The National Institutes of Health (NIH) recently announced 19 recommendations for the diagnosis, management, and treatment of asthma in six key area, including four new recommendations targeting allergic asthma. The new guidance, published in the Journal of Allergy and Clinical Immunology, represents the first updates to federal comprehensive asthma management and treatment guidelines in more than a decade, and focuses on tailored treatment interventions for specific age groups based on disease severity.
The recommendations are based on systematic reviews conducted by the Agency for Healthcare Research and Quality and input from National Asthma Education Prevention Program (NAEPP) participant organizations, medical experts, and the public.
Around 60% of People With Asthma Have Allergic Asthma
“The 2020 update stresses the importance of targeted interventions for individuals with asthma who have allergies to specific allergens or experience allergy or asthma symptoms when exposed to those allergens,” says Michelle M. Cloutier, MD, chair of the NAEPP Coordinating Committee (NAEPPCC) Expert Panel Working Group and professor emerita of pediatrics and medicine at UConn Health School of Medicine, Farmington, Connecticut. “Since the last update to the guidelines was published 13 years ago, we have made really substantial progress in understanding how to treat asthma in both children and adults, and the new guidelines reflect some of these new approaches.”
More than 25 million people in the United States have asthma, and allergic asthma is the most common type, affecting around 60% of people with asthma, according to the Asthma and Allergy Foundation of America (AAFA). Common triggers of allergic asthma include cockroaches, dust mites, mold, pets, and pollen. Both allergic and non-allergic asthma present with the same symptoms, such as shortness of breath and wheezing.
Four New Recommendations for Reducing Exposure to Allergens
The update specifically addresses interventions designed to reduce exposure to allergens, with four new recommendations:
- For individuals with asthma but no allergies to indoor allergens or symptoms when exposed to an allergen, environmental intervention in the home is not recommended.
- For individuals with asthma and specific allergies or symptoms when exposed to specific indoor allergens, multiple strategies to reduce allergens are recommended.
- For individuals with asthma who are sensitive to dust mites, dust mite-impermeable pillow and mattress covers are recommended as a multicomponent intervention and not a single-component intervention. (The National, Heart, Lung, and Blood Institute [NHLBI], part of the NIH, also recommends high efficiency particulate air [HEPA] filtration vacuum cleaners since using only one strategy often does not improve asthma outcomes).
- For individuals with asthma who are allergic to indoor pests and exposed to cockroaches, mice, or rats, integrated pest management is recommended to prevent infestation and reduce allergen levels in the home.
Updated recommendations concerning immunotherapy and allergy shots are as follows:
- For individuals aged 5 years and older with allergic asthma, allergy shots, known as subcutaneous immunotherapy, are recommended for people whose symptoms worsen after exposure to certain allergens.
- Sublingual immunotherapy, which involves placing drops or tablets containing allergens under the tongue, is not supported by current evidence for the treatment of allergic asthma.
These recommendations are based on systematic reviews conducted by the Agency for Healthcare Research and Quality and input from NAEPP participant organizations, medical experts, and the public. The NHLBI coordinates the NAEPCC and the 19-member expert panel working group that developed the 2020 Focused Updates to the Asthma Management Guidelines: A Report from The National Asthma Education and Prevention Program Experts Panel Working Group.
- New updates to federal guidelines revamp asthma management. National Institutes of Health (NIH) website. https://www.nih.gov/news-events/news-releases/new-updates-federal-guidelines-revamp-asthma-management. Published December 3, 2020.
- What are asthma guidelines and why are they important? National Heart, Lung, and Blood Institute (NHLBI) web site. https://www.nhlbi.nih.gov/health-topics/asthma-management-guidelines-2020-updates/faqs#topic4. Updated March 3, 2021.
- Allergens and Allergic Asthma. Asthma and Allergy Foundation of America (AAFA). https://www.aafa.org/allergic-asthma/. Updated September 2015.