How to Recognise Allergic Asthma and What Helps?

We all know asthma as a respiratory condition. But it’s not just coughing that troubles people with asthma — breathing itself becomes a struggle. The cause isn’t as straightforward as you might think, either. Asthma can be triggered by infections, allergens, or even stress. In this article, we’ll focus specifically on how to recognise allergic asthma and what helps you manage it.

What is allergic asthma — differences from regular asthma

Allergic asthma isn’t simply “ordinary” asthma that flares up now and then because of pollen. It’s a specific type with a clear cause rooted in the immune system’s reaction to allergens. While non-allergic asthma can be triggered by viral infections, cold air, or stress, allergic asthma is driven by an exaggerated immune response.

When you inhale an allergen — say, a pollen grain or a dust mite protein — your body starts producing specific IgE antibodies. These antibodies latch onto mast cells in your airways and wait. The next time you encounter that allergen, the alarm goes off: mast cells release mediators like histamine and leukotrienes. This triggers the characteristic IgE-mediated eosinophilic inflammation. Your airways swell, start producing thick mucus, and the smooth muscle around them tightens. That’s exactly where the feeling of not being able to draw a breath comes from.

This mechanism is remarkably common. According to data from the Czech Society of Allergology and Clinical Immunology (ČSAKI), up to 60% of all adult asthma cases have an allergic component. In children, the figure is even higher. Allergic asthma typically appears at a younger age and very often goes hand in hand with allergic rhinitis — more on that shortly.

Symptoms by severity — GINA classification

A feeling of someone sitting on your chest, a dry irritating cough that wakes you at night, and wheezing with every breath out — these are classic allergic asthma symptoms. They’re not the same for everyone, though. Intensity and frequency vary, and that’s exactly how doctors determine how severe your asthma is. They use international GINA (Global Initiative for Asthma) guidelines, which are updated every year.

According to GINA 2024, asthma is classified into several steps based on how often you experience symptoms and how much they limit you:

• Intermittent asthma: Symptoms occur less than once a week, night-time waking from cough or breathlessness is virtually non-existent, and between episodes you’re completely symptom-free. Lung function is normal.
• Mild persistent asthma: Symptoms appear more than once a week but not every day. They may wake you at night (though less than once a week). Daily activities start to be mildly affected.
• Moderate persistent asthma: You have symptoms every day. Night-time waking from asthma happens more than once a week. You need a reliever medication daily, and your activities are noticeably limited.
• Severe persistent asthma: Symptoms bother you constantly — essentially every day, often multiple times. Night-time attacks are frequent. Physical activity becomes very difficult.

Determining severity doesn’t rely solely on what you tell your doctor. Objective measurements are part of the picture. The foundation is spirometry, which measures how fast and how much air you can exhale. FeNO (fractional exhaled nitric oxide) testing is also used to gauge the level of eosinophilic inflammation in the airways. Keeping a symptom diary helps your doctor build an accurate picture of how well your asthma is controlled.

Triggers — pollen, dust mites, pets, mould, occupational

Identifying your trigger is absolutely crucial for managing allergic asthma. Allergens are everywhere around us and can be either seasonal or year-round.

Dust mites

According to global data, dust mites are the most common perennial trigger of allergic asthma. Their allergens are found in their droppings, and they thrive most in our beds. Night-time coughing fits and breathlessness are highly characteristic of dust mite allergy.

Pollen

The classic seasonal culprit. In spring it’s tree pollen (birch, alder), in summer it’s grasses, and in late summer and autumn it’s weeds (ragweed, mugwort). Asthma tends to worsen significantly during these periods.

Animal allergens

It’s not just fur — the main culprits are saliva, urine, and skin flakes from cats, dogs, rodents, and other pets. Cat allergens are exceptionally resilient and can persist in an environment for months.

Mould

Mould spores are found both outdoors (Alternaria, Cladosporium) and indoors (Aspergillus, Penicillium), typically in damp areas like bathrooms and basements. In some asthma sufferers, inhaling spores of Aspergillus fumigatus can lead to a serious complication called allergic bronchopulmonary aspergillosis (ABPA).

Occupational allergens

Certain occupations carry a higher risk. Bakers may react to flour, automotive workers to isocyanates in paints, healthcare workers to latex, and farmers to storage mites.

Pinpointing exactly what bothers you is the first step towards relief. Without that knowledge, treatment is essentially shooting in the dark.

Diagnosis — spirometry, FeNO, SPT

If you suspect allergic asthma, the path inevitably leads to an allergist or pulmonologist. Diagnosis doesn’t rely on symptom descriptions alone — it’s built on objective tests that confirm airway narrowing and identify the allergic cause.

