Diabetes and Asthma: Allergy Season Safety
By Sara Lyle
Ahead of the fall allergy season – when asthma-related hospital visits spike each year – we asked experts how people with diabetes and asthma can stay safe with allergens all around.
You’ve probably read about the link between obesity and type 2 diabetes. But did you know there is a strong correlation between obesity and asthma, too? Throw in diabetes and things can get even more complicated.
“Asthma can interact with obesity, increasing circulating levels of inflammatory cytokines [produced by the immune system] and leading to an increased risk of insulin resistance and type 2 diabetes,” said Dr. Jeffrey Demain, professor at the University of Washington and spokesperson for the Asthma and Allergy Foundation of America.
One of the biggest issues with asthma and diabetes is the common use of corticosteroids in people with asthma (more on that later). In advance of peak allergy season, Demain explained how people living with these conditions can stay safe when allergens seem to be all around.
What’s the connection between obesity and asthma?
There are several potential reasons why obesity is associated with worse asthma, Demain said, including:
Dietary factors: Diets that are high in sugar and saturated fatty acids, or low in antioxidants and fiber, are associated with increased respiratory symptoms like airway inflammation and decreased lung function and can contribute to obesity. Vitamin D deficiencies may also be a risk factor for developing both obesity and asthma.
Mechanical factors: Increased body fat in the chest wall and abdomen decreases the lung volume during respiration, making it more difficult to breathe.
Other health conditions: Individuals with obesity often have other problems, such as sleep apnea and acid reflux, which have been associated with increased asthma symptoms and potential severity.
Common allergens that can increase the risk of asthma complications
Outdoor allergens include pollens and molds. Tree pollen is high in the spring, grass pollen is high in the summer, and weed pollen is high in the fall. Mold spores are often higher in early spring, late fall, and following a rainstorm. Thunderstorms can also intensify allergen exposure, particularly grass allergens.
Exposure to ozone, pollution, smoke, and other particles in the environment can provoke worsening respiratory symptoms. These particles can mix with pollen grains, intensifying the reaction for those who are allergic, said Demain.
Indoor allergens include animal dander, dust mite droppings, mouse urine, cockroaches, and mold. Chemical exposure in a closed environment may also cause symptoms.
How can people with asthma and diabetes or obesity minimize risks around allergens?
First, it’s important to know what you're allergic to and monitor pollen reports. Otherwise, Demain advises to:
Stay indoors with windows and doors closed during times of unhealthy air quality.
Stay indoors with windows and doors closed during high pollen and mold cycles.
Use a HEPA air filter to “clean” indoor air and vacuum with a HEPA filter to pick up allergens on carpets and floors.
Animals can be a major source of allergies. If you have a pet, bathe them every two weeks and try to keep them out of the bedroom.
Avoid dust magnets like clutter, throw pillows, and stuffed animals.
If someone has asthma and diabetes, what medications may be harmful to treat asthma?
The use of systemic corticosteroid medications like prednisone is associated with several adverse effects, including insulin resistance, glucose intolerance, and hyperglycemia. However, inhaled corticosteroids may have less of an effect.
Steroids can certainly make diabetes management difficult. Lower doses should be used when possible, with the use of other non-steroid medications and possibly other newer medications for asthma.
Recommended medications during allergy season
For allergies, the use of over-the-counter non-sedating antihistamines is perfectly safe for people with diabetes. Avoid syrups, which are often filled with sugar. Antihistamine nasal sprays, such as Astelin (azelastine), may be preferred over nasal steroids if trying to minimize topical steroids.
There are also several allergy eye drops that are now sold over the counter, such as Pataday (olopatadine). Allergy shots are also a consideration for those with proven environmental allergies.
The bottom line
Demain said his first piece of advice is listening to the patient to get a better understanding of what they’re struggling with and how their quality of life has been impacted. Do they have any other comorbidities, such as sleep apnea or acid reflux?
“I then validate for them that asthma and diabetes are, indeed, more common and difficult to control in a patient with obesity,” he said. “Weight loss, even 5 percent, can improve control of both asthma and diabetes.”
Demain said that after getting a read on a patient’s motivation to lose weight, he’ll ask what they’ve tried so far to lose weight. What’s worked and what hasn’t? What are the barriers to making changes?
Referring to a dietician is a good start. There are also new medications to treat obesity. While there are many factors that contribute to asthma and allergies in people with diabetes, weight loss is certainly an important step toward improving both asthma and diabetes control.
Learn more about diabetes, allergens, and obesity here: