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Could it be asthma? I have hay fever but now I’m wheezing too.

Published: February 27, 2014 10:00 AM

It’s possible, but difficult to say for sure, since mild wheezing can accompany seasonal allergies, or hay fever, and both can be set off and worsened by some of the same irritants: dust mites, mold, pet dander, pollen, and tobacco smoke. And, too, symptoms of asthma and allergies can develop gradually and vary over time, says Rachel Miller, M.D., professor of medicine at Columbia University Medical Center.

The most common signs of seasonal allergies are itchy and watery eyes, nasal congestion, a runny nose, and sneezing. On the other hand, wheezing, and feeling out of breath, tightness in the chest, and cough are hallmark signs of asthma. In addition to the triggers mentioned above, cold air, strenuous exercise, respiratory illness (such as the flu), and some drugs can also set off an asthma flare-up or attack. For people with asthma, such triggers can cause inflammation in the walls of the airways and make the muscles around the airways spasm. This constricts the airways and causes increased mucus production, both of which make it difficult for air to move in and out of the lungs.

While many people with allergies don’t have asthma, research shows that allergy sufferers are at increased risk for asthma, especially if you have a family history of the condition. “Asthma is essentially allergies of the airway in some people," Miller said. “So for some people, it’s another clinical manifestation of allergies.”

For more information about asthma see our Consumer Reports Best Buy Drugs report.

If wheezing is not a symptom you typically associate with your allergies, and your current antihistamine is not helping, Miller recommends making an appointment with an allergist for a proper diagnosis. He or she will try to identify triggers and will need to rule out other causes, including Chronic Obstructive Pulmonary Disease (COPD) or a respiratory condition such as pneumonia or bronchitis. In addition to questions about your medical history, symptoms, and lifestyle habits, you’ll need to undergo a breathing test called spirometry.

If your doctor determines you have asthma, he or she will discuss a treatment plan including lifestyle changes, and if needed, an inhaled steroid to reduce and prevent inflammation, swelling, and mucus buildup in your airways and lungs to help prevent asthma attacks and help you breathe easier. Not everyone with asthma needs an inhaled steroid, but if your doctor determines you do, our latest Best Buy Drugs report on asthma treatments recommends beclomethasone (QVAR) and generic budesonide suspension nebulizer. Both are as safe and effective as other inhaled steroids, though beclomethasone is the least expensive of the two, ranging from $142 to $177 per month, depending on dose.

If it’s allergies, you have several options. For one, there’s avoidance of your triggers. In our 2009 survey of allergy sufferers, one in five respondents said they found relief with avoidance measures, including staying indoors with windows shut and the air conditioner on during the summer, having someone else mow the lawn, and limiting outdoor activities to low-pollen days. When those tactics worked, they were even more effective than taking over-the-counter medicine for allergies.

For more on allergies, see our Consumer Reports Best Buy Drugs report.

Also consider switching to a different antihistamine. Some people respond better to one antihistamine than to others, so some trial and error may be necessary to find one that works for you. Taking dosing convenience, cost, and effectiveness and safety into account, our latest Consumer Reports Best Buy Drugs report on antihistamines recommends lower-cost loratadine, (Claritin and generic) cetirizine (Zyrtec and generic), or fexofenadine (Allegra and generic). Those drugs are less likely to cause drowsiness than older antihistamines, such as brompheniramine, chlorpheniramine, and diphenhydramine. Prescription steroid nasal sprays, such as fluticasone (Flonase and generic) and mometasone (Nasonex), are very effective, but you should stop taking them if they cause irritation or nosebleeds.

Finally, if you've tried medications and nondrug approaches and still no relief, talk to an allergist about immunotherapy, also known as allergy shots. Research shows immunotherapy can effectively and safely reduce symptoms and the need for medication.

Related: Last gasp for Primatene Mist asthma inhaler?

— Ginger Skinner


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