Combined Pathology: What Does It Mean?
A combined pathology means a combination of bronchial asthma with atopic dermatitis (meets less often) and an allergic rhinitis (occurs more often).
There are three fundamental documents for the recommendations: GINA (Global Initiative for Asthma, a 2016 version) and ARIA (Allergic rhinitis and its impact on asthma – 2008) with updates 2010, PRACTALL (Practical allergy, Practical allergy, section Diagnosis and treatment of asthma in childhood – diagnosis and treatment of asthma in children) 2012.
Treatment in such situations has a number of characteristics.
Bronchial asthma + atopic dermatitis:
- The diet requires a lot of attention;
- Gistaminolibrators can cause not an only exacerbation of dermatitis, but also exacerbation of asthma due to an increase in histamine in the mucosa of the respiratory tract and subsequent bronchial obstruction;
- Inhalation allergens (“air allergens”) can cause cross-reactions together with food products (the list we presented in articles about pollinosis and household allergies).
With simultaneous exacerbation of asthma and atopic dermatitis, it is not recommended to use antihistamines of the first generation (suprastin, dimedrol, tavegil, diazolin, fenistil) in connection with thickening of mucus in the bronchi and possible worsening of exacerbation of asthma. The exception for children is ketotifen – sedative antihistamine, which despite the not fully studied mechanism of action, has a beneficial effect on the course of asthma exacerbation of mild severity. In this case, it is not recommended to use Ketotifen ONLY with asthma exacerbation. Inhalation preparations should always be present in the treatment of an exacerbation.
Bronchial asthma + allergic rhinitis
- With simultaneous exacerbation of asthma and allergic rhinitis, treatment of both diseases is very important. Without adequate nasal breathing, it is difficult to restore the permeability of the bronchi;
- Intranasal steroids (nazonex, avamis, etc.) do not replace inhaled steroids (pulmicort, flixotide, serotide, etc.) and cannot be used alone to relieve exacerbation and asthma, and rhinitis;
- Intranasal steroids and inhaled steroids used simultaneously do not increase the risk of side effects and do not require dose adjustment;
- Antihistamines of the 1st generation should not be used for exacerbation of asthma (see above for reasons).
Antihistamines of the 2 generation do not affect the exacerbation of asthma, therefore can not be used to treat its exacerbation, but can be used to treat concomitant allergic rhinitis. This means that one can not treat asthma with Zirtek, but it can be used when concomitant allergic rhinitis exacerbated.
Antileukotrienes (Montelukast, Singulair) can be used to treat a combination pathology since they affect both the upper and lower respiratory tract. Today, indications for the treatment with montelukast are both bronchial asthma and allergic rhinitis.
However, local steroids (inhalation and intranasal) remain more effective treatment for both asthma and rhinitis.
The indications for ASIT are allergic rhinitis and bronchial asthma of a mild and moderate course. This is the only method of treatment that affects the development of the disease, inhibiting the deterioration of the disease, allowing to achieve remission. The combination of asthma with allergic rhinitis is the basis for ASIT planning since this method of treatment will affect both diseases.