Birch trees are known for their tall, thin trunks and white bark. But did you know they trigger a lot of allergy symptoms for much of the population each spring? These allergy symptoms can range from nasal symptoms, like sneezing and a stuffy nose, to the lesser-known oral allergy syndrome (OAS).

What Is OAS?

If you have a pollen allergy, you could have OAS. It is a mild form of food allergy.¹ With OAS, your mouth and throat may itch or tingle right after you eat certain raw fruits, vegetables, seeds or nuts. You might even get hives where the food touched your skin or swelling of your mouth, lips, tongue and throat. Many people with OAS can eat the foods that cause reactions if they are cooked or if the skin is removed.

It might seem strange that you would react to some foods because of an airborne tree pollen. This happens when your immune system gets confused. The pollen is similar to the proteins in some foods, so your body can’t tell the difference. So if you are allergic to birch pollen, your body might think it’s invading your body when you eat an apple. This is called cross-reactivity.

What’s the Difference Between OAS and Anaphylaxis?

The symptoms of OAS sound similar to anaphylaxis. So how do you know the difference?

Anaphylaxis (anna-fih-LACK-sis) is a severe reaction that comes on quickly and usually affects more than one organ system (part of the body), such as the skin or mouth, the lungs, the heart and the gut. It requires epinephrine and immediate medical attention. Some symptoms include:

• Skin rashes, itching or hives
• Swelling of the lips, tongue or throat
• Shortness of breath, trouble breathing or wheezing (whistling sound during breathing)
• Dizziness and/or fainting
• Stomach pain, bloating, vomiting or diarrhea
• Uterine cramps
• Feeling like something awful is about to happen
  
  

OAS is milder and often only affects the mouth. It can come on immediately when eating the offending food and go away quickly after eating the food.

But call your doctor if your OAS:

• Gets worse
• Happens when you eat nuts or cooked fruits and vegetables
• Trigger any of the above symptoms of anaphylaxis
  
  

What Foods Could I React to If I Have a Birch Pollen Allergy?

If you are allergic to birch pollen, there are several foods you could react to. But you may not react to every food on the list. Here are foods that cross-react with a birch pollen allergy:

• Almond
• Apple
• Apricot
• Carrot
• Celery
• Cherry
• Hazelnut
• Kiwi
• Parsley
• Peach
• Peanut
• Pear
• Plum
• Soybean
  
  

If you do not have symptoms when eating birch-related fruits and vegetables, you may continue to eat them as tolerated. If you have severe OAS symptoms, you should discuss this with an allergist. You’ll want to avoid eating the foods that trigger them, especially when birch pollen is high. Birch trees release their pollen between January to April, depending on where they grow. And birch trees grow throughout most of the United States, so they are hard to avoid.

If you have a reaction to almonds, hazelnuts or peanuts, you might have more serious symptoms. These nuts can cause anaphylaxis, a serious, life-threatening reaction. If you have symptoms when eating these nuts, talk to your doctor right away.

Birch trees are not the only plants that can trigger OAS. If you have symptoms of OAS, your doctor can perform tests to diagnose your pollen allergies so OAS won’t leave you guessing.

Medical Review February 2018.

References
1. Oral allergy syndrome (OAS) | AAAAI. (n.d.). Retrieved March 1, 2017, fromhttps://www.aaaai.org/conditio...ergies-can-be-relate;

Did you know there are different types of asthma? One type you may not have heard of is called eosinophilic [EE-oh-sin-oh-FILL-ick] asthma. It is sometimes called e-asthma or eos asthma for short. It is a type of asthma that has increased inflammatory cells called eosinophils [EE-oh-sin-oh-FILLS] in the airway. An estimated 25 million people in the United States have a diagnosis of asthma and about 10% of them have poorly controlled, severe asthma. Many of these patients could have e-asthma.   

What Is Eosinophilic Asthma?

Eosinophilic asthma is a type of asthma that is caused by high levels of white blood cells called eosinophils in the airways of the lungs. The purpose of these white blood cells is to help you fight infections. Sometimes these immune cells are over-reactive and cause inflammation in the body, including in the lungs. People who have high levels of eosinophils can have swelling in the airways which can lead to asthma symptoms.

Eosinophilic asthma is a type of severe asthma. It usually starts in adulthood and may not respond to treatment with a common asthma medicine called a corticosteroid. In addition, this type of asthma can be associated with increased allergies.

If you have eosinophilic asthma, you can have allergic or non-allergic asthma triggers. Other types of asthma, such as allergic asthma, are more often triggered by specific allergens such as animal dander, mold spores, dust mites, and environmental allergens in the air.

How Do You Treat Eosinophilic Asthma?

Your doctor may do several tests to confirm your type of asthma. This may include checking your mucus or saliva for eosinophils, checking your blood eosinophil count, or doing a test that checks your breath for a nitric oxide gas. Your doctor will also ask you about your current and past symptoms, as well as any current and/or history of allergies If your doctor diagnoses you with e-asthma, understanding this unique type of asthma is important to help you manage symptoms and have better quality of life.

Current management of e-asthma begins with standard guideline-based therapy. For example, most people with asthma are prescribed two medicines:

• A controller medicine that treats airway swelling – usually an inhaled corticosteroid
• A quick-relief medicine to help relieve symptoms when they occur by relaxing bronchospasms [brahn-ko-spaz-uhmz] – when muscles tighten and squeeze around the airways
  
  

Depending on how often and how severe your symptoms are, you may take these medicines every day or as needed. Your health care provider should develop a clear, written, and understandable action plan for effective management of asthma symptoms.

For some people with e-asthma, the common controller medicines may not work well enough on their own to control asthma symptoms. Once your doctor looks at your tests, medical history, and current symptoms, the next step is making a plan for your treatment. Shared-decision making can be undertaken with your health care provider to see if you need to add a targeted therapy. This type of asthma treatment is known as a biologic, or monoclonal antibody therapy.

Biologics target specific cells (pathways that are part of your immune system) to block swelling and reduce symptoms. You get these therapies as a shot or by IV every few weeks or two months, depending on the treatment.

Current biologic options for e-asthma include:

• Omalizumab
• Benralizumab
• Dupilumab
• Mepolizumab
• Reslizumab
• Tezepelumab-ekko
  
  

How Does Eosinophilic Asthma Affect Quality of Life?

If you have uncontrolled asthma, no matter the type, you are at higher risk for emergency room visits, hospital stays, or death. If you have severe asthma, you may have symptoms every day and go to the emergency room more often than people with well-controlled asthma. Severe asthma can limit your ability to do even simple tasks, can be debilitating, and can decrease your overall quality of life. Identification of severe subtypes of asthma (like e-asthma) may be very important for treatment of your uncontrolled asthma.

A study by the Asthma and Allergy Foundation of America (AAFA) in 2017 found that people with severe, uncontrolled asthma have greater emotional, social, and financial burden of disease. But not all people with severe, uncontrolled asthma are aware of what type of asthma they may have or that biologic treatments exist that may control their asthma better and improve their quality of life. This is an issue that you should be aware of and discuss with your health care provider.

If you have asthma, talk with your doctors specifically about how asthma negatively affects your day-to-day life. Let them know what you hope to achieve with treatment. Ask them if you are a potential candidate for biologic asthma treatments.

We also encourage health care professionals to work closely with their patients to understand the many ways severe asthma is affecting quality of life. Together, people with asthma and their support teams can develop a shared understanding of asthma management and treatment goals.

Medical Review: May 2022 by John M. James, MD

Long, hot days are great for outdoor activities, but pollen can threaten to keep you indoors if you have pollen allergies and allergic asthma. They may leave you longing for a rain shower to wash the pollen away. But rain causes plant growth, producing more pollen, right? So is rain good for those with allergies or not?

The Good News About Rain and Pollen

Did you know pollen counts may actually be higher when it’s dry? You would expect rain to make plants grow, producing more pollen. So a dry spell would mean less pollen, right? Not really.

During dry seasons, trees can actually release more pollen.¹ There is less moisture in the air to weigh down the pollen grains when the wind blows. This helps more pollen travel farther and more easily.

Light, steady rain showers can wash the pollen away, keeping it from flying through the air. The humidity that follows helps keep pollen down too. Rain can have a welcome benefit for those with pollen allergies.

The Not-So-Good News About Rain and Pollen

Overall, rain is good if you have pollen allergies. But rain can cause issues for those with allergies to grass, weeds, dust and mold.

When it rains when grass and weed pollen is high, drops can hit the ground and break up clumps of pollen into smaller particles. They then quickly disperse, causing a sudden increase in allergy and allergic asthma symptoms during the rain shower. This tends to happen more during sudden, heavy downpours.

If you’re in a rainy and humid season, mold and dust mite counts can climb. Mold thrives in damp conditions. Remove leaves before they can become a problem. Lower your indoor humidity to keep mold at bay indoors.

Dust mites can also multiply in humid conditions. If the rain is keeping you indoors, take steps to control your indoor allergens.

Watch the Weather and Seek Allergy Treatment

Rain can be a good thing for pollen allergies. But you can have too much of a good thing. Next time the showers rain down, be grateful for the temporary relief. If the rains keep pouring down, watch out for a spike in mold, dust, and weed and grass pollen soon after.

You can manage your allergies and allergic asthma by visiting a board-certified allergist to help you manage your symptoms and by tracking the weather and pollen on these sites:

Accuweather/AAFA personalized respiratory forecast – Visit Accuweather.com for a personalized asthma forecast for your area. Enter your location. Then from the Personalized Forecasts drop-down menu, choose Respiratory. The Accuweather/AAFA forecast will show asthma alerts along with your forecast. The page also includes tips from AAFA on managing weather-related asthma issues.

National Allergy Bureau – Sign up to receive email alerts or download the app from the AAAAI to alert you of your area’s pollen counts.

Many treatments are available to help you manage your pollen allergies, no matter what the weather does. AAFA’s annual Spring Allergy Capitals™ report provides insights into cities where people are most affected by spring allergies. Download the report to see where your city ranks.

Medical Review July 2017, updated May 2018

References
1. G. G. Franchi, B. Piotto, M. Nepi, C. C. Baskin, J. M. Baskin, E. Pacini; Pollen and seed desiccation tolerance in relation to degree of developmental arrest, dispersal, and survival. J Exp Bot 2011; 62 (15): 5267-5281. doi: 10.1093/jxb/err154

As spring begins, now is a good time to start fresh by giving your home a thorough cleaning. If you have asthma and allergies, cleaning your home can help reduce allergens and triggers in your home. Follow this checklist to help improve your indoor air quality and keep asthma and allergy triggers at bay. Be sure to use CERTIFIED asthma & allergy friendly® products to have a healthier home.

Bedrooms

• Remove clutter.
• Replace pillows if more than two years old.
• Wash curtains and throw rugs in water at 130 F or hotter weekly.
• Mop solid surface floors and under all furniture.
• Remove dust on and behind furniture, like dressers and nightstands, on ceiling fans and light fixtures, and closet shelves (use a microfiber cloth or CERTIFIED asthma & allergy friendly® dust cloth that traps allergens).
• Check allergen barrier covers on mattresses and pillows for wear – replace, if necessary.
• Replace or clean filters in air cleaners.
• Vacuum mattresses, fabric furniture, and wall-to-wall carpet weekly with a CERTIFIED asthma & allergy friendly® vacuum. (Long term, it is best to replace carpet with CERTIFIED solid surface flooring, if possible.)
  
  

Bathrooms

• Fix leaks.
• Dust or rinse clean the exhaust fan covers.
• Clean and remove mold (check showers, tubs, sinks, toilets, and inside cabinets).
• Check shower curtains for signs of mold and mildew – replace, if necessary.
• If your bathroom has a window, remove curtains, and replace with frosted glass or blinds (clean weekly).
• Wash throw rugs in water at 130 F or hotter weekly.
  
