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Fertilizers and freshly cut grass can worsen asthma symptoms. When working the yard, consider wearing a mask to keep from breathing in particles. It's a bug's life. Citronella candles and bug spray may keep mosquitoes at bay, but they can also trigger asthma symptoms.

It may help to stay several feet away from any strong smelling candles, and when using mosquito repellent. Choose lotions that are unscented instead of aerosol sprays that will help reduce or avoid these triggers.

Other tips that may help you when using repellant products are to empty flowerpots or other containers holding water, wear long-sleeved shirts, long pants and socks when outside and stay indoors at sunrise and sunset when mosquitoes are most active. Understand and use medications as prescribed.

While limiting exposure can be helpful, you can never completely eliminate contact with all potential asthma and allergy triggers.

This is why it is important to always use your maintenance or controller medications as prescribed and with proper technique, even if you are feeling well.

If you have asthma, remember to keep your quick-relief rescue medicine with a spacer or valved holding chamber close at hand in case of symptoms. Other tools that may be helpful include a peak flow meter and a written Asthma Action Plan. Related Blogs. Do I Need Supplemental Oxygen?

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AIT can modify the prognosis of ARD and should therefore be considered a valuable first-line treatment. The present study highlights gaps in current asthma and rhinitis guidelines and addresses specific aspects of ARD, such as global assessment of both asthma and rhinitis or the specific role of variable allergen exposure in the clinical expression of the disease.

This concept reflects the obvious epidemiological, pathophysiological, diagnostic, and therapeutic relationship between both disorders.

In fact, rhinoconjunctivitis and asthma are considered different manifestations of the same disease, and this observation determines clinical management.

It is therefore surprising that consensus guidelines do not usually consider asthma and rhinoconjunctivitis as one disease that should be managed using a comprehensive approach. Furthermore, the focus of current guidelines is mostly on the pathophysiological, clinical, and therapeutic aspects of rhinoconjunctivitis and asthma, with no emphasis on the etiological factors [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ].

Nevertheless, allergens play a decisive role in the onset of symptoms and influence the clinical manifestations and progress of both rhinoconjunctivitis and allergic asthma.

Therefore, a comprehensive understanding of patients with allergic respiratory disease ARD requires that specific aspects of the etiological agent be addressed in the guidelines. The present consensus defines the characteristics of ARD and reflects on the peculiarities of the disease as a single entity.

This document is based on available evidence and the experience of clinical experts. It provides advice to professionals treating patients whose peculiarities are not explicitly included in guidelines and makes a series of recommendations to address this unmet need.

A scientific committee formed by the authors of this manuscript reviewed the relevant medical literature and developed a structured questionnaire to include specific aspects of ARD from routine practice that are poorly covered by current guidelines.

The 71 items were divided into 4 blocks as follows: 1 Definition and Epidemiology, 2 Physiopathology and Etiology, 3 Symptoms, Classification, and Diagnosis; and 4 Treatment: Avoidance, Drug Treatment, and Allergen Immunotherapy AIT.

After analyzing the results of the first round, one of the facilitators provided an anonymous summary of the results, as well as the reasons allergists provided for their judgements.

Thus, allergists were encouraged to revise their earlier answers in light of the replies of other members of the panel, and a second round was held to address the remaining questions.

A 9-point, single, ordinal, Likert-type scale was used to grade opinion on each item. The survey also offered the possibility of adding individual explanatory observations for each answer.

Once the second round was finished, the results were analyzed. The median position of the scores and the level of agreement or disagreement [ 12 ] achieved were measured according to the following criterion: consensus was considered to have been reached for an item when no more than a third of the scores were outside the region of three points 1—3, 4—6, 7—9 from where the median was located.

In the literature review carried out, we found that most guidelines and position papers on rhinitis [ 2 , 3 , 4 , 5 , 6 ] emphasize the relationship between asthma and rhinitis Table 1 , and specific sections of some asthma guidelines discuss the relationship between asthma and rhinitis [ 7 , 8 , 9 , 10 ] Table 2.

