Q: Many people with food allergies also have asthma. Since respiratory symptoms are common in both conditions, how do patients know whether they’re experiencing a severe allergic reaction or an asthma flare?

Todd A. Mahr, MD: This is a common question from parents and patients because anaphylaxis and asthma do have similar symptoms.

With anaphylaxis, the reaction is going to be acute and it’s usually timed with exposure to an allergen, such as ingestion of a food allergen or a bee sting.

It’s not a smoldering flare that worsens over time, which is classically what happens with asthma. The asthma patient may develop a cold or an upper respiratory infection that causes sneezing, sniffles and scratchy throat and progresses to coughing, wheezing and shortness of breath.

Hives are often a differentiator: there are typically no hives or skin conditions that develop as a result of an asthma flare, whereas with a food-allergic reaction hives often develop. You might have a runny nose and some congestion due to anaphylaxis, but those symptoms are related to the ingestion of the food allergen, not an asthma flare.

Another hallmark of anaphylaxis is the sudden onset of symptoms. It can start within seconds of exposure to an allergen. I train parents and patients to initiate their Anaphylaxis Action Plan at the earliest sign of symptoms. The Anaphylaxis Action Plan is designed to explain what’s going on and what to do next. That’s the key.

Anaphylaxis and asthma are treated differently. We don’t want a patient who is experiencing a food-related allergic reaction thinking they are having an asthma flare, and then grabbing their albuterol inhaler, when what the patient really needs is an epinephrine auto-injector.

I go over this and review steps with parents and patients as often as possible. Don’t debate with yourself, ‘Oh, this sudden coughing fit is probably just a cold starting.’ Learn to recognize your symptoms and what they mean.


Todd A. Mahr, MD, FACAAI, is a board-certified allergist and immunologist in La Crosse, Wisconsin. He is President-Elect of the American College of Allergy, Asthma & Immunology (ACAAI) and Immediate Past Chairperson for the American Academy of Pediatrics Section on Allergy and Immunology.


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