The standard workup involves several steps:

1. Spirometry: The basic lung function test. You’ll breathe into a device that measures how much air and how quickly you can exhale. In asthma, a drop in FEV1 (the volume of air exhaled in the first second) is typical. The key part is the bronchodilator reversibility test: after you’re given a reliever medication (SABA, e.g. Ventolin), the measurement is repeated. If FEV1 improves by 12% and at least 200 ml, this indicates reversible airway narrowing — a hallmark of asthma.
2. FeNO measurement: This modern, non-invasive test measures the concentration of nitric oxide (NO) in exhaled air. Elevated NO levels are produced by airway cells during eosinophilic inflammation. A FeNO value above 25 ppb (parts per billion) in adults, according to EAACI (European Academy of Allergy and Clinical Immunology) guidelines, strongly suggests allergic inflammation and helps the doctor decide whether to start inhaled corticosteroids.
3. Allergy testing: To confirm the allergic nature of your asthma, the specific allergen needs to be identified. This is done through either skin prick tests (SPT), where drops of allergen extracts are applied to the forearm skin, or through blood tests measuring specific IgE antibodies (sIgE).

In unclear cases where basic tests come back negative but suspicion of asthma persists, your doctor may order a bronchoprovocation test. During this test, you inhale a substance (e.g. methacholine) in controlled conditions — in people with asthma, even low concentrations will trigger airway narrowing.

United Airway Disease — the link with rhinitis

Got a blocked nose and trouble breathing at the same time? That’s no coincidence. The upper and lower airways form a single connected system, lined by the same type of mucosa (epithelium). That’s why experts now talk about the concept of “United Airway Disease”. Inflammation that starts in the nose as allergic rhinitis very often “spills over” into the airways — and vice versa. It’s essentially a combined asthma-rhinitis condition.

The numbers are striking: up to 80% of asthma sufferers also have allergic rhinitis. And here’s the important part — untreated allergic rhinitis is a significant risk factor for worsening asthma. Nasal inflammation leads to mouth breathing, which lets unfiltered, cold, dry air reach the lungs and irritate the airways. On top of that, inflammatory substances from the nose can drip down into the lower respiratory tract.

The good news? It works the other way round too. Consistent treatment of allergic rhinitis, primarily with intranasal corticosteroids (INCS), has been shown to improve asthma control by 30–40%. The latest ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines from 2024 actually recommend that allergy sufferers with asthma use a combined nasal spray containing both a corticosteroid (INCS) and an antihistamine (INAH). Treating the nose, in other words, is also treating the lungs.

Treatment — from SABA to biologics

Treating allergic asthma has long since moved beyond reaching for an inhaler only when you can’t breathe. The modern approach, defined by GINA 2024 guidelines, is stepwise and primarily targets chronic inflammation rather than just suppressing symptoms. The goal is for you to live a normal, unrestricted life.

Treatment is stepped up gradually based on the severity of your symptoms:

Step 1

For patients with very mild, occasional symptoms. Using a reliever alone (SABA, e.g. Ventolin) is no longer recommended. Instead, when symptoms arise you take a combination of an inhaled corticosteroid (ICS) and a fast-acting bronchodilator (formoterol). This ensures that every reliever dose also delivers anti-inflammatory treatment.

Step 2

If your symptoms are more frequent, you need regular daily treatment with a low-dose inhaled corticosteroid (ICS) to suppress inflammation, plus a reliever inhaler for as-needed use.

Step 3

When a low dose of ICS isn’t enough, the next step is a combination of an inhaled corticosteroid and a long-acting bronchodilator (LABA). This ICS-LABA combination is delivered in a single inhaler and forms the backbone of maintenance therapy for most asthma patients.

Step 4

For poorly controlled asthma, a third medication — a LAMA (e.g. tiotropium) — is added to the ICS-LABA regimen to further open up the airways.

Step 5

For patients with the most severe form of asthma that can’t be controlled even with high-dose inhaled medications, biologic therapy is available. These are modern drugs (biologics for asthma) that selectively block specific immune molecules driving the inflammation. They include:

Omalizumab

An anti-IgE antibody, suitable for patients with confirmed allergy.

Mepolizumab, Reslizumab, Benralizumab

These target interleukin-5 (IL-5), which is crucial for eosinophil function.

Dupilumab

Blocks receptors for IL-4 and IL-13, two other key molecules in allergic inflammation.

Tezepelumab

The newest biologic, which blocks TSLP — a molecule sitting at the very top of the inflammatory cascade. Tezepelumab is effective across a broad spectrum of patients with severe asthma.

The right treatment is always tailored to the individual and belongs in the hands of a specialist. Make sure you discuss your condition with an allergist or pulmonologist.

AIT for asthma — SCIT vs. SLIT (ČSAKI 2024)

Allergen immunotherapy (AIT) is the only treatment that doesn’t just address symptoms — it targets the root cause of the allergy. It works by “retraining” your immune system so it no longer overreacts to the allergen. In patients with allergic asthma, AIT can reduce the need for medication and prevent the disease from progressing.