However, no guidelines consider both asthma and rhinoconjunctivitis as one disease and offer a comprehensive approach. With respect to the issues addressed in this study, consensus was achieved for In the first round, consensus was achieved in all but 7.

Among the items for which consensus was achieved, it is especially interesting that experts consider that individual aeroallergens may be related to specific clinical profiles and should be taken into account for patient management.

In addition, pharmacological treatment of ARD in routine practice is often based on the intensity of symptoms during previous exposures and may not always be established using a step-up approach, as recommended by clinical practice guidelines.

As for AIT, the experts think that this approach can modify the prognosis of ARD and should therefore be considered a valuable first-line treatment. Detailed results for each item mean, median, percentage of distribution of respondents located outside the region of the median, interquartile range, and consensus result are shown in Tables 3 , 4 , 5 and 6.

In fact, there are currently no consensus guidelines for ARD patients. Thus, management is not based on homogeneous criteria and requires the use of 2 separate guidelines, 1 for asthma and 1 for rhinoconjunctivitis.

This consensus study aimed to collect expert opinions from Spanish allergologists about the symptoms, classification, diagnosis, and treatment of ARD to provide a comprehensive approach for clinical practice.

A major goal was to address the importance of the allergen as the modulator of individual variability in clinical expression based on the duration and intensity of exposure.

Allergic inflammation is present in both the upper airway and the lower airway [ 14 , 15 ], although it may be of locally different intensity items 4, 17, Therefore, a unified assessment of the airway is necessary, irrespective of whether symptoms of both asthma and rhinoconjunctivitis are present at a given time in a patient item 9.

Not all clinical manifestations must occur simultaneously in ARD patients, although the risk of developing the other clinical manifestations of ARD in the future is greater than in the general population [ 16 ].

In ARD patients, allergens and clinical exacerbations are the main triggers of inflammation acute and chronic. The ARD consensus highlights the importance of considering allergic sensitization in diagnostic and therapeutic decisions.

Various airborne allergens can induce a variety of respiratory symptoms with a wide spectrum of severity [ 17 ]. Furthermore, sensitization to several agents polysensitization can also substantially modify the clinical features and prognosis of ARD patients [ 18 ].

As shown by several studies, specific allergens more frequently induce symptoms in the upper respiratory tract than in the lower respiratory tract item 27 [ 19 ].

In addition, some airborne allergens are related to the most severe forms of asthma item 28 [ 20 ] or persistent forms of asthma [ 21 ], and some allergens can lead to worse quality of life than others owing to the characteristics of their exposure item 29 [ 22 ].

Age at sensitization and allergen involved have even been linked to the appearance of specific symptoms [ 23 ]. Sensitization to certain allergens, for instance Alternaria species, has also been noted as a risk factor for exacerbations [ 24 ], severe exacerbations, and even death from asthma [ 25 ].

Furthermore, recent studies have linked specific allergens to various late reactions in asthma: whereas house dust mites induce more severe late reactions than pollens, animal dander allergens are related to reactions of intermediate intensity [ 26 ].

Other factors modulate the clinical response to the allergen. Contact with an allergen causes pathophysiological changes that affect the development of symptoms triggered not only by allergens, but also by other agents, such as infectious microorganisms item These symptoms are more intense when patients are exposed to both an allergen and an infectious agent [ 27 ].

Recent studies have linked the persistence of asthma after removing the allergenic trigger in individuals with ARD with the activation of Th2-mediated myeloid dendritic cells [ 28 ].

Allergen exposure can influence the results of the diagnostic tests most commonly used in rhinoconjunctivitis and asthma. Whereas allergy tests skin prick test, specific IgE, allergen challenge are still useful when patients have no symptoms item 49 , lung function tests may fail to detect bronchial involvement item Thus, the diagnosis of allergic rhinitis can be made independently of the allergenic exposure.

