Allergic asthma
Allergic (atopic) asthma is the most common asthma phenotype, an IgE-mediated eosinophilic airway inflammation triggered by aeroallergens, presenting with episodic wheeze, cough, and dyspnea in an atopic patient. Diagnosis combines demonstrated variable airflow obstruction with evidence of allergen sensitization, and treatment is inhaled corticosteroid-based controller therapy with allergen avoidance and, for severe disease, anti-IgE or anti-eosinophil biologics.
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What this article covers
- Overview
Definition: allergic (atopic) asthma is a chronic eosinophilic airway inflammation driven by IgE-mediated responses to inhaled allergens, producing reversible airflow obstruction.
- Epidemiology
The predominant asthma phenotype, especially in children and young adults.
- Risk factors
Personal or family history of atopy: the strongest predictor.
- Pathophysiology
Allergic sensitization: aeroallergen exposure generates allergen-specific IgE that arms airway mast cells.
- Clinical features
Episodic symptoms: wheeze, cough, chest tightness, and dyspnea, often nocturnal or early morning.
- Differential diagnosis
Nonallergic (non-atopic) asthma: asthma without allergen sensitization (Asthma).
- Diagnosis
Establish by variable airflow obstruction plus evidence of allergen sensitization: the diagnostic basis is demonstrating variable expiratory airflow limitation (spirometry showing obstruction with…
- Management
First-line controller, an inhaled corticosteroid: for example budesonide 200 mcg inhaled twice daily, used regularly; current guidelines favor ICS-containing therapy even for mild disease, with an…
- Complications
Life-threatening exacerbations and status asthmaticus.
- Prognosis
Good with adherent controller therapy: most patients achieve control and normal activity.
- Prevention
Reduce aeroallergen exposure: dust-mite-proof bedding, humidity and mold control, and pet and pollen avoidance.
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