  

Living/Family Room

• Remove clutter.
• Remove dust from ceiling fans and electronics.
• Mop solid surface floors and under all furniture.
• Wash curtains and throw rugs in water at 130 F or hotter weekly.
• Replace filters in air cleaners.
• Vacuum furniture and wall-to-wall carpet weekly with a CERTIFIED asthma & allergy friendly®.
  
  

Kitchen

• Fix leaks.
• Remove mold (check sinks, inside cabinets, produce bins, trash cans, and refrigerator seals).
• Wipe down the tops of cabinets and range hoods often with warm, soapy water.
• Wash curtains and throw rugs in water at 130 F or hotter weekly.
• Clean your garbage disposal with baking soda and white vinegar.
• Mop floors and under all furniture.
  
  

The time you spend on spring cleaning is a good investment, especially if you have asthma and allergies. If you have severe asthma and allergies, it is best to have someone else do your cleaning for you, if possible.

Looking for tips for other areas of your home? Check out our Healthier Home Checklist. Our interactive Checklist can help you learn ways to improve your indoor air quality and reduce asthma and allergy triggers throughout your entire home.

A concerning and dangerous trend is circulating on social media channels like Facebook, Twitter, and TikTok. People are breathing in hydrogen peroxide through nebulizers to try to prevent or treat COVID-19.

DO NOT put hydrogen peroxide into your nebulizer and breathe it in. This is dangerous!

It is not a way to prevent nor treat COVID-19. Visit aafa.org/covid19 for information about asthma, allergies, and COVID-19.

Hydrogen peroxide can be used as a cleaner and stain remover, and can cause tissue damage if you swallow it or breathe it in. According to the Agency for Toxic Substances and Disease Registry:

"Hydrogen peroxide can be toxic if ingested, inhaled, or by contact with the skin or eyes. Inhalation of household strength hydrogen peroxide (3%) can cause respiratory irritation. Exposure to household strength hydrogen. peroxide can cause mild ocular irritation. Inhalation of vapors from concentrated (higher than 10%) solutions may result in severe pulmonary irritation."

A nebulizer is a “breathing machine” used to treat asthma. It turns liquid asthma medicine into a mist. You then breathe in the medicine through a mask or mouthpiece.

Only use asthma medicine prescribed by your doctor in your nebulizer. Other chemicals can be harmful to your lungs.

To understand asthma, a chronic disease that causes your airways to become inflamed, it helps to first know how your airways work.

Watch on YouTube

How Do Normal Airways Work?

When we breathe in, air moves through our airways – from our nose or mouth, down a large hollow tube in the front of the neck called a windpipe or trachea – and into our lungs.

The trachea divides into two tubes called bronchial [bron-KEE-uhl] tubes in the lungs. They look like upside-down trees. As the bronchial tubes pass through the lungs, they divide into smaller air passages called bronchioles [bron-KEE-ohlz]. At the end of each bronchiole are tiny air sacs that fill up with air, like tiny balloons, each time we breathe in. These are called alveoli [al-VEE-uh-lahy].

Air comes into our lungs each time we breathe in. This air has oxygen in it. Oxygen has a special job. It helps feed, or give energy to, all parts of our body so we can walk, talk, eat and exercise.

How Do Your Airways Work When You Have Asthma?

When you have asthma, your airways aren't able to function as well as they should.

Common asthma symptoms are:

• Coughing
• Shortness of breath
• Wheezing
• Chest tightness
  
  

Asthma causes inflammation, or swelling, in the lungs. It can also cause squeezing, called bronchoconstriction [bron-KOH-con-STRICK-shun], and extra sensitive or twitchy airways.

When something bothers your airways, you have trouble breathing. This is called an asthma attack or episode. It gets harder to breathe because the tiny muscles around your airways squeeze tightly and they have swelling inside.

Your airways will make more mucus inside your airways, which makes it even harder to breathe. These changes in your airways can cause coughing and wheezing.

There is no cure for asthma. But you can take steps to manage it. If you have asthma, it's important to see an asthma specialist, like an allergist or pulmonologist, to come up with the right asthma treatment plan. Medicines and avoiding asthma triggers can help reduce swelling and relax tight muscles in your airways.

In December 2019, a new coronavirus named SARS-CoV-2 started spreading and triggered a pandemic (worldwide outbreak). This coronavirus causes an illness known as COVID-19.

The coronavirus spreads through close contact from person to person. A person with the virus can spread it to others by talking, coughing, sneezing, singing, or breathing. The virus will be in large or small droplets that are exhaled from the mouth or nose out into the air.

If you are within 6 feet (2 meters) of someone who is ill with COVID-19, you may be at greatest risk for becoming infected. But it may be possible to catch the virus even if you are more than 6 feet away from an infected person because very small droplets can spread in the air. If someone who is sick coughs on or near your face, you may get infected. People may be infected with the coronavirus and not show any symptoms. They may spread the virus without knowing it. The virus may also spread through direct contact with a person who has COVID-19.

What Are the Symptoms of COVID-19?

According to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), COVID-19 symptoms can include:

• Fever
• Chills
• Cough
• Shortness of breath or trouble breathing
• Feeling tired and weak
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Stuffy or runny nose
• Nausea or vomiting
• Diarrhea
  
  

If you or someone you know has these emergency warning signs, call 911 or go to the emergency room immediately:

• Trouble breathing or shortness of breath
• Pain or pressure in the chest that doesn’t go away
• Newly confused
• Can’t wake up or stay awake
• Cyanosis which is tissue color changes on mucus membranes (like tongue, lips, and around the eyes) and fingertips or nail beds – the color appears grayish or whitish on darker skin tones and bluish on lighter skin tones
  
  

According to the CDC, this list may not include all symptoms. If you have any symptoms that are severe or concerning, call your doctor.

The CDC warns that symptoms may appear two to 14 days after coming in contact with the virus.

How Can I Tell the Difference Between Asthma, COVID-19, the Flu, a Cold, or Seasonal Allergies?

Some symptoms are similar between these respiratory illnesses. Respiratory illnesses may worsen asthma, so it’s important to keep taking your asthma medicines. If you have a fever and a cough, call your doctor. If you have seasonal allergies, there are things you can do to treat them at home. If your allergy symptoms are hard to control, make an appointment with an allergist.

This chart can help you figure out if you may be feeling symptoms of asthma, allergies, or a respiratory illness like COVID-19, the flu, or a cold:

Click to see larger image (English)

Click to see larger image (Spanish)

Are People With Asthma at Risk of Severe Illness From COVID-19?

Many studies show that having asthma does not put you at a greater risk of getting COVID-19 or having severe COVID-19.^1,2,3 A study published in “The Journal of Allergy and Clinical Immunology: In Practice” (JACI: In Practice) found that people with well-controlled asthma have less severe COVID-19 outcomes than people with uncontrolled asthma.⁴

The CDC continues to list moderate-to-severe asthma as a chronic lung disease that can make you more likely to have severe illness from COVID-19.

No matter what, it is important to keep your asthma well-controlled. If your asthma is not under control, you are at a greater risk in general of having an asthma episode or attack, going to the emergency room, staying in the hospital, or even death. If you feel like your asthma is not well-controlled, talk with your doctor as soon as possible.

Even though people with asthma are not at the highest risk for COVID-19, it is still important to keep your asthma under control. Common medicines you may take for asthma and allergies do not increase your risk of getting COVID-19. They will help you keep your asthma under control. You are at greater risk for having an asthma attack if you stop taking your medicines. Take your medicines at the first sign of symptoms as listed on your asthma action plan. Continue to take these medicines as prescribed:

• Quick-relief medicine (such as albuterol)
• Inhaled corticosteroids (controller medicines)
• Oral corticosteroids (such as prednisone)
• Biologics
• Antihistamines (allergy medicine)
• Proton pump inhibitors for acid reflux
• Nasal allergy sprays
• Allergy shots
  
  

If you have any questions about asthma medicines and COVID-19, talk with your doctor.

If you need to take quick-relief medicine (such as albuterol) for an asthma episode, use an inhaler (with a spacer if directed by your doctor) if possible. Using a nebulizer can increase the risk of sending virus particles in the air if you are sick. But if you have a nebulizer and solution, it is OK to use it to treat an asthma episode. When using a nebulizer, limit the number of people in the room or use it in a room by yourself.

How Can I Avoid Getting COVID-19 (And Other Respiratory Infections)?

The following steps will help you avoid COVID-19, the flu, and other respiratory infections:

1. Get your vaccines.

Vaccines can help protect you, your loved ones, older adults near you, teachers, and essential workers from getting a respiratory infection. They can also cut down your symptom severity if you do get sick. Vaccines reduce the burden on our health care system by reducing the number of people who get COVID-19 or the flu.

Everyone who is 6 months and older can get a COVID-19 vaccine for free with no out-of-pocket costs in the United States. There are currently four vaccines available: Pfizer, Moderna, Johnson & Johnson (J&J), and Novavax.

Visit vaccines.gov to find out where you can get the COVID-19 vaccine near you. Most people can get the COVID-19 vaccine with no issues. Allergic and adverse reactions are rare.

The flu vaccine is recommended for everyone age 6 months and older with rare exceptions.

It is safe to get both the COVID-19 vaccine and the flu vaccine at the same time.

2. Wear a mask.

Face masks can help reduce the spread of the coronavirus. They can benefit people who are vaccinated and unvaccinated alike. Some people may have COVID-19 and not show symptoms for a few days, while some may not have any symptoms at all. And some vaccinated people have gotten breakthrough infections, which have usually been mild.

Wear a mask that fits snugly on your face, and covers your nose, mouth, and beard completely. Wear a mask when you leave your home, if you are caring for someone at home who is sick, and if you have been exposed to someone with COVID-19. People with asthma should be able to wear face masks.

Face masks offer other benefits as well. They can reduce your exposure to pollen, air pollution, and other respiratory infections like the flu.

3. Keep a physical distance from people outside your household.

In general, the more closely you interact with other people and the longer that interaction, the higher the risk of coronavirus or flu spread. Try to stay home when possible when these illnesses are spreading in your community. Avoid large crowds of people, especially in indoor locations. When in public, keep at least 6 feet apart. Stay away from people who are sick or have been in contact with someone who is sick. Even when you’re at home with family, don’t share makeup, food, dishes, or eating utensils.

Postpone any unnecessary travel during the COVID-19 pandemic. See the CDC’s guidelines on how to protect yourself at specific locations and in certain situations, such as shops, public places, gatherings, and more.

4. Wash your hands properly and often.

Use soap and warm water to wash your hands for 20 to 30 seconds. Always wash your hands before and after eating and after coughing or sneezing. Don’t touch your eyes, nose, or mouth.

If you don’t have access to running water, use an alcohol-based hand sanitizer that is at least 60% ethyl alcohol (ethanol) or 70% isopropyl alcohol (isopropanol).

5. Make sure your indoor spaces are well-ventilated and have good indoor air quality.

If you are staying indoors more because of COVID-19, be mindful of the quality of your indoor air. The air inside our homes can often be more polluted than the air outside. Unhealthy indoor air can be full of asthma triggers and allergens that can cause symptoms and make your asthma harder to control. Take steps to improve and maintain healthy indoor air quality.

Air circulation is important too. Keep your indoor spaces well-ventilated by opening windows or doors, using fans, running air cleaners, or using proper air filters in your HVAC system.

Current evidence shows the risk of the coronavirus spreading is much lower outdoors than indoors. Good ventilation in your indoor environment may help reduce the spread of the coronavirus. It may also affect the risk of transmission (how fast it spreads).

On days when pollen is low and air quality is good, open your windows to let in fresh air. Run your HVAC system as much as possible (especially when windows are closed). Use high efficiency air filters in your HVAC system and replace them at least every three months.

6. Take care of your health.

Take your asthma control medicines as directed to keep your airways open. Eat well and get enough sleep.

Pollen (such as grass or ragweed pollen) may impact people across the U.S. too. Seasonal allergies can affect people with allergic asthma. If pollen allergies trigger asthma symptoms for you, be sure to follow your allergy treatment plan to keep your allergies under control to prevent asthma episodes or attacks.