However, according to guidelines, diagnosis of asthma requires the objective demonstration of lower respiratory tract involvement reversible obstruction, hyperresponsiveness [ 7 ]. The expert panel agreed that the therapeutic and diagnostic approach to ARD patients cannot be solely and strictly based on the recommendations of current guidelines.

This must be registered in the medical history Items 34 and 35 and is particularly important if therapeutic recommendations are given when patients are not exposed to the allergens.

In the opinion of the expert panel, unlike non-allergic rhinitis and asthma, maintenance therapy may only be administered to ARD patients during allergen exposure item 55 [ 9 ].

However, maintenance therapy may also be used over longer periods to ensure good control item As suggested previously [ 30 ], there is a common underlying pathogenic mechanism in all patients with ARD, despite differences in clinical manifestations and types of allergic sensitization.

Identification of the causative allergen and prescription of an allergen-oriented treatment improve disease control and prognosis, irrespective of whether asthma and rhinoconjunctivitis appear simultaneously or sequentially.

Allergen immunotherapy AIT is an etiology-based treatment and should be considered a first-line option in ARD based on the clinical relevance of allergen sensitization, in which exposure to an allergen elicits allergic symptoms with significant intensity or duration.

However, contrary to published evidence [ 31 ] and the opinion of the expert panel, some guidelines [ 8 , 9 ] do not consider AIT to be first-line treatment.

This consensus advocates for early indication of AIT under the premise that immunotherapy is most effective in the early stages of ARD item 63 when the optimal dose is applied, thus combining efficacy and safety.

Likewise, substantial evidence indicates a preventive effect in the progression from allergic rhinitis to asthma [ 36 ] item 68 , especially in children [ 37 ]. The experts considered that only some studies in children treated with pollen AIT have demonstrated the development of fewer new sensitizations when compared with those not treated with AIT.

Furthermore, this has not been demonstrated for every allergen or in adults treated with AIT. Polysensitization is an important factor when determining the prognosis of ARD and the indication for AIT item In polysensitized patients, both maintenance treatment strategies item 61 and AIT composition item 69 must be tailored after taking into consideration the most clinically relevant allergen.

However, polysensitization does not necessarily mean polyallergy [ 41 ]. Molecular diagnosis and knowledge of the predominant allergen are very useful for selecting genuinely polyallergic patients to receive AIT.

The inclusion of more than 1 allergen in AIT must be considered when there is more than 1 relevant allergen. The authors of this consensus advocate administration of the complete doses of each allergen to ensure the effectiveness of AIT, although this issue warrants further research item ARD is not reflected in the main clinical practice guidelines.

Consequently, given that allergy is the most important cause of persistent rhinoconjunctivitis and asthma, the absence of specific references to patients with ARD [ 9 ] is remarkable.

It is also interesting that the defining characteristics of ARD, such as the clinical variability conditioned by allergen exposure, have not been assessed. Therefore it is difficult to classify ARD patients according to the criteria currently proposed by guidelines item The assessment of these aspects would enable a better approach in ARD patients.

The dynamic nature of allergic diseases has previously been described [ 37 ]. Therefore, appropriate control of these patients requires the evaluation of the whole airway, even though symptoms may not be present at a given time.

The panel of experts highlighted the existence of several unmet needs. Multiple allergens are frequently implicated in ARD, making it very difficult to identify the most important one. Furthermore, we must bear in mind the existence of other factors not related to the allergen that might contribute to the onset of symptoms.

However, the expert panel recommends a holistic approach to ARD patients, taking into account the clinical expression of respiratory disease at different levels and including its severity and level of control after treatment Figs.

It would be desirable to use questionnaires on disease control [ 44 ] and quality of life [ 45 ] to provide a global evaluation of ARD.

As far as we know, no one has previously addressed the need for a global approach to ARD. Therefore, the expert panel proposes a series of recommendations based on the specific aspects of allergic patients with rhinitis and asthma that can be useful in daily clinical practice Table 7.

