Treatment of Allergy

Treatment of Allergy

Allergy Treatment

Allergy treatment is very important to lead a normal life style. An allergic reaction is an immunologically mediated reaction to substances which are considered harmless to most of us. The substances which cause allergy are called Allergen.

Avoidance is the best preventive