If you stopped seeing your allergist or getting allergy shots (immunotherapy) during the COVID-19 pandemic, consider making an appointment soon. Keeping up with your regular allergist visits is an important part of keeping your asthma controlled.

The most important thing you can do is to keep your asthma under control. If your asthma is not under control, call your doctor right away.

In general, tracking your symptoms and following your asthma action plan are key to managing your asthma. Some people use peak flow meters to monitor their airways. Monitoring your blood oxygen levels with a pulse oximeter (or “pulse ox”) is not a recommended part of home management of asthma. Many pulse oximeters you can buy for home use are not as accurate as medical grade devices.

It is important to remember that the symptoms you feel should always come before pulse ox and peak flow numbers. But if your peak flow numbers are down and you don’t have symptoms, follow your asthma action plan and contact your doctor.

There are no data demonstrating that monitoring your pulse ox through an oximeter or smartphone app will help manage your asthma. As always, talk with your doctor about the best ways to monitor your symptoms and asthma control.⁶

If I Think I Have COVID-19, What Should I Do?

If you start having symptoms of COVID-19, get tested or take an at-home test. If you have mild symptoms and are not at high risk for having more severe COVID-19, you do not need to call your doctor. Call your local health department within 24 hours to let them know so they accurately report local cases.

If you are at high risk for severe COVID-19, call your doctor within 24 hours if you test positive. They may want to you to take the medicine Paxlovid.

Many pharmacies have various testing options (including at-home or drive-thru tests). The United States Postal Services is providing free at-home COVID-19 tests. U.S. households can get eight rapid antigen COVID-19 tests for free. To receive them, you’ll need to complete an online form. Please note: You will not need to enter any credit or debit card details to place the order.

Some doctors may offer telehealth (video or virtual appointments). If that is an option, ask your insurance company if telehealth is covered under your plan. And if you have Medicare, you might be able to have a virtual visit with your doctor. The government expanded the coverage of telehealth services during the COVID-19 pandemic.

Stay home and isolate from family members so you don’t spread the coronavirus to other people.

Medical Review, July 2022 by Mitchell Grayson, MD

References
1. Chhiba, K.D., Patel, G.B., Vu, T.H.T, Chen, M.M., Guo, A., Kudlaty, E., Mai, Q., Yeh, C., Muhammad, L.N., Harris, K.E., Bochner, B.S., Grammar, L.C., Greenberger, P.A., Kalhan, R., Kuang, F.L., Saltoun, C.A., Schleimer, R.P., Stevens, W.W., & Peters, A.T. (2020). Prevalence and characterization of asthma in hospitalized and non-hospitalized patients with COVID-19, Journal of Allergy and Clinical Immunology. https://doi.org/10.1016/j.jaci.2020.06.010.
2. Butler, M. W., O’Reilly, A., Dunican, E. M., Mallon, P., Feeney, E. R., Keane, M. P., & McCarthy, C. (2020). Prevalence of comorbid asthma in COVID-19 patients. Journal of Allergy and Clinical Immunology. https://doi.org/10.1016/j.jaci.2020.04.061
3. Lieberman-Cribbin, W., Rapp, J., Alpert, N., Tuminello, S., & Taioli, E. (2020). The Impact of Asthma on Mortality in Patients With COVID-19. Chest. https://doi.org/10.1016/j.chest.2020.0air pol.575
4. Huang, B. Z., Chen, Z., Sidell, M. A., Eckel, S. P., Martinez, M. P., Lurmann, F., Thomas, D. C., Gilliland, F. D., & Xiang, A. H. (2021). Asthma disease Status, COPD, and COVID-19 severity in a large Multiethnic POPULATION. The Journal of Allergy and Clinical Immunology: In Practice. https://doi.org/10.1016/j.jaip.2021.07.030
5. Kampf, G., Todt, D., Pfaender, S., & Steinmann, E. (2020). Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. Journal of Hospital Infection, 104(3), 246–251. doi: 10.1016/j.jhin.2020.01.022
6. Heneghan, C. (2018, January 30). Self-management of asthma – is there an app or pulse oximeter for that? Retrieved from https://blogs.bmj.com/bmjebmsp...-app-pulse-oximeter/

AAFA is pushing to lower the costs of asthma and allergy medicines, including inhalers. We know the high cost of medicine can be a barrier to treatment.

Some major asthma inhaler manufacturers have announced $35 a month caps on out-of-pocket costs. The price cap will apply to people with commercial/private insurance or no insurance. The inhalers that will be price capped include:

AstraZeneca (effective June 1, 2024):

• AIRSUPRA® (albuterol and budesonide) inhalation aerosol
• BEVESPI AEROSPHERE® (glycopyrrolate and formoterol fumarate) inhalation aerosol
• BREZTRI AEROSPHERE® (budesonide, glycopyrrolate, and formoterol fumarate) inhalation aerosol
• SYMBICORT® (budesonide and formoterol fumarate dihydrate) inhalation aerosol

Boehringer Ingelheim (effective June 1, 2024):

• Atrovent® HFA (ipratropium bromide HFA) inhalation aerosol
• Combivent® Respimat® (ipratropium bromide and albuterol) inhalation spray
• Spiriva® HandiHaler® (tiotropium bromide) inhalation powder
• Spiriva® Respimat®25 mcg (tiotropium bromide) inhalation spray
• Spiriva® Respimat®5 mcg (tiotropium bromide) inhalation spray
• Stiolto® Respimat® (tiotropium bromide and olodaterol) inhalation spray
• Striverdi® Respimat® (olodaterol) inhalation spray

GSK (with price change going into effect no later than Jan. 1, 2025):

• Advair Diskus (fluticasone propionate and salmeterol inhalation powder)
• Advair HFA (fluticasone propionate and salmeterol inhalation aerosol)
• Anoro Ellipta (umeclidinium and vilanterol inhalation powder)
• Arnuity Ellipta (fluticasone furoate inhalation powder)
• Breo Ellipta (fluticasone furoate and vilanterol inhalation powder)
• Incruse Ellipta (umeclidinium inhalation powder)
• Serevent Diskus (salmeterol xinafoate inhalation powder)
• Trelegy Ellipta (fluticasone furoate, umeclidinium, and vilanterol inhalation powder)
• Ventolin HFA (albuterol sulfate inhalation aerosol)

AAFA is leading the way to reduce health care costs for people with asthma

"On behalf of the 27 million people in the United States with asthma, we appreciate the leadership of President Biden and Senator Sanders to bring down costs for asthma treatments. Pricing announcements made in March by some manufacturers of inhalers will mean lower costs and improved access to asthma medicine for many people with asthma starting this June,” said AAFA President and CEO Kenneth Mendez. “As President Biden indicated, more can and should be done. It’s not just drug companies, others need to step forward. We welcome continued efforts to improve affordability and accessibility of these essential medicines so all patients can get the treatment they need.”

AAFA continues to raise the voice of the patient community and draw attention to the ways America’s complex drug pricing ecosystem makes asthma medications more expensive for people who need them most. Drug manufacturers, pharmacy benefit managers, insurers, employers, and the government must work together to improve affordability and access.

Access to affordable drugs is a critical component of reducing racial disparities in asthma. Black and Hispanic individuals not only experience higher rates of asthma but also are more likely to be uninsured or underinsured. Deaths due to asthma – although decreasing overall – occur at a much higher rate in the Black and Puerto Rican populations than in the White population. Black individuals are nearly three times as likely to die from asthma than White individuals.

Last fall, AAFA shared patient stories and its Asthma Disparities in America report with the Senate Health, Education, Labor, and Pensions (HELP) Committee which then launched an investigation into the high price of asthma inhalers early this year.

AAFA’s research indicates that when the cost of medicine becomes a barrier to treatment, people with asthma resort to rationing or simply discontinue use.

Access to asthma medications can save lives, reduce hospitalizations, and lower the more than $82 billion in annual costs to the U.S. economy from this chronic disease. But the U.S. health care system is complex, and often leaves patients with few affordable options.

Flovent HFA and Flovent Diskus are inhaled corticosteroid medicines used as a controller medicine to treat asthma. Flovent HFA is also used to treat eosinophilic esophagitis (EoE). Glaxo Smith Kline (GSK), the manufacturer of Flovent, discontinued production of Flovent HFA and Flovent Diskus. As part of this process, GSK is making an “authorized generic” which is the exact same medicine with the same dosing but without the branding.

Below are some answers to frequently asked questions about this change.

1. What’s the difference between the brand name Flovent inhalers and the generic fluticasone inhalers?

The authorized generic options for Flovent HFA and Flovent Diskus are the same inhaler devices and medicine (fluticasone) as found in the brand name Flovent. They work exactly the same. They just don’t have the brand label.

2. How do I know if the generic fluticasone will be covered by my insurance?

Access to the authorized generic fluticasone (active ingredient in Flovent) will depend on your health insurance and your pharmacy benefits or formulary. While we hope most insurance plans will replace the brand name Flovent with the authorized generic, there may be some that don’t. It may create delays for people to get the medicine they need.

If you are currently using brand name Flovent HFA or Flovent Diskus, check with your insurance to see if the authorized generic versions are covered. For some people, the out-of-pocket costs may unexpectedly be higher with the generic if your plan doesn’t have the authorized generics on your insurance plans preferred drug lists.

3. What do I do if I have asthma and can’t get the authorized generic fluticasone or if my insurance doesn’t cover it?

If the authorized generic is not covered by the insurance provider, you can work with the insurance company to ask for a “formulary exception” to determine if your insurance company will provide an exemption and cover the medicine.

If your insurance plan will not cover the authorized generic fluticasone and a formulary exception is not available, there are other inhaler options for the treatment of asthma. Talk with your doctor about inhaler options, what dose to take if you are prescribed another medicine, and ask them to show you how to use these inhalers.

If your prescription changes from fluticasone propionate HFA or fluticasone propionate Diskus to something else, you need to be aware of what medicine you have been prescribed and how to use it. Not all inhalers are used the same way. Some insurers are transitioning to breath-actuated inhalers (like the Diskus versions) on their preferred drug lists, but these are not appropriate for some people with asthma.

4. What do I do if I have EoE and can’t get the authorized generic fluticasone or if my insurance doesn’t cover it?

If your insurance plan will not cover the authorized generic fluticasone, call your doctor to talk about your treatment options. Your doctor may need to follow up with your insurance company to appeal for the generic fluticasone to get covered. There aren’t other substitutes available for the treatment of EoE. Your doctor may talk with you about changing your treatment to a different medicine (budesonide).

5. What can I do now to prepare for a possible switch to the authorized generic or another medicine?

It is really important for people with asthma to continue their asthma control medicines, especially during respiratory illness season. Fluticasone works by controlling inflammation and swelling in the airways to prevent asthma attacks.

If you are currently using Flovent, you should check with your doctor or pharmacist about the best next steps for them. The authorized generic of Flovent is the exact same product without the brand label.

If you are switching to a different medicine, you should consult your doctor about appropriate dosing and also ask for training on how to administer the medicine.

If you use Flovent, you should speak with your doctor as soon as possible to determine the best course of action to continue treatment.

6. What do I do if I get a different inhaler than I’ve used before?

Not all inhalers are used the same way. Be sure you are aware of what medicine you are prescribed and ask your doctor about dosing and how to use the inhaler.

7. Why does the authorized generic cost me more? If it is the same exact drug, why isn’t it covered by my insurance?

The authorized generic fluticasone may have higher or lower out-of-pocket costs for patients than the brand name Flovent.

The U.S. has a complicated drug pricing ecosystem. Manufacturers, pharmacy benefit managers, insurance companies, and federal policies can create situations that reduce access to critical medicines for patients.

It’s not yet clear what impact this situation will have on pricing. GSK (the maker of Flovent) has released the statement below offering their perspective on this issue.

Did you know pollen might be responsible for your allergic reactions to fruit or vegetables? If your mouth or throat itches when you eat certain fruit or vegetables, you could have oral allergy syndrome (OAS). And you would have a pollen allergy to thank for that.