The most suitable approach to these patients involves the assessment of all clinical manifestations of the disease, including both rhinoconjunctivitis and asthma, irrespective of whether they are present at a given time. The clinical manifestations of ARD are variable and related to allergen exposure.

Different airborne allergens can be related to specific clinical profiles in patients with ARD. Thus, the causative allergen must play a greater role in decisions on diagnosis and therapy, since the duration and severity of the disease are determined to a large extent by the allergen.

Pharmacological treatment is often chosen based on the severity of symptoms reached in previous allergenic exposures. Therefore, AIT must be considered a first-line treatment and indicated in the early phases because, unlike pharmacological treatment, it can modify the prognosis of the disease.

Therefore, the expert panel considers the development of guidelines that recommend a comprehensive approach to patients with respiratory allergy to be an unmet need. Bousquet J, Van Cauwenberge P, Khaltaev N, Aria Workshop Group, World Health Organization.

Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. Article Google Scholar. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma ARIA update in collaboration with the World Health Organization, GA 2 LEN and AllerGen.

Article PubMed Google Scholar. Scadding GK, Durham SR, Mirakian R, Jones NS, Leech SC, Farooque S, et al. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clin Exp Allergy. Article CAS PubMed Google Scholar. Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, et al.

The diagnosis and management of rhinitis: an updated practice parameter. Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al.

Allergic Rhinitis and its Impact on Asthma ARIA guidelines: revision. Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, et al.

Clinical practice guideline: allergic rhinitis. Otolaryngol Head Neck Surg. Plaza V, Alonso S, Alvarez C, Gomez-Outes A, Gómez F, López A, et al.

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By Mayo Clinic Staff. Thank you for subscribing! Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. Show references What does asthma have to do with your allergies? Probably a lot.

American College of Allergy, Asthma and Immunology. Accessed Jan. Burks AW, et al. Middleton's Allergy: Principles and Practice. Elsevier; Asthma Wenzel S. Treatment of severe asthma in adolescents and adults.

Journal of Allergy and Clinical Immunology. Zuberi FF, et al. Role of montelukast in asthma and allergic rhinitis patients. Asthma symptoms. Pakistan Journal of Medical Sciences. Li JTC expert opinion. Mayo Clinic. Products and Services A Book: Mayo Clinic Book of Home Remedies.

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The quality of the air we breathe affects each of us and can be especially troublesome for people with asthma. Check daily air quality levels and air pollution forecasts in your area. Learn more about how to improve and maintain your clean air at home, work and school. Lawn and garden maintenance.

Before working in the yard, check your local pollen count. Consider gardening in the early morning or evening when the pollen count is at its lowest. Fertilizers and freshly cut grass can worsen asthma symptoms.

When working the yard, consider wearing a mask to keep from breathing in particles. It's a bug's life. Citronella candles and bug spray may keep mosquitoes at bay, but they can also trigger asthma symptoms.

It may help to stay several feet away from any strong smelling candles, and when using mosquito repellent. Choose lotions that are unscented instead of aerosol sprays that will help reduce or avoid these triggers. Other tips that may help you when using repellant products are to empty flowerpots or other containers holding water, wear long-sleeved shirts, long pants and socks when outside and stay indoors at sunrise and sunset when mosquitoes are most active.

Understand and use medications as prescribed. While limiting exposure can be helpful, you can never completely eliminate contact with all potential asthma and allergy triggers.

This is why it is important to always use your maintenance or controller medications as prescribed and with proper technique, even if you are feeling well. If you have asthma, remember to keep your quick-relief rescue medicine with a spacer or valved holding chamber close at hand in case of symptoms.

Other tools that may be helpful include a peak flow meter and a written Asthma Action Plan. Related Blogs. Do I Need Supplemental Oxygen? January 17, Barriers and Solutions to Implementing Stock Asthma Medication in Schools December 13,