There are two main forms:

Subcutaneous immunotherapy (SCIT)

The classic injection-based approach. The allergen is administered in gradually increasing doses by injection at the doctor’s surgery — initially weekly, later once every 4–6 weeks. Treatment lasts 3–5 years. According to ČSAKI guidelines from 2024, SCIT is absolutely contraindicated in patients with uncontrolled asthma due to the risk of a severe reaction.

Sublingual immunotherapy (SLIT)

A more modern and safer form. The allergen is taken daily at home as drops or a tablet placed under the tongue. For asthma sufferers with dust mite allergy, the Acarizax tablet, for example, carries a strong recommendation from international authorities (e.g. the UK’s NICE).

The indication for AIT in asthma is clear: it must be well-controlled allergic asthma with a confirmed allergy to a specific, clinically relevant allergen (most commonly pollen or dust mites). The aim is not only to improve asthma but often also the accompanying allergic rhinitis.

Acute attack — what to do

Even with the best treatment plan, an acute asthma attack can strike. It’s a frightening experience, but it’s vital not to panic and to know what to do. The right response can save a life.

1. Stay calm: Panic makes breathlessness worse. Try to breathe slowly and steadily.
2. Use your reliever inhaler: Immediately take your reliever medication (SABA, e.g. Ventolin, or an ICS-formoterol combination). Take 4–10 puffs, ideally through a spacer, which ensures the medication reaches deep into your lungs. Take each puff one at a time with a short pause in between.
3. Adopt a relief position: Sit upright, lean slightly forward, and rest your elbows on your knees or on a table. This position engages your accessory breathing muscles and makes breathing easier.
4. Repeat the dose: If you’re no better after 20 minutes, you can take another dose of your reliever (again, 4–10 puffs).
5. Call an ambulance: If your condition doesn’t improve after the second dose, your breathlessness is worsening, you can’t speak in full sentences, or your lips and fingernails are turning blue, call emergency services immediately. Don’t wait for it to “pass”.

If the attack is part of a broader allergic reaction (anaphylaxis) and you carry an adrenaline auto-injector (EpiPen), use it according to your doctor’s instructions and call emergency services straight away.

Children with asthma — special considerations

Asthma in children and allergies often go hand in hand. In young children, however, diagnosis and treatment are a bit more complex. It’s frequently part of the so-called atopic march: it starts with atopic eczema in infancy, followed by food allergy, then allergic rhinitis in preschool years, and eventually asthma develops.

Reliable spirometry is generally only feasible from around age 5, when children are able to cooperate with the test. For younger children, the doctor relies primarily on parental descriptions of symptoms (recurrent night-time cough, wheezing during colds) and on the positive response to a trial course of treatment. A peak flow meter — a simple device for measuring peak expiratory flow — is often used for monitoring at home.

Treatment follows similar principles to adults, but with an emphasis on safety. For the youngest children, inhaled medications are delivered through a spacer with a face mask to ensure the drug is actually inhaled. It is absolutely essential not to stop preventive inhaled corticosteroid (ICS) treatment just because your child is symptom-free at the moment. Stopping treatment can lead to serious relapses. I know the thought of “steroids” can worry parents, but modern inhaled corticosteroids act locally in the lungs and are very safe when dosed correctly.

How to prevent asthma?

Allergy-driven asthma can also be influenced by your behaviour and the environment you live in. Beyond a healthy lifestyle, it’s important to focus on reducing allergen levels in your home.

The starting point is a HEPA-filter air purifier, which effectively removes pollen, mould spores, pet allergens, and dust mite particles from the air. If you’re battling humidity — which favours mould and dust mites — consider pairing it with a dehumidifier. Ideal indoor humidity should sit between 40 and 50%.

TIP: How to choose an air purifier for allergy sufferers

In winter, on the other hand, central heating dries the air out, and dry air can irritate your airways. In that case, an air purifier with a built-in humidifier can help.

If dust mites are your trigger, one of the best investments you can make is anti-dust-mite encasings for your mattress, pillow, and duvet. From personal experience, you’ll notice the difference after the very first night. These barrier covers made of nanofabric prevent allergens from reaching you and cut off dust mites’ access to their food source. Your allergic asthma then has no reason to wake you up at night.

You might also like: REVIEW of bedding for allergy sufferers

Conclusion

Living with allergic asthma can be tough, but modern medicine and the right prevention give you powerful tools to bring it under control. The key is understanding that this isn’t just occasional breathlessness — it’s chronic inflammation that demands a systematic approach. From an accurate diagnosis through stepwise treatment to targeted measures at home, every step counts. I know how frustrating it can be when you can’t breathe properly and it feels like your body is fighting against you. But you’re not in this alone.

If you suspect that allergic asthma might be affecting you or your children, don’t wait. The best thing you can do today is book an appointment with an allergist. An accurate diagnosis is the foundation of successful treatment — and it’s what will let you take a deep breath again and live life to the full, without unnecessary limitations. Well-managed asthma is no barrier to an active lifestyle, sport, or a good night’s sleep.

Frequently asked questions