1. Cross-reactivity is the reason for OAS symptoms. OAS is the result of a confused immune system. The pollen of some trees and grasses are similar to the proteins of certain raw fruits, vegetables, seed or nuts.

2. Birch, alder, ragweed, mugwort, Timothy grass and orchard grass pollen cause most OAS symptoms. These pollens are similar to the proteins of certain raw fruits, vegetables, seed or nuts. If you are allergic to any of these pollens, you may have OAS symptoms.

3. You may be able to eat foods that cause OAS symptoms if you remove their skins and/or cook them. Heat affects the proteins, so you may be able to eat these foods cooked instead of raw. For example, a fresh apple may cause symptoms, but a person with OAS may be able to eat applesauce without symptoms.

4. If you’re allergic to these pollens but don’t have symptoms when eating related foods, you can still eat them. But if you have severe OAS symptoms, avoid those foods and talk to your allergist.

5. Your OAS symptoms may be worse when pollen peaks. For example, birch trees release pollen January through April, depending on where you live. Ragweed pollen season is in the summer and fall. You may notice that your symptoms are worse during the times when the pollen you are allergic to is highest.

6. OAS can be confused with food allergy. It can cause symptoms such as an itchy or tingling mouth, face, tongue or throat. You may also have some mouth and throat swelling or hives where the food touched your skin. Rarely, OAS can trigger anaphylaxis, a severe allergic reaction, so it is important to know if you have OAS or a food allergy and how to treat it.

7. If you have OAS symptoms to nuts, this could actually be signs of anaphylaxis, a serious allergic reaction. If you have any symptoms while eating nuts, see a board-certified allergist as soon as possible. Nuts are more likely to cause a serious allergic reaction which must be treated with epinephrine and immediate medical attention. And if you don’t know if you are having OAS symptoms or anaphylaxis to any foods, talk to your allergist.

Here is a list of some pollens and the foods they may cross-react with. You may not react to every food on the list.

Birch Tree Pollen Cross-Reactions

• Almond
• Apple
• Apricot
• Carrot
• Celery
• Cherry
• Hazelnut
• Kiwi
• Parsley
• Peach
• Peanut
• Pear
• Plum
• Soybean

Alder Tree Pollen Cross-Reactions

• Almond
• Apple
• Celery
• Cherry
• Hazelnut
• Peach
• Pear
• Parsley

Ragweed Pollen Cross-Reactions

• Banana
• Cantaloupe
• Cucumber
• Honeydew
• Watermelon
• White potato
• Zucchini

Mugwort Weed Pollen Cross-Reactions

• Aniseed
• Bell pepper
• Black pepper
• Broccoli
• Cabbage
• Caraway
• Cauliflower
• Chard
• Coriander
• Fennel
• Garlic
• Onion
• Parsley

Timothy and Orchard Grass Pollen Cross-Reactions

• Orange
• Peach
• Tomato
• Watermelon
• White Potato

If your allergies are worse in the spring and summer time, you may have a grass pollen allergy.

What Is a Grass Pollen Allergy?

Grasses are one of the most common causes of allergy. Each year, plants (including grasses) release tiny pollen grains to fertilize other plants of the same species. Unfortunately for people with grass allergies, this pollen triggers allergic reactions. Symptoms of a grass pollen allergy include:

• Runny nose
• Sneezing
• Itchy nose, eyes, ears and mouth
• Stuffy nose (nasal congestion)
• Red and watery eyes
• Swelling around the eyes
  
  

You may not see the grass pollen in the air, but your body can react to even small amounts.

Many people know pollen allergy as “hay fever.” Experts usually refer to pollen allergy as “seasonal allergic rhinitis.”

What Types of Grasses Cause Allergy Symptoms?

If you have a grass pollen allergy, you may be allergic to more than one type of grass.

There are hundreds of types of grasses, but only a few are responsible for allergy symptoms. Your geographic location may determine which grasses may be responsible for your symptoms.

The most common types of grasses that cause allergies are:

• Bermuda
• Johnson
• Kentucky
• Orchard
• Rye
• Sweet Vernal
• Timothy
  
  

When Is the Grass Pollen Season?

In northern regions of the United States, grasses usually pollinate in the late spring or early summer. In southern regions, grasses may pollinate throughout many seasons and could trigger symptoms throughout the year.

These small, light and dry grass pollen grains are released into the air and can travel for hundreds of miles by the wind.

How Can I Prevent Allergic Reactions to Grass?

Here are 11 ways you can reduce allergic reactions to grass pollen:

How Can I Manage My Grass Allergy Symptoms?

The first step is to get properly tested and diagnosed. Once your allergist knows what specific allergens cause your symptoms, they can work with you to create a plan.

There are over-the-counter and prescription pills, liquids, or nasal sprays that can help reduce or prevent grass allergy symptoms. These medicines include antihistamines, decongestants, and nasal corticosteroids. Most allergy medicines work best when you start taking them before pollen season begins. This allows the medicine to prevent your body from releasing histamine and other chemicals that cause your symptoms.

But if you do not get complete relief from your grass pollen allergy symptoms from these medicines, you may benefit from immunotherapy (allergy shots). Immunotherapy is a long-term treatment that can help prevent or reduce the severity of allergic reactions. It can change the course of allergic disease by modifying the body’s immune response to allergens.

There are two types of immunotherapy available for grass allergy: allergy shots and allergy tablets.

• Allergy shots – Subcutaneous immunotherapy (SCIT) is given at your doctor’s office. It involves getting injections of allergens in an increasing dosage over time. During the course of immunotherapy, a person with grass allergy becomes progressively less sensitive to that allergen. You may experience relief within one to three years of starting SCIT. The most common side effects for SCIT include local reactions at the injection site, such as redness, itching, swelling, tenderness, and pain. Less common systemic reactions may include generalized redness, hives, itching, swelling, wheezing, and low blood pressure.
  
  
• Allergy tablets – Sublingual immunotherapy (SLIT) is a form of immunotherapy that can be done at home. It is needle free and involves placing a tablet containing the allergen under your tongue for one to two minutes and then swallowing it. Treatment begins prior to the grass allergy season and continues throughout the grass allergy season. By taking these tablets every day, you may reduce your grass allergy symptoms. This treatment offers people with these allergies a potential alternative to allergy shots. SLIT tablets also have side effects and some may be serious, which is why it’s important to talk with your doctor about your treatment options.
  
  

Both forms of allergy immunotherapy (shots and tablets) are prescribed by your doctor. Talk to your doctor to get started on your allergy treatment plan.

Published June 2018, Updated June 2021

The Asthma and Allergy Foundation of America (AAFA) released our 2024 Allergy Capitals™ report.

AAFA’s report ranks the top 100 most challenging cities in the contiguous United States (“lower 48 states”) to live with seasonal pollen allergies. The report includes data from the previous year to create a ranking of the 100 most populated cities based on:

• Tree, grass, and weed pollen scores
• Over-the-counter allergy medicine use
• Availability of board-certified allergists/immunologists
  
  

Wichita, Kansas, is the #1 Allergy Capital for the second year in a row due to:

• Higher-than-average tree and grass pollen
• Higher-than-average allergy medicine use
• Fewer board-certified allergists/immunologists
  
  

See the full ranking of 100 cities: allergycapitals.com

What Does It Mean If I Live in a Top Allergy Capital?

About 1 out of 4 adults and 1 out of 5 children have seasonal allergic rhinitis, also known as “hay fever.” If you have seasonal allergies and live in a top Allergy Capital, seasonal allergies may affect you more.

If your city is a top Allergy Capital, it may have higher-than-average pollen counts, high sales of over-the-counter allergy medicine, and fewer allergists. Read the report to find out how your city ranks and what you can do to take care of your allergies.

Are Pollen Seasons Getting Worse?

It’s not just your imagination. Pollen seasons start earlier, last longer, and are more intense. Climate change and botanical sexism are to blame. Due to climate change, there is also an increase in carbon dioxide in the air, causing trees to make more pollen.

“Botanical sexism” refers to the preference to plant “male” (wind-pollinating) trees instead of “female” (fruit-, seed-, and nut-bearing trees). More wind-pollinating trees can lead to more pollen.

Read the report to learn more about the effects of climate change and botanical sexism.

What Does It Mean If I Live in an Allergy Capital Lower on the List?

You may still be greatly affected by seasonal allergies. On one or more of the ranked factors, your city may be doing better compared to other cities. For example, your city may have more allergists available compared to other cities.

What Does It Mean If My City Isn’t Listed on the Report?

AAFA's Allergy Capitals report ranks the top 100 populated metro areas in the United States. If your hometown is near a major city, your area may be included in the metro area of the major city. For example, the Seattle metropolitan area includes Tacoma, Bellevue, Everett, and all cities and suburbs in the surrounding area.

If your city's population is lower than the population of the 100th most populated city, then your city will not be ranked. You may be greatly affected by seasonal allergies, but your town is not reflected in the report. This is why Scranton, Pennsylvania – a city that was named an Allergy Capital for the past few years – is not ranked on this year's report. As of 2022, Scranton is no longer one of the 100 most-populated cities. Instead, it has been replaced by Fayetteville, Arkansas, moving it off our list.

How Can I Get Relief from Seasonal Allergies?

No matter where you live, it’s hard to escape pollen. But you can manage your pollen allergy.

There are a number of available and accessible options to help you find relief. Work with your doctor to include the steps below in your allergy treatment plan:

1. Limit your contact with pollen. Here are some steps you can take to reduce your contact with pollen during pollen season:

• Check pollen counts daily.
• Plan outdoor activities on low pollen days.
• Stay inside on high pollen days.
• Outside, wear sunglasses, a hat or head covering, and a mask to limit the amount of pollen that gets into your eyes, nose, mouth, and lungs.
• Remove your shoes before entering your home.
• Change and wash clothes after outdoor activities.
• Wipe furry animals off when they come inside or bathe them weekly.
• Shower before bed to keep pollen out of your bedding.
• Keep windows closed during pollen season or peak pollen times (usually midday).
• Use central air conditioning or air cleaners with a HEPA or CERTIFIED asthma & allergy friendly® filter, if possible.
• Clean bedding, floors, and fabric furniture once a week.
• Clean blinds, curtains, and washable rugs once a month.
  
  

2. Use allergy medicines and treatments. There are over-the-counter and prescription options to help you prevent or treat allergy symptoms.

• Nasal corticosteroid sprays
• Long-acting antihistamines
• Decongestants
• Cromolyn sodium
• Leukotriene receptor antagonists (or modifiers)
  
  

Some of these treatments work best if you start them a couple of weeks before your allergy season begins. Talk with your doctor before and after the start of any new medicine.

3. Rinse out your nose with a saline solution made with distilled water. A nasal rinse can help clear your sinuses and nose. This can help remove pollen and mucus. It may be best to do a nasal rinse before you use a medicine nasal spray. Rinse your nose with warm saline solution (salt water) using a Neti pot or a special rinse bottle.

4. Ask your doctor about immunotherapy. If you do not get complete relief from medicines, talk with your allergy doctor about immunotherapy. There are two types of immunotherapy: allergy shots and sublingual (under-the-tongue) immunotherapy.

For more tips, learn more about managing pollen allergies.

The 2024 Allergy Capitals report is an independent research project of the Asthma and Allergy Foundation of America and made possible by support from Bayer Claritin®.

AAFA thanks Pollen Sense, Komodo Health, and Circana for their support with data and report content.

The views and opinions expressed in this report are those of the AAFA authors and do not necessarily reflect the policies or positions of other individuals, sponsors, organizations, or companies.

It's important to get rid of expired or unused medicines, inhalers, and epinephrine auto-injectors properly. They can be harmful to someone they aren't prescribed for, especially children. Or they could get into the hands of someone who might misuse them. And getting rid of them improperly can cause them to end up in the water supply, affecting humans and wildlife alike. There are several ways you can dispose of your medicines in a way that is safe and better for the environment.

Disposing of Pills and Patches

The U.S. Drug Enforcement Administration (DEA) hosts National Prescription Drug Take Back Day twice a year, usually each April and October. Designated law enforcement agencies across the U.S. will allow you to drop off expired, unused prescription pills and patches so they can be safely disposed.

To find an agency near you that is participating in National Prescription Drug Take Back Day, use the Collection Site Locator.

The agencies will only take pills, tablets, capsules, patches or other solid forms of prescription medicines. They cannot take needles, sharps, inhalers, liquids, or illegal drugs. This includes liquid nebulizer medicine and epinephrine auto-injectors.

Some pharmacy chains, like Walgreens and CVS, have medicines drop boxes in select locations. Check with your pharmacy to find out what types of medicines they will accept.

Disposing of Epinephrine Auto-Injectors

To dispose of epinephrine auto-injectors or needles, visit safeneedledisposal.org. You can search by state to find where you can take these for safe disposal.

Disposing of Inhalers

To dispose of inhalers, the Food and Drug Administration (FDA) recommends that you read "handling instructions on the labeling of inhalers and aerosol products. These products could be dangerous if punctured or thrown into a fire or incinerator. To properly dispose of these products and follow local regulations and laws, contact your trash and recycling facility."

Some Walgreens locations accept inhalers, but this varies by location. Contact your local Walgreens to confirm if they accept inhalers.

Other options for disposal may include the local health department, police or fire department, pharmacies, and trash and recycling facilities. Please contact the facility before visiting. Verify if they accept inhalers, as well as any procedures for disposal.

Disposing of Liquids

Contact your pharmacy for instructions on how to dispose of liquid medicines, like children's antihistamines and nebulizer medicines. Walgreens also accepts liquid medicines.

Disposing of OTC Medicines

Walgreens and CVS will accept over-the-counter (OTC) medicines.

You can also dispose of OTC medicines safely at home if you follow the right steps. According to knowyourotcs.org, follow these steps:

1. Mix medicines with an unpleasant substance, like kitty litter or used coffee grounds. Do not crush tablets or capsules.
2. Place the mix in a container, like a sealed plastic bag.
3. Throw the container in your trash.
   
   

The FDA has more information on how to safely dispose of medicines.

Updated September 2022

Face masks are an essential tool in our fight against the coronavirus that causes COVID-19. They also have other benefits for people with asthma and allergies.

Can People With Asthma Wear Face Masks?

Yes, people with asthma can wear face masks.

“For people with mild asthma or well-controlled asthma, it’s probably not going to be an issue,” said Dr. David Stukus, member of the Medical Scientific Council for the Asthma and Allergy Foundation of America (AAFA). “For people who have very severe disease and have frequent exacerbations, ER visits, hospitalizations, require lots of medications and frequent symptoms, it might cause more issues for those folks.”

It’s important to keep your asthma under control. Keep taking your medicines as prescribed. If you are having breathing issues that need your quick-relief inhaler (albuterol) more than two or more times per week, it’s a sign to call your doctor.

If you’re having trouble wearing a mask, try a different fabric, type, or fit. According to the WHO, medical masks, when worn the right way, do not cause you to breathe in more carbon dioxide or reduce your oxygen levels. Other studies back this up as well.¹ And a face mask made of three layers probably won’t fit tightly enough to affect your oxygen either. If your mask is uncomfortable, try a new type of mask.

How Do Face Masks Help Reduce the Spread of the Coronavirus?

The coronavirus that causes COVID-19 is airborne and spreads from person to person. It can spread through droplets from your nose or mouth when you breathe, talk, sing, yell, eat, sneeze, or cough. You are most likely to catch it if you are not fully vaccinated and less than 6 feet (2 meters) away from someone who is infected.

It’s best to wear a mask in public indoor spaces even if you are fully vaccinated. They also recommend universal indoor masking for all teachers, staff, students, and visitors to schools, regardless of vaccination status.

Masks are effective in reducing the spread of the coronavirus in both vaccinated and unvaccinated people.² Studies have shown many people have COVID-19 and don’t show symptoms. Or they may have the virus a few days before they show symptoms. The purpose of wearing a face mask is to protect you as well as keep you from spreading COVID-19 to other people. This is especially important in public indoor spaces.

Wearing a face mask may also make COVID-19 symptoms less severe if you do get it.³ Several studies show that face masks may reduce the amount of particles of the coronavirus you take in, which can result in milder illness.²

Proper care of your face mask is also important to help you reduce your chances of getting COVID-19. Follow these steps when putting on and removing a face mask:

• Wash your hands or use hand sanitizer before putting on a face mask.
• Avoid touching the face mask while using it.
• If your face mask gets damp, replace it with a clean one.
• Remove the mask by the ear loops or ties, trying to not touch the parts of the mask that touch your face.
• Wash your hands or use hand sanitizer.
• Wash fabric face masks in hot, soapy water right away. Throw away disposable masks immediately.
  
  

What Kind of Face Mask Should I Wear?

There are several types of masks available that can help you reduce the spread of the coronavirus.

N95 and KN95 Masks or Respirators

You may consider wearing an N95 mask or respirator for better protection or if you interact with large numbers of the public or are at increased risk for severe illness. NIOSH-approved N95 respirators labeled “surgical” or “medical” should be prioritized for health care personnel. N95 and KN95 masks should be properly fitted. There are several pharmacies that currently provide free masks (N95 respirators) to the public.

Although respirators may be available in smaller sizes, they are typically designed to be used by adults in workplaces, so they have not been tested for broad use in children.

KN95 masks provide an alternative to N95 respirators and are recommended for non-health-care settings for non-medical use. People who are at increased risk of COVID-19 illness, teachers, staff, and other adults in the indoor school setting may prefer KN95 masks.

Not all KN95 masks meet the similar requirements for N95 masks. Find a reliable source to purchase KN95 masks. Do not use KN95 masks with exhalation valves because they can allow the virus to escape.

Cloth and Disposable Masks

There are many options for cloth face masks. You can buy disposable (surgical) or reusable face masks at many major retail stores or online, or you can make your own. Fabric made from 100% cotton, such as heavy-duty quilt fabric or a knit fabric, can be effective.

If you have a latex allergy, be careful with elastic ear loops. Choose face masks with fabric ear loops or that tie behind your head.

Finding a mask that is comfortable and fits well will provide the best protection. If you feel the need to readjust or pull on your mask, it does not fit well. Consider these following:

• Masks with multiple layers of fabric
• Masks that fit snugly against the sides of your face without any gaps
• Masks that cover your nose, mouth, and chin
• Masks with a metal strip or nose guard to keep air from leaking out
• Mask fitter or brace over a disposable or cloth mask to prevent air leaking out of the sides and top
• Combining one disposable mask underneath a cloth mask (the second mask should push the edges of the inner mask against your face)
• Knotting and tucking ear loops of a three-ply mask (See video below)
• Masks with three layers:

• An outer water-resistant layer (such as polyester or polyester blend)
• A middle layer of non-woven fabric (such as polypropylene
• An inner layer of cotton
  
  

Keep in mind that some businesses or schools may mandate which types of masks are most appropriate in their environment.

Watch on YouTube

Children 2 years and older should wear a mask that is made for children to ensure it is snug without any gaps. Children with a disability that keeps them from safely wearing a mask and children under 2 should not wear masks.

Try different styles and fabrics to see what works for you. To tell if a face mask will be effective, hold your mask up to a light. If you can easily see the light through your mask, it may not provide enough protection. Make sure your face mask blocks the light but still allows you to breathe through it.

Some types of face coverings are not effective at preventing the spread of coronavirus. Bandannas cannot fit tightly enough against your face. If you have a mask with a vent or valve, check the inside of the mask. If you see fabric inside that covers the valve or vent, then the mask is OK to wear. If you see the vent or valve from the inside of the mask, you should not wear the mask because droplets from your mouth and nose can pass through the valve as you exhale.

Do not choose masks that:

• Are made of fabric that makes it hard to breathe, such as vinyl
• Have exhalation valves or vents which allow virus particles to escape, unless the inside of the valve/vent is covered by fabric
  
  

Do not wear two disposable masks at a time or combine a KN95 mask with any other mask.

What Can I Do If My Job Requires Me to Wear a Face Mask?

You may be required to wear a mask as part of your job. Different places may require you to wear a mask. And if your job is located indoors around other people, it is best to wear a mask. If your asthma is not well-controlled and you have trouble breathing while wearing a face mask, what are your options? (Reminder: If your asthma is not well-controlled, talk with your doctor!)

The first step is to try a different mask style – most people with asthma should be able to wear a mask comfortably. Try different types of face masks in different fabrics or styles to find something more breathable. If your job is strenuous, it may feel harder to breathe through a mask.

The second step is to work with your employer. Talk about ways you can work while still helping prevent the spread of COVID-19.

Here are some ways you may be able to work with your employer:

• Ask for time off to get the COVID-19 vaccine and boosters.
• Ask to serve in a role away from the public or other employees.
• Ask if you can work a different shift or from home.
• If you are part of a union, work with your union representative to ask for reasonable accommodations.
• Ask if you can take more frequent breaks if you feel a face mask is affecting your breathing.
• Stay home if you start having asthma or COVID-19 symptoms.
  
  

People with asthma may be covered under the Americans with Disabilities Act (ADA). Under this act, people with disabilities can ask for reasonable accommodations so they can work. If your work requests won’t create a hardship for your employer, you can ask for accommodations.

But the ADA also says if an accommodation could cause harm to other people, then a business does not need to provide the accommodation. If a person with asthma is coughing and not wearing a mask, they might be exposing other people to COVID-19. In this case, the employer could require the person with asthma to stay home or wear a face mask.

If your company requires a face mask, try to find one that works for you. Refer to the mask suggestions above.

Don’t be afraid to talk to your supervisor or human resources representative. They may also have some creative ideas to help you do your job while managing your asthma.

Remember, wearing a face mask is only part of the strategy to prevent the spread of COVID-19. Getting fully vaccinated, physical distancing, improving air ventilation, and washing your hands often can also help protect you and other people from COVID-19.

What Are Other Benefits to Wearing Face Masks?

Pollen can trigger asthma. Wearing a mask can help keep pollen from getting into your nose and lungs. Even though a mask can help prevent symptoms, consider going outside when pollen counts are lower.

Cold weather can trigger asthma. When it’s cold, wearing a face mask can warm and humidify the air you breathe. And masks can reduce your exposure to air pollution.

Masks also can protect you from respiratory infections like the flu, COVID-19, and even the common cold.

Medical Review July 2022 by Mitchell Grayson, MD

References
1. Wearing a mask does not affect oxygen saturation in patients with or without asthma. American Academy of Allergy Asthma & Immunology. (n.d.). Retrieved October 6, 2021, from https://www.aaaai.org/About/News/News/mask.
2. Centers for Disease Control and Prevention. (n.d.). Science Brief: Community use of cloth masks to control the spread of SARS-COV-2. Retrieved October 6, 2021, from https://www.cdc.gov/coronaviru...anchor_1619456988446.
3. Gandhi, M., Beyrer, C., & Goosby, E. (2020). Masks Do More Than Protect Others During COVID-19: Reducing the Inoculum of SARS-CoV-2 to Protect the Wearer. Journal of general internal medicine, 35(10), 3063–3066. https://doi.org/10.1007/s11606-020-06067-8

In our second post in our “AAFA Explains” series, we look at claims that salt treatment (also known as halotherapy) can improve your asthma.

This blog series looks at complementary and alternative medicine (CAM) aimed at asthma and allergies. The Asthma and Allergy Foundation of America wants to guide you as you decide between choices that may be “likely safe” or “potentially unsafe.”

CAM treatments usually do not go through the same rigorous scientific research as new drugs and medical procedures. As a result, whether or not CAM works (called efficacy) is unproven for most treatments.

Salt therapy – such as salt rooms, caves or lamps - falls into that category.

What is salt therapy?

“Salt rooms” are popping up in the U.S., Australia, the U.K. and elsewhere. These rooms charge you a fee to enter, like a spa. Salt crystals coat the rooms and the air is salt-laden as an attempt to mimic naturally occurring salt caves.

