Smoke allergy
Sensitivity to tobacco or wood smoke, which worsens airway symptoms.
About smoke allergy
Sensitivity to smoke, whether from tobacco, wood burners, bonfires or open fires, is common, but it is important to understand the mechanism: smoke reactions are irritant rather than a true IgE-mediated allergy. Smoke is a mixture of fine particles and irritant gases that inflame and irritate the lining of the nose, eyes and airways directly, rather than triggering the antibody response seen with pollen or dust mite. Even so, smoke is a powerful and widely recognised trigger for respiratory symptoms, and people with asthma, existing hay fever, children and older adults are especially susceptible.
Symptoms usually appear within minutes of exposure and include a runny or blocked nose, sneezing, a scratchy or sore throat, coughing and stinging, watering eyes. In people with asthma, smoke is a well-established trigger for wheeze, chest tightness and breathlessness, and both active and second-hand tobacco smoke can make asthma harder to control and worsen eczema. Reactions to a single exposure are generally not life-threatening, but a severe asthma attack always needs prompt attention, and long-term smoke exposure carries wider health risks.
Management is centred on avoidance: keeping homes and cars smoke-free, improving ventilation, avoiding wood-smoke and bonfire exposure where possible, and support to stop smoking where relevant. Because this is an irritant effect, allergy testing is usually unhelpful, though skin-prick or specific-IgE tests may be used to check for co-existing allergies. Any underlying asthma or rhinitis is treated as usual, which may include antihistamines and steroid nasal sprays. See a GP if smoke reliably worsens breathing or symptoms are frequent.
Common triggers
- Smoke and products containing it
Symptoms
- Sneezing and a runny or blocked nose
- Itchy, red or watery eyes
- Itchy throat, nose or ears
- Coughing or wheezing
- Worsening of asthma
Avoidance & management
- Reduce exposure to the trigger where possible
- Keep windows closed during high-exposure periods
- Use air filtration and wash bedding regularly
- Shower and change clothes after exposure
- Use prescribed antihistamines, nasal sprays or preventers
Sources & references
Allergy safety: what everyone should know
Mild-to-moderate reaction signs
- Itching, hives or a raised rash
- Swelling of lips, face or eyes
- Tingling mouth, sneezing, runny nose
- Stomach pain, nausea or vomiting
Anaphylaxis — call 999 (UK) or 112 (EU) immediately
- Difficult or noisy breathing, wheeze, persistent cough
- Swelling of the tongue or tightness in the throat
- Dizziness, collapse, pale and floppy (young children)
- Use an adrenaline auto-injector (e.g. EpiPen) at once if prescribed, then call an ambulance even if symptoms improve
Allergy or intolerance? A true allergy involves the immune system and can escalate quickly; an intolerance (e.g. lactose intolerance) is unpleasant but not life-threatening. The symptoms overlap, so self-diagnosis is unreliable.
Getting tested: home-testing kits based on IgG are not diagnostically valid. If you suspect an allergy, ask a GP for referral to an allergy clinic for skin-prick or specific-IgE testing and a supervised food challenge where appropriate.