9 Medicines for Asthma and Allergies

Inhaled Corticosteroids

Inhaled corticosteroids are one of the most important therapies for any asthma, including allergic asthma.

"These are the gold standard, and they work by basically blocking the inflammation response in the lungs," said Mitchell H. Grayson, MD, associate professor of pediatrics, medicine, microbiology, and molecular genetics at the Medical College of Wisconsin in Milwaukee.

Known as "controller" medications, they take a few days to work—so they aren't for short-term symptom control.

Leukotriene Receptor Antagonists

Also considered "controller" medications, these drugs, like Singulair (montelukast sodium), can treat allergic asthma because they inhibit an inflammation-causing chemical released by the immune system. However, they can also treat non-allergic asthma, said Jill Poole, MD, associate professor of internal medicine at the University of Nebraska Medical Center in Omaha.

The pros are that they come in pill form and have few side effects. The drawback is that the effect is generally mild. "If you have mild persistent or mild intermittent asthma, sometimes they will work quite well," said Dr. Mitchell.

In 2020, the U.S. Food and Drug Administration (FDA) required a boxed warning about serious behavior and mood-related changes with montelukast (Singulair and generics). The FDA writes, "We decided a stronger warning is needed after conducting an extensive review of available information and convening a panel of outside experts, and therefore determined that a Boxed Warning was appropriate."

Short-acting Beta Agonists

You know these inhalers—every asthmatic in the movies carries one to take an occasional puff. Known as "rescue medications," these drugs act within minutes to quickly resolve symptoms.

"We warn everyone who has asthma to carry one of these," said Dr. Poole.

Albuterol and related medications such as Maxair (pirbuterol) are bronchodilators, meaning they work by relaxing the airways. These drugs shouldn't be used frequently (1-2 times a week or less).

A way to utilize your quick-relief "rescue medication" is to take it ahead of a triggering event, such as exercise, which will prevent the bronchoconstriction normally brought about if the inhaler had not been used. People with exercise-induced asthma can use one 20 minutes before working out to prevent problems, said Dr. Mitchell.

Long-acting Beta Agonists (LABAs)

People who find themselves using rescue medications frequently may need to switch to long-acting beta agonists, which can be effective for 12 hours or more, said Dr. Poole.

Common products include Advair (a combination of the beta agonist fluticasone and the steroid salmeterol) and Symbicort (a combination of the beta agonist formoterol and the steroid budesonide). A combination formulation (a beta agonist plus a steroid) is important as long-acting beta agonists on their own can worsen asthma.

Although Advair was given a black box warning in 2003 from the U.S. Food and Drug Administration (FDA), the black box warning was removed by the FDA in December 2017 as its review of clinical trials found that treating asthma with long-acting beta agonists (LABAs) in combination with inhaled corticosteroids (ICS) does not result in significantly more serious asthma-related side effects than treatment with ICS alone.

Antihistamines

Antihistamines block the immune system's chemical histamine, which is key in allergic reactions.

"If you have an allergy component to your asthma, they can be beneficial," said Dr. Poole. Antihistamines are usually combined with inhaled corticosteroids or Singulair and can reduce inflammation in the nose and the lungs. They are cheap, available over-the-counter, and have relatively few side effects. They're quick acting, so they may help if you're allergic to cats and are about to visit a friend with one, said Dr. Grayson. Antihistamines shouldn't be used chronically.

Omalizumab (Xolair)

Xolair is one of the few drugs specifically for allergic asthma. It binds to immunoglobulin E (IgE), an antibody type produced in response to an allergen.

It won't help non-allergic asthma, a type triggered by exercise, cold air, or other non-allergy irritants.

Xolair is expensive, so it is usually given in more severe cases, said Dr. Mitchell, such as people who have repeat trips to the emergency room. It's an injected drug with a boxed warning about a risk of anaphylaxis, a potentially life-threatening allergic reaction. (Healthcare providers monitor for such reactions after giving the injections.)

Allergy Shots

Allergy shots, or "immunotherapy," can be helpful in mild-to-moderate allergic asthma. The first step is to get a skin test to identify your allergens. Then you get a shot containing a small amount of the allergen (say, cat dander) about once a week. Four to six months later, you begin maintenance shots once every three-to-four weeks. Eventually, your body becomes desensitized to the substance, but this can take up to five years, said Dr. Poole. And it's not clear how effective the shots are for anything other than hayfever, added Dr. Grayson.

Oral Corticosteroids

Oral corticosteroids, as opposed to inhaled steroids, are generally used in the short term for serious asthma attacks, said Dr. Mitchell. This stronger form of the drugs can cause potentially serious side effects if used in the long term.

If you still have symptoms and a controller medication isn't doing enough to stop them, your healthcare provider might want to give you oral steroids for four to five days to get you back into good health. Oral steroids such as prednisone take 4-6 hours to take effect, said Dr. Mitchell.

Theophylline

Theophylline, sold under brand names such as Theo-24 and Uniphyl, is also a bronchodilator and has been used to relieve symptoms, particularly coughing at night.

It comes in pill form, which is a plus. But there are potential side effects ranging from diarrhea to neurological problems if the dose gets too high.

Patients have to have regular blood tests, and the drug is "hardly used anymore," said Dr. Poole.