The history of natural salt caves as an asthma remedy is ancient. In Russia and Eastern Europe, people with asthma would descend into salt caves. The belief is that breathing in extremely small salt crystals would help open up the airways and assist with the buildup of mucus.

What does science tell us about salt therapy?

Studies evaluating salt therapy for asthma are few.

One of the largest studies to examine the use of salt caves evaluated the therapy for COPD (chronic obstructive pulmonary disease). COPD is a chronic disease of the lungs caused by smoking.

Researchers reviewed 151 articles about salt therapy. They checked for high-quality studies (randomized controlled trials), like those conducted for prescription medications.

Of the 151 studies, they found just one randomized controlled trial. Researchers reviewed three other studies to include more people. Many people in the studies reported feeling better after undergoing salt therapy. But researchers identified several quality concerns about these four studies.

As a result, researchers were unable to draw any conclusions. Some of the missing or incomplete information included:

• Whether the subjects had COPD or asthma
• What medications the patients took
• How severe their breathing difficulties were at the start of the study
• The long-term effect of the treatment (for example, people were examined only right after treatment)

In some countries, medical societies have warned that salt caves can have negative effects. For example, the salt cave could induce bronchoconstriction in some people.

Another danger is that if you have asthma, you may stop taking your regular medicine. Halotherapy is expensive. Many patients may struggle to afford both prescription medicines and salt therapy. But long-term control medications are needed to help prevent and control asthma symptoms. Take them as your healthcare provider tells you to, even if you feel well.

Is halotherapy safe?

"If your goal is to find a new way to de-stress, salt caves can do the trick. They’re cool, quiet and relaxing," said Maureen George, PhD, RN, AE-C, FAAN, a member of AAFA’s Medical Scientific Council, and an Associate Professor of Nursing at the Columbia University School of Nursing. "If you’re looking for a natural way to treat your asthma, halotherapy is not what you’re looking for. It has not been rigorously studied, despite claims from ‘experts’."

Patients should also know that inhaling concentrated salts (hypertonic saline) has been proven to irritate the airways, causing cough and mucus, which can make asthma worse for some people.

The bottom line:

Halotherapy, or sitting in a salt room, is not likely to make your asthma better. For most asthma patients, halotherapy is “likely safe.” Since you don't know how you will react, AAFA warns that it is best to err on the side of caution and avoid salt rooms.

Key definitions:

Randomized controlled trials: Participants are randomly placed into two groups. One group does not receive any treatment. The other group receives the treatment under consideration. Researchers follow both groups over time. At the end of the study, they compare results.

Efficacy: Whether or not a treatment works, and by how much.

Reference:

Rashleigh R., Smith S.M., Roberts N.J. (2014). A review of halotherapy for chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease.

Medical Review May 2016.

When you have asthma, how you clean your home is an important part of asthma control. You want to reduce or remove allergens and triggers like mold, pests, dust mites, and animal dander. A multi-part cleaning plan will be most effective.

Clean your home regularly to reduce the spread of the coronavirus (SARS-CoV-2) that causes COVID-19 or other respiratory illnesses like influenza (flu). To prevent asthma symptoms, clean and disinfect your home in a way that kills the viruses and is asthma friendly.

Cleaning Can Worsen Indoor Air Quality

When you’re cleaning, you may actually spread asthma triggers or worsen your indoor air quality. Some tools like feather dusters only move dust around, which can spread dust mites and small particles through the air. Some vacuum cleaners can leak air, spitting the particles from your carpet right back into the air.

And then there’s cleaning products. The very solutions that clean can actually cause asthma symptoms. Many cleaning products contain strong scents, chemicals, and volatile organic compounds (VOCs) that can trigger asthma. One study found that regular use of cleaning products was as harmful as smoking several cigarettes a day.¹ Some products may remove some allergens and asthma triggers but can still irritate your lungs.

Cleaning Versus Disinfecting Versus Sanitizing

Did you know cleaning products don’t always disinfect, and disinfectants don’t always clean? And what’s the difference between cleaning, disinfecting, and sanitizing?

• Cleaning removes dirt and germs. This can be done simply with soap and water.
• Disinfecting uses chemicals to kill germs. It does not clean or remove the germs.
• Sanitizing reduces the number of germs to a safe level. A surface is considered sanitized when either cleaning and/or disinfecting reduces the germs to safe level according to public health guidelines.
  
  

To properly sanitize a surface, clean first to remove germs, dirt, and residue. Then disinfect to kill remaining germs.

Asthma-Friendly Cleaning Tips

If you have asthma or live with someone with asthma, create a plan on how to clean and sanitize your home. Try these tips to reduce exposure to asthma triggers:

• Use liquid or gel cleaners instead of commercial spray cleaners, and choose unscented products when possible. Wear a face mask and gloves (latex free if you are allergic to latex).
  
  
• Open windows and run fans during cleaning.
  
  
• Change your clothes and take a shower after cleaning.
  
  
• Use a damp cloth to remove dust or use CERTIFIED asthma & allergy friendly® dusting cloths that trap dust particles.
  
  
• Vacuum at least weekly with a CERTIFIED vacuum with HEPA filtration, or use washable throw rugs and wash them in hot water (130 F or hotter) weekly.
  • Some vacuums cause particles from the floor to get into the air. This can trigger asthma symptoms. If possible, have someone without asthma do the vacuuming while people with asthma are not in the room.
    
    
• Wash bedding in hot water weekly.
  
  
• Reduce clutter that tends to collect dust.
  
  
• Run an exhaust fan in your bathroom for 15 to 20 minutes after showering to reduce mold growth.
  
  
• Remove mold at first sight with soap, warm water, and a brush. If the mold doesn’t remove easily with soap and water, a person without asthma can use a bleach solution if there is good air ventilation.
  
  
• Have someone without asthma clean for you, if possible. Wearing a mask while you clean may help reduce your exposure to asthma triggers.

Cleaning to Prevent the Spread of the Coronavirus

The Centers for Disease Control and Prevention (CDC) recommends that you clean regularly to reduce the spread of the new coronavirus. But not every cleaning product will kill the virus.

These cleaning solutions will kill the virus that causes COVID-19 when used properly:

• Undiluted rubbing alcohol (at least 70% ethyl or isopropyl) – Leave on the surface for at least 30 seconds.²
• Hydrogen peroxide 3% concentration – Leave on the surface for 1 minute.³
• Bleach (5 tablespoons or 1/3 cup per gallon of water OR 4 teaspoons per quart of water) with a sodium hypochlorite concentration of 5 to 6% – Leave on the surface for 1 minute.⁴
  
  

Bleach is a common asthma trigger. People with asthma should avoid using bleach or areas where bleach is being used when possible. If you must use bleach:

• Mix it in the right proportion
• Wear a mask and gloves
• Use it in a well-ventilated room
• Don’t mix bleach and ammonia
• Have someone else clean for you, if possible
  
  

Vinegar and essential oils (like tea tree oil) are not EPA-registered disinfectants and will not kill the new coronavirus.

For a list of more cleaners, see the full list of EPA-registered disinfectants for use against COVID-19.

Homemade Cleaners for General Cleaning

Simple soap and warm water can be effective in many cases for general cleaning. But you’ll want to use something else to disinfect (kill germs).

Homemade cleaning recipes using baking soda, vinegar, borax, hydrogen peroxide, or dish soap may be less likely to cause asthma symptoms. Some people who are sensitive to scents prefer to use steam cleaners to clean. (But be careful if steam triggers your asthma.) Some homemade cleaning recipes call for using essential oils, like tea tree oil. But essential oils can actually be an asthma trigger because of their strong scents, and they release VOCs.

The Environmental Protection Agency (EPA) reviews cleaning products to help you choose options that are better for your health and the environment. You can view the EPA’s Safer Choice products list to find options.

References
1. Svanes, Ø, Bertelsen, R. J., Lygre, S. H., Carsin, A. E., Antó, J. M., Forsberg, B.,... Svanes, C. (2018). Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction. American Journal of Respiratory and Critical Care Medicine, 197(9), 1157-1163. doi:10.1164/rccm.201706-1311oc
2. Cleaning and Disinfection for Households. (2020, May 27). Retrieved June 22, 2020, from https://www.cdc.gov/coronaviru...ng-disinfection.html3. Chemical Disinfectants. (2016, September 18). Retrieved June 22, 2020, from https://www.cdc.gov/infectionc...ethods/chemical.html4. Cleaning and Disinfection for Households. (2020, May 27). Retrieved June 22, 2020, from https://www.cdc.gov/coronaviru...ng-disinfection.html

When spring allergy season first starts, causing you to sniffle and sneeze, tree pollen is to blame. Trees start producing pollen as early as January in the Southern U.S. Many trees keep producing pollen through May.

What Are the Symptoms of a Tree Pollen Allergy?

Pollen allergy symptoms are commonly called “hay fever.” Pollen released by trees, as well as grasses and weeds, cause these symptoms. They include:

• Runny nose (also known as rhinorrhea – this is typically a clear, thin nasal discharge)
• Stuffy nose (due to blockage or nasal congestion – one of the most common and troublesome symptoms)
• Sneezing
• Itchy nose, eyes, ears, and mouth
• Red and watery eyes
• Swelling around the eyes
  
  

If you have allergic asthma and are allergic to tree pollen, you might also have asthma symptoms while the trees are pollinating.

Tree pollen is light so the wind can carry it for miles. These light, dry grains easily find their way to your sinuses, lungs, and eyes, making them hard to avoid.

What Trees Cause the Most Symptoms?

Some tree pollen causes more problems than others. Some of the trees that cause the most symptoms are:

• Alder
• Ash
• Aspen
• Beech
• Birch
• Box elder
• Cedar
• Cottonwood
• Elm
• Hickory
• Juniper
• Maple
• Mulberry
• Oak
• Olive
• Pecan
• Poplar
• Walnut
• Willow
  
  

Being allergic to some trees could cause you to react to certain foods. It happens because the tree pollen is similar to the protein in some fruits, vegetables, and nuts.¹ Your immune system gets confused and can’t tell the difference between the two. Eating these foods may cause your mouth or face to itch or swell. These foods may include apples, cherries, pears, and more. This is called pollen food allergy syndrome (PFAS) or oral allergy syndrome (OAS). Birch and alder trees cause the most PFAS food reactions.

In some cases, your tree pollen allergy may cross-react with some nuts, like peanuts or almonds. If you have mouth itching or swelling while eating nuts, you could have a more serious, life-threatening reaction called anaphylaxis, which is common with nut allergies. If this happens to you, call your doctor right away.

What Can I Do to Relieve My Pollen Allergy Symptoms?

Thankfully, there are several options for relieving pollen allergy symptoms, available both over the counter and by prescription. Talk with your doctor about your symptoms and treatment options. Your doctor might have you take a combination of medicines to keep your symptoms controlled. These medicines include:

• Nasal sprays
• Eye drops
• Antihistamines
• Decongestants
• Leukotriene [loo-kuh-trahy-een] modifiers (such as montelukast)
  
  

If these medicines don’t completely relieve your symptoms, your doctor might also give you immunotherapy. This is a long-term treatment that can reduce the severity of your allergic reactions. It usually involves regular shots, tablets, or drops you take under the tongue.

You can also take steps to reduce your exposure to tree pollen:

• If you haven’t had allergy testing, find a board-certified allergist to test you for pollen allergies. Work with your doctor to come up with a treatment plan.
• Start taking allergy medicine before pollen season begins.
• Limit your outdoor activities when pollen counts are high. This will cut down the amount of pollen allergen you inhale and help reduce your symptoms.
• Watch pollen counts on a website like the National Allergy Bureau™.
• Wear sunglasses and cover your hair when going outside.
• Keep your windows closed during peak tree pollen season and use a CERTIFIED asthma & allergy friendly® filter on your central air conditioner.
• Wipe your pets off before they come indoors.
• Dry your clothes in a dryer and not outside on a clothesline.
• Change and wash clothes you wear during outdoor activities as soon as you come inside.

