If breathing difficulty, coughing or wheezing is not accompanied by any other symptoms, especially if symptoms begin before eating, it is likely asthma, she says.
When in doubt, epinephrine is safe and effective as emergency treatment for both situations and, in fact, is used to treat severe asthma even when it’s not related to anaphylaxis, Rambasek says.
Asthma and Celiac Disease
Many people navigate both asthma and celiac disease, an autoimmune disease that affects an estimated 1 in 133 Americans.
Those with celiac disease were 60 percent more likely to develop asthma than those without, according to a 2011 report in the Journal of Allergy and Clinical Immunology. The researchers did not find a reason for the link but suggested that a vitamin D deficiency could play a role.
It’s important to keep up regular doctor visits to manage both celiac disease and asthma, says Alice Bast, CEO of Beyond Celiac. “Stay compliant with both the gluten-free diet and your asthma treatment regimen,” she says.
Carolyn Lynch McKinley of Omaha, Nebraska, relies on her doctors to help manage both asthma and celiac disease. After a lifetime of adapting to symptoms and receiving various diagnoses for digestion issues, rashes and bone pain, she was diagnosed with celiac disease in May 2007. Around the same time, a serious asthma attack while mowing the lawn sent her to the hospital and pushed asthma to the forefront of her health concerns.
“I think your body at some point says it can’t take it anymore,” she says.
McKinley, 47, learned about various triggers for her frequent sinus infections and asthma. Now she takes seasonal allergy medications and nasal spray to keep her asthma at bay, along with following a strict gluten-free diet to manage celiac disease.
Managing Multiple Conditions
There is no cure for asthma, food allergies or celiac disease, so avoidance, preparation and communication are essential for success.
Before he steps on the soccer field, Luke Yates, 15, of Austin, Texas, takes a puff on his inhaler to keep his asthma in check. That and twice daily maintenance inhaler doses allow him to play a sport he loves. He also must carry two epinephrine injectors at all times due to his allergies to peanuts, tree nuts, sesame and chickpeas.
Preparation is key, especially carrying a rescue inhaler for asthma flare-ups and epinephrine auto-injectors for anaphylaxis, says Tia Mason Howard.
“It may sometimes feel like a vicious cycle in managing asthma and monitoring the foods you eat every day,” she says. “But I’ve found that educating our circle of family and friends about both conditions has created a more inclusive and thriving social environment for our daughter.”
Asthma, a chronic condition that causes inflammation and narrowing of the airways, includes symptoms such as shortness of breath and wheezing. According to the AAFA, types of asthma include:
The most common, it affects about 60 percent of people with asthma. Allergens cause an allergic reaction, prompting the immune system to release IgE. Too much IgE can trigger inflammation (swelling) of the airways in the lungs, making it harder to breathe and triggering an asthma attack.
Exercise-induced bronchoconstriction (EIB)
Airflow obstruction that occurs because of exercise. As many as 90 percent of people with asthma will experience symptoms of EIB during exercise. Coughing is the most common symptom. Symptoms usually don’t occur immediately at the start of exercise. They may begin during exercise and will usually worsen 5 to 10 minutes after stopping exercise.
A subtype of asthma, which is rare and usually severe. Eosinophils are a type of white blood cells in the immune system. If there are too many, they can cause inflammation in the airways. Eosinophilic asthma does not respond to most asthma medicines, like inhaled corticosteroids, but biologics may help reduce symptoms.
Contributor Wendy Mondello is a health writer. She has a teen with asthma and multiple food allergies.