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SPECIAL FEATURE cold. That combination may push the person over the edge and cause them to become symptomatic." A Compound Problem The National Heart, Lung, and Blood Institute (NHLBI) estimates that more than 25 million Americans have asthma, and as many as 60% of adults and 90% of children have allergies. Single allergens may trigger asthma, but sometimes the compounding effect of exposure to multiple triggers at once can spur exacerbation. William Hicks, M.D., head allergist, partner at HealthEast, points to patients with 14 | Twin Cities MD NEWS I MDNEWS.COM exercise-induced asthma catching a cold as an example of a possible additive trigger. "Asthma triggers may coincide and sometimes be additive," Dr. Hicks says. "For example, if there is one trigger, there may not be any symptoms, but if there are two, then there may be an asthma exacerbation. A classic example of this is someone who has exercised-induced asthma. This person may be fine until he or she has a A Difficult Time of Year Although allergies are prevalent yearround, winter proves a difficult time for asthmatics because viral infections may contribute, along with common year-round allergens, such as dust mites, cockroaches, pet dander and mold, to making asthma dangerously symptomatic — presenting with severe coughing, chest tightness, shortness of breath and wheezing, according to the NHLBI — says Dr. Hicks. Patients facing this dangerous combination benefit from evolved medical understanding of winter's unique allergy and viral dynamic. Limited treatments for the viral component of the equation and typically ineffective antibiotics used to treat winter asthma make for a dangerous combination for patients with asthma, a virus and allergies. Dr. Reinhardt notes that asthmatics who have this combination have demonstrated increased risk for hospitalization. "In the past, it was common to treat winter asthma exacerbations with antibiotics and call it 'bronchitis,'" says Dr. Reinhardt. "As time has passed, we've seen that patients don't seem to benefit from antibiotic treatments. For winter asthma, we've realized that it's not bacterial, which explains why antibiotics don't work. Viral infections aren't easy to treat, and antiviral medications aren't so readily available." Dr. Reinhardt acknowledges that increasing medications to treat severe asthmatics follows National Institutes of Health (NIH) guidelines, but he points out that this strategy does nothing to address the root of the problem. As physicians have moved away from antibiotic methods to treat winter asthma, efforts to identify and avoid allergic triggers have escalated. In conjunction with a comprehensive patient history, ImmunoCAP blood

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