It may be hard to avoid tree pollen during the late winter and spring. But you can reduce your symptoms with the right treatment.

Medical Review: Content summarized from https://aafa.org/allergies/typ...tree-pollen-allergy/ which was reviewed June 2022 by John James, MD

References
1. Oral allergy syndrome (OAS) | AAAAI. (n.d.). Retrieved January 17, 2023, from https://www.aaaai.org/tools-fo...lergy-syndrome-(oas)

Springtime pollen allergies are in full swing. With every cough or sniffle, you may wonder if it’s asthma or allergies, the flu, the common cold, or even COVID-19. But how can you tell the difference?

The Asthma and Allergy Foundation of America (AAFA) created a respiratory symptoms chart to help you recognize the similarities and differences between these conditions.

Click to see larger image (English)

Click to see larger image (Spanish)

Asthma Symptoms

Asthma is a chronic disease that causes your airways to be inflamed. The best way to manage it is to take your asthma medicines, avoid your triggers, and treat asthma symptoms as soon as they occur.

Common symptoms of asthma include:

• Shortness of breath
• Cough
• Chest tightness or pain
• Wheeze (a whistling sound when you breathe)
• Waking at night due to asthma symptoms
• A drop in your peak flow meter reading (if you use one)
  
  

Symptoms can come on gradually, or they can come on suddenly.

What to Do If You Have Asthma Symptoms

At the first sign of asthma symptoms, take your quick-relief (sometimes called “rescue”) medicine. Follow the Yellow/Caution Zone on your Asthma Action Plan. The earlier you treat asthma symptoms, the better your chances are of not having an asthma emergency.

Asthma can be life-threatening, so it’s important to know the signs of an asthma emergency and to keep your quick-relief inhaler with you at all times.

Red/Danger Zone symptoms are a medical emergency. Take your quick-relief medicines right away as directed on your Asthma Action Plan and then get immediate medical attention. Call 911 or go directly to the emergency room if you have these asthma symptoms:

• Asthma is getting worse quickly
• Asthma quick-relief (rescue) medicines are not helping
• Chest tightness or pain
• Severe shortness of breath
• Breathing is faster or slower than normal
• Breathing may be hard or shallow
• Trouble walking or talking due to shortness of breath
• Chest retractions (skin sucks in between or around the neck, chest plate, and/or rib bones when inhaling; this is rare in adults)
• Ribs or stomach moving in and out deeply and rapidly
• Expanded chest that does not deflate when you exhale
• Shoulders hunched over (“posturing”)
• Cyanosis, a tissue color change on mucus membranes (tongue, lips, and around the eyes) and fingertips or nail beds – the color appears grayish or whitish on darker skin tones and bluish on lighter skin tones
  
  

COVID-19 Symptoms

The coronavirus that causes COVID-19 is a respiratory virus that started spreading worldwide in December 2019. According to the CDC, COVID-19 symptoms can include:

• Fever
• Chills
• Cough
• Shortness of breath or trouble breathing
• Feeling tired and weak
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Stuffy or runny nose
• Diarrhea
• Nausea or vomiting
  
  

This list may not include all of the symptoms. As new variants of the coronavirus appear, the information about symptoms may change.

People age 5 and older can get a COVID-19 vaccine.

What to Do If You Have COVID-19 Symptoms

If you have any of these symptoms or if you have been exposed to someone who has COVID-19, take an at-home test or contact your doctor right away. Avoid contact with others unless absolutely necessary. Call before you go to your doctor’s office and ask for instructions. Your doctor may have a special process for you to follow so you don’t risk spreading it to other patients and staff. They may have you get tested elsewhere for COVID-19 and will give you further instruction.

If you have these severe symptoms, call 911 or go to the emergency room right away:

• Trouble breathing or shortness of breath
• Pain or pressure in the chest that doesn’t go away
• Newly confused
• Can’t wake up or stay awake
• Cyanosis which is tissue color changes on mucus membranes (like tongue, lips, and around the eyes) and fingertips or nail beds – the color appears grayish or whitish on darker skin tones and bluish on lighter skin tones
  
  

If you have to leave home for treatment, wear a face mask to prevent spreading the virus. Isolate yourself from people you live with and wear a face mask around them even at home. Clean and sanitize surfaces that are touched often like doorknobs, light switches, and cell phones.

Flu (Influenza) Symptoms

The flu is a contagious respiratory illness caused by influenza viruses. Symptoms can start suddenly and can cause mild to severe illness. It can also cause death in severe cases. Common flu symptoms include:

• Fever (often very high, 101 or above)
• Headache
• Extreme tiredness
• Chills
• Constant cough
• Sore throat
• Runny or stuffy nose
• Body aches in bones and/or muscles
• Diarrhea and vomiting (more common in children)
  
  

Thankfully, a flu vaccine is available. To reduce your chances of getting and spreading the flu, get the flu vaccine every year. The CDC recommends that people ages 6 months and older get the flu vaccine. Even if you catch a strain of flu that isn’t covered by the current year’s vaccine, getting vaccinated can make your illness less severe and lower your chance of being hospitalized.

People with asthma, as well as senior adults and people with other pre-existing conditions, are at high risk from complications from the flu.

It is important to get the flu vaccine every year. You can get the flu and COVID-19 at the same time. This increases your chance of becoming very ill. The flu vaccine also protects high-risk people you know and come in contact with, like essential workers, teachers, family and friends, pregnant women, children, and senior adults.

What to Do If You Have Flu Symptoms

If you have flu symptoms or are exposed to someone with the flu, contact your doctor right away. There are anti-viral treatments for the flu that can reduce symptoms. But you have to take them within two days of getting sick.

Like COVID-19, call your doctor before walking into their office if you have symptoms or have been exposed to the flu.

If you start having flu symptoms and have trouble breathing, start following the Yellow/Caution Zone on your Asthma Action Plan.

Cold Symptoms

The common cold is usually mild compared to the flu and COVID-19. But even a mild cold can trigger asthma symptoms, so if you catch a cold, you want to take it seriously.

Common symptoms of a cold include:

• Mild cough
• Sneezing
• Runny or stuffy nose
• Sore throat
• A short fever
• Aches and pains
  
  

What to Do If You Have Cold and Other Respiratory Symptoms

If you start having trouble breathing when sick with a cold, start following the Yellow/Caution Zone on your Asthma Action Plan. Contact your doctor if symptoms do not improve. And get immediate medical help for emergency asthma symptoms.

Allergy or Rhinitis (Nasal) Symptoms

Irritants and allergens can cause inflammation in your nose. This is called rhinitis. When your symptoms coincide with a certain season of the year, it’s commonly called “hay fever” even though it doesn't cause a fever and can be triggered by many different allergens.

Common allergens that can cause rhinitis include animal dander, dust mites, mold, and pollen.

Allergy symptoms can include:

• Itching in the nose and eyes
• Sneezing
• Stuffy nose (congestion)
• Runny nose
• Mucus (phlegm) in the throat (postnasal drip)
  
  

The inflammation (swelling and irritation) in your nose can cause it to produce a fluid called mucus. The mucus may flow out of your nose, as well as down the back of your throat. It can irritate the back of your throat and cause coughing.

Allergies are not contagious, unlike colds, the flu, and the coronavirus. They are caused by a reaction of your immune system.

What to Do If You Have Allergy Symptoms

If you have allergies, the best way to prevent or reduce symptoms is to reduce or avoid contact with the things you are allergic to. Some steps you can take include:

For dust mite allergy:

• Use CERTIFIED asthma & allergy friendly® dust mite-proof covers for pillows, comforters, duvets, mattresses, and box springs.
• Wash your bedding and pillowcases in hot water weekly to reduce allergens.
  
  

For animal dander allergy:

• Keep pets out of the bedroom to reduce pet dander allergen in your bedding.
  
  

For mold allergy:

• Run a fan in your bathroom for 15 to 20 minutes after showering or bathing.
• Fix plumbing leaks in your home.
  
  

For pollen allergy:

• Plan indoor activities on days when pollen counts are high.
• Keep your windows closed during high pollen and mold seasons. When entering your home, leave your shoes at the door.
• Wear sunglasses and a face mask to protect pollen from getting in your eyes, nose, and mouth when outdoors on high pollen days.
  
  

In general:

• Clean your floors weekly with a CERTIFIED asthma & allergy friendly® vacuum.
• Replace the filters on your heating/air conditioning units as recommended by manufacturer.
  
  

If reducing your exposure to allergens isn’t enough, there are several treatments that can help. Treatments can include nasal sprays, antihistamines, decongestants, and immunotherapy (allergy shots). See a board-certified allergist for allergy testing. They can recommend a treatment plan to help you get relief.

Uncontrolled rhinitis can lead to sinusitis, a sinus infection. If you have asthma, rhinitis symptoms can irritate your lungs and cause asthma symptoms. So if you have allergies, it’s important to get treatment to make sure they are well-controlled.

How to Reduce the Spread of the Coronavirus, the Flu, and Other Respiratory Illnesses

What can you do to reduce your chances of getting sick? To stop the spread of the respiratory infections: get vaccinated, wash hands often for at least 20 seconds with soap and water, wear a face mask when COVID cases in your community are high, and increase air flow in your indoor environment.

If you have asthma, keeping your asthma under control can reduce your chances of having a severe asthma episode or attack if you get sick.

If you do get sick, get plenty of rest, drink water, and follow your Asthma Action Plan if you have asthma.

Always contact your doctor about any concerning symptoms, no matter what. And go to the emergency department or call 911 for emergency signs and symptoms.

Did you know the mask you’ve been wearing to protect yourself and others from COVID-19 may have other benefits? It can be a vital tool to help you prevent asthma and allergy symptoms.

A mask acts like a barrier. It can block some of the particles in the air – such as allergens, pollution, and viruses – and keep them from getting into your nose, mouth, and lungs. It may help reduce asthma and allergy symptoms and protect you from getting sick or spreading an illness.

Here are some of the ways wearing a face mask can benefit you if you have asthma and allergies.

Masks can help reduce the spread of respiratory infections like COVID-19 and the flu. The coronavirus that causes COVID-19 and the flu are viruses that spread from person to person. You can catch them when you are near an infected person when they cough or sneeze. People can spread the coronavirus and the flu a few days before they even have symptoms. Some people don’t even have symptoms when they have COVID-19.

The flu can be serious, especially for people with asthma. Each year, it sends thousands of people to the hospital and causes deaths. People with asthma are at high risk of getting other serious health problems – such as pneumonia – from the flu.

Millions of people around the world have gotten very ill or have died from COVID-19. Studies show people with asthma are not at greater risk of getting COVID-19 or having severe COVID-19.^1,2,3 But COVID-19 may be serious for anyone, especially people with certain health conditions (such as severe asthma).

There are several other steps you can take to help prevent the spread of COVID-19 and the flu. Along with wearing a mask, follow these steps to help keep your and other people healthy:

• Get the COVID-19 and flu vaccines. The COVID-19 vaccine is available for anyone 6 months and older. The CDC recommends people ages 6 months and older get the flu vaccine every year.
• Wash your hands often for at least 20 seconds with soap and warm water, especially after coughing or sneezing. If you don’t have access to running water, use an alcohol-based hand sanitizer.
• Don’t touch your eyes, nose, or mouth.
• Stay away from people who are sick.
• If you feel sick, stay home from work or school and contact your doctor.
  
  

Masks may stop allergens in the air from getting into your nose, throat, and lungs. If allergens like pollen, mold, and animal dander cause you to have allergy and asthma symptoms, you may get some relief from wearing a face mask. They can be especially helpful when pollen and mold counts are high, or on public transportation, such as planes, where animals may be present. In fact, some studies have shown that people had fewer allergic rhinitis symptoms during the COVID-19 pandemic because of wearing masks.^4,5

Masks may give you some protection from air pollution. Polluted air can be full of harmful gases, smoke from fires, volcanic ash, and dust particles. Air pollution can irritate your airways and trigger asthma symptoms. Wearing a face mask may cut down some of that pollution from getting into your lungs. The quality of the mask will impact how well it does at blocking pollution. A simple cloth mask or disposable surgical mask will block some, but not all air pollution.

