Asthma, Allergies, and Airway Problems in Hypermobility

How Common Are Asthma and Allergies in Hypermobility Syndromes?

A 2007 case-control study published in the Annals of the Rheumatic Diseases surveyed 509 people: 221 healthy controls, 126 with Hypermobility Syndrome (HMS, now generally called HSD), and 162 with EDS. It found a significantly increased prevalence of asthmatic symptoms in both groups compared to controls - an odds ratio of 2.4 in HMS and 3.1 in EDS, meaning EDS patients had roughly three times the odds of asthma symptoms as the control group. Atopy (the tendency toward allergic conditions generally, including hay fever and eczema) was similarly elevated, with an odds ratio of 2.7 in HMS and 2.6 in EDS.

These findings held up under closer clinical scrutiny, not just self-report: a subgroup of 157 responders underwent full clinical and blood testing, and the increased asthma and atopy rates were confirmed by that clinical assessment, not just questionnaire answers.

Why Airways Themselves May Be Part of the Problem

A subgroup of 57 subjects underwent physiological lung testing, which found increased lung volumes, impaired gas exchange, and an increased tendency for both the lower and upper airways to collapse. That last finding is mechanically distinct from typical asthma, where airways narrow due to inflammation and muscle constriction - airway collapse is closer to a structural, connective-tissue-driven floppiness of the airway itself, similar to how joints and other soft tissues behave in hypermobility.

The study's authors proposed two possible explanations: either a genetic linkage between whatever causes hypermobility and whatever causes asthma susceptibility, or a more direct effect where the same connective tissue defect that affects joints also affects the airways and lung tissue directly. The study could not fully distinguish between these explanations, and reduced exercise tolerance was also observed more often in the HMS and EDS groups, which may relate to either the respiratory findings or to hypermobility-related fatigue and deconditioning discussed elsewhere on this site.

A 2023 Study Adds a Broader, Mental-Health-Linked Picture

A 2023 cross-sectional study by Reina-Gutierrez and colleagues, published in Respiratory Medicine and Research, surveyed adults with hEDS in Belgium using the Nijmegen Questionnaire, a validated screening tool for functional respiratory complaints (breathing pattern disorders like hyperventilation and air hunger, a broader category than diagnosed asthma), alongside measures of central sensitization and the Hospital Anxiety and Depression Scale. It found that 84.9% of respondents scored in the range suggestive of a functional respiratory complaint.

The same survey found probable anxiety in 54.3% of respondents and probable depression in 30.6%, and breathing-complaint severity correlated with both central sensitization scores and mental health symptoms. That correlation does not establish which comes first. It is consistent with the airway-collapse mechanism Morgan and colleagues described above, but it is also consistent with anxiety-driven changes in breathing pattern, or with the central sensitization that shows up across other hEDS/HSD symptoms making breathing sensations feel more intense than they otherwise would. The study was not designed to separate those explanations, so this adds a documented association, not a settled mechanism.