People who are exposed to harmful amounts of air pollution for hours need better protection. (People who work outside during times the air quality is rated poor, or people who are exposed to high levels of indoor air pollution at their workplace.) NIOSH-approved N95 masks or respirators capture 95% of tiny (0.3 micron) particles in the air. They are very effective at blocking most types of air pollution.

KN95 masks provide an alternative to N95 respirators and are recommended for non-health-care settings for non-medical use. Not all KN95 masks meet the similar requirements for N95 masks. Find a reliable source to purchase KN95 masks.

Can People With Asthma Wear Masks?

Now that you know some of the benefits, you may wonder if people with asthma can wear a mask. The answer is yes! Not only can you wear a face mask if you have asthma, but it can be another tool to help you stay healthy and keep your asthma under control.

Medical Review: December 2021 by Mitchell Grayson, MD

References
1. Chhiba, K.D., Patel, G.B., Vu, T.H.T, Chen, M.M., Guo, A., Kudlaty, E., Mai, Q., Yeh, C., Muhammad, L.N., Harris, K.E., Bochner, B.S., Grammar, L.C., Greenberger, P.A., Kalhan, R., Kuang, F.L., Saltoun, C.A., Schleimer, R.P., Stevens, W.W., & Peters, A.T. (2020). Prevalence and characterization of asthma in hospitalized and non-hospitalized patients with COVID-19, Journal of Allergy and Clinical Immunology. https://doi.org/10.1016/j.jaci.2020.06.010.
2. Butler, M. W., O’Reilly, A., Dunican, E. M., Mallon, P., Feeney, E. R., Keane, M. P., & McCarthy, C. (2020). Prevalence of comorbid asthma in COVID-19 patients. Journal of Allergy and Clinical Immunology. https://doi.org/10.1016/j.jaci.2020.04.061
3. Lieberman-Cribbin, W., Rapp, J., Alpert, N., Tuminello, S., & Taioli, E. (2020). The Impact of Asthma on Mortality in Patients With COVID-19. Chest. https://doi.org/10.1016/j.chest.2020.0air pol.575
4. Mengi, E., Kara, C. O., Alptürk, U., & Topuz, B. (2022). The effect of face mask usage on the allergic rhinitis symptoms in patients with pollen allergy during the covid-19 pandemic. American journal of otolaryngology, 43(1), 103206. https://doi.org/10.1016/j.amjoto.2021.103206
5. Dror, A. A., Eisenbach, N., Marshak, T., Layous, E., Zigron, A., Shivatzki, S., Morozov, N. G., Taiber, S., Alon, E. E., Ronen, O., Zusman, E., Srouji, S., & Sela, E. (2020). Reduction of allergic rhinitis symptoms with face mask usage during the COVID-19 pandemic. The journal of allergy and clinical immunology. In practice, 8(10), 3590–3593. https://doi.org/10.1016/j.jaip.2020.08.035

Studies show that poor outdoor air quality can worsen asthma and allergies.¹ This news may make you think you need to stay indoors to avoid air pollution. But your indoor air may actually be worse than the outdoor air.

Along with taking your medicines, avoiding your asthma triggers and allergens is an important part of asthma and allergy management. And one way to reduce your exposure is by improving and maintaining healthier indoor air quality.

The Truth About Indoor Air Quality

Particles or gasses that are not normally part of the air affect air quality. This is called air pollution. Air pollution can also happen indoors. Why is this?

1. Bad outdoor air can enter your home. You bring outdoor air inside any time you open a door or window. You can also bring in pollen and smoke. Leaks around doors and windows can let polluted outdoor air in too.
2. Indoor air also has allergens, such as dust, pet dander, and mold.
3. Building materials, furniture, carpets, scents, and cleaners can release chemicals into the air.
   
   

Clean outdoor air needs to replace indoor air often or else the indoor air becomes more polluted. That means allergens, smells, and pollutants stay in your home and recirculate.

So what can you do to improve your indoor air quality? One of the best things you can do is start reducing asthma triggers and allergens in your bedroom.

Improve Your Bedroom’s Environment

We spend one-third of our lives in our bedrooms. But they can have the worst air quality of any room in our homes. Your bedroom may be full of allergens, asthma triggers, scents, and chemicals.

Reduce Allergens and Triggers

The bedroom tends to have the highest amount of allergens. As you try to improve your indoor air quality, start with your bedroom first. Here are some ways to reduce bedroom allergens:

• Use CERTIFIED asthma & allergy friendly® allergen barrier bedding.
• Wash sheets once a week in 130 F water.
• Keep pets out of your bedroom and off your bed.
• Don’t let wet or damp clothing pile up.
• Replace your mattress every 10 years and pillows every two years.
• Vacuum floors and mattresses weekly.
• Use a CERTIFIED air cleaner.
• If possible, use central air conditioning with a CERTIFIED HVAC filter. If you don’t have air conditioning and the heat is also high, consider going to places like the mall or the library to avoid the poor air quality and the heat.
  
  

If your bedroom has a connected bathroom, don’t forget about the allergens in there too.

• Run a fan or vent for at least 15 to 20 minutes after showering to prevent mold.
• Fix leaks in or near sinks, toilets, tubs, and showers.
• Allow towels and washcloths to dry thoroughly after bathing.
• Clean your shower, tub, and sinks often with vinegar or detergent and water to keep mold from building up.
• Clean under sinks and behind toilets often where mold and other allergens may build up.
• If you already have mold, clean it as soon as possible with detergent and water. Wear a mask or have someone else clean it for you.
  
  

Keep the Outside From Getting In

When the outdoor air is poor, you’ll want to reduce it from getting inside as much as possible. It’s impossible to keep all outdoor allergens from getting in your bedroom. But there are things you can do to reduce exposure:

• Wear sunglasses and a hat or other hair covering when outdoors.
• Shower every night before bed to keep pollen from getting in your bedding.
• If you work outside, change clothes outside of the bedroom.
• Seal air leaks in windows and doors leading outside and keep your windows closed when pollen is high.
  
  

Reduce Scents and Chemicals

Scents and chemicals in your bedroom can affect your air quality. Even pleasant scents, like candles, plug-ins, essential oils, and potpourri, can cause asthma symptoms.

New furniture, especially mattresses, can have a strong scent. This is called offgassing. It is the release of gasses from chemicals called volatile organic compounds (VOCs).

While experts don’t know if VOCs have any long-term effects, they do know VOCs can have some short-term effects. Some VOCs can cause:

• Eye irritation
• Breathing problems
• Dizziness
• Nausea
• Allergic skin reactions²
  
  

If you have asthma, let your new bedroom furniture air out in another room or garage before you move it into your bedroom. Remove any plastic or wrappings. You could also check with the company you buy your furniture from to see if they would let your furniture air out in their warehouse before they deliver it.

Paint and new building materials can release VOCs too. So if you remodel your bedroom, make plans to use another room until the scents are gone.

But the bedroom is not the only place asthma and allergy triggers can hide. After you’ve improved the air quality in your bedroom, the next rooms to work on are your living room and kitchen.

Published October 2017. Updated October 2021.

Many products promise to help control allergens but not all of them do. When you are shopping for products for your home, look for the CERTIFIED asthma & allergy friendly® mark. It indicates the product has passed our testing standards to help you have a healthier home.

Visit aafa.org/certified to search for CERTIFIED products. There you can also learn more about the asthma & allergy friendly® Certification Program.

References
1. Tiotiu, A. I., Novakova, P., Nedeva, D., Chong-Neto, H. J., Novakova, S., Steiropoulos, P., & Kowal, K. (2020). Impact of Air Pollution on Asthma Outcomes. International journal of environmental research and public health, 17(17), 6212. https://doi.org/10.3390/ijerph17176212
2. Volatile Organic Compounds' Impact on Indoor Air Quality. (2017, April 19). Retrieved September 14, 2017, from https://www.epa.gov/indoor-air...t-indoor-air-quality

Why You Need to Rinse and Spit

Did you know there is a connection between oral health and asthma?

When you use an asthma inhaler that has corticosteroids [CORE-te-coh-STAIR-oids] in it, the medicine can stick to the inside of your mouth. When the medicine stays in your mouth, it may cause problems with your teeth, gums, tongue, and cheeks.

Using corticosteroid inhalers can lead to:

• Thrush – a fungal infection on your tongue or cheeks
• Dry mouth
• Gum irritation and swelling
• Cavities (dental caries)
  
  

Examples of inhalers that have corticosteroids include:

• Advair Diskus® and Wixela Inhub® (fluticasone/salmeterol)
• AirDuo® (fluticasone/salmeterol)
• ArmonAir™ Digihaler® (fluticasone propionate)
• ARNUITY® ELLIPTA® (fluticasone furoate)
• Asmanex® Twisthaler® (mometasone)
• Dulera® (mometasone/formoterol) HFA
• Fluticasone propionate (generic version of Flovent)
• Pulmicort® Flexhaler® (budesonide)
• QVAR® RediHaler™ (beclomethasone dipropionate)
• Symbicort® (budesonide/formoterol) HFA
  
  

If you aren’t sure if your inhaler has a corticosteroid in it, contact your doctor.

The good news is you can keep your mouth healthy! After you use your asthma inhaler, rinse your mouth well with water and spit it out or brush your teeth. If you have a child with asthma, they may be more likely to get cavities, so it is important to teach them to rinse and spit after using their asthma inhaler.

Don’t forget to also floss, brush your teeth twice a day, and limit sugary foods and drinks. See your dentist twice a year so they can make sure your mouth and teeth stay healthy.

Hives, those annoying itchy red bumps, often occur with an allergic reaction or sometimes a viral infection. Or sometimes, they can be more serious when they happen with a severe allergic reaction called anaphylaxis.

Most of the time, you can find what caused them. But what if you can’t?

There is a condition called chronic idiopathic urticaria (ur-ti-KAIR-ee-uh). Simply put, it means hives that stick around for more than six weeks for no known reason. Many people call it CIU. About 1.5 million people in the U.S. have it.

What Is CIU?

Hives caused by an allergic reaction or a viral infection usually go away after a short time.

CIU is different. It can be harder to diagnose. Women are more likely to have CIU than men. Symptoms usually occur between the ages of 20 and 40. For many, the condition typically lasts 1 to 5 years.

Some signs of CIU are:

• Itchy red bumps (hives) anywhere on the body
• Hives that last longer than 6 weeks (maybe even months or years)
• Hives brought on by no known cause
• Unpredictable symptoms that come and go
• Isn’t always relieved by allergy medicines
  
  

No one really knows what causes CIU. They do know that heat, cold, alcohol, exercise, tight clothes and nonsteroidal anti-inflammatory medicines (ibuprofen, aspirin) may make it worse.

CIU is not life threatening. But sudden hives can be one of the symptoms of a severe allergic reaction.

Go to the emergency room or call 911 if:

• Your hives are severe and cover a large area of your body
• You have other symptoms such as difficulty breathing
  
  

What Do I Do If I Think I Have CIU?

If you think you have CIU, see a board-certified allergist or dermatologist. Both types of specialists treat CIU. They will do a physical exam and ask about your medical history. They may also do allergy testing and blood tests, if necessary.

How Is CIU Treated?

Your doctor may try a combination of different medicines to try to relieve CIU. They may first prescribe an allergy medicine called an antihistamine.¹ If that doesn’t work, there are other medicines your doctor may try until they find the ones that work for you.

Treatment may lessen your symptoms but not relieve them completely. Since CIU can be frustrating, support may help you cope as well. Support groups, such as the Asthma and Allergy Foundation of America’s Skin Conditions Support forum, can connect you with others with CIU. Talking to others who understand what you’re going through can be comforting.

Medical Review September 2017.

References
1. Godse, K. V. (2009). CHRONIC URTICARIA AND TREATMENT OPTIONS. Indian Journal of Dermatology, 54(4), 310–312. http://doi.org/10.4103/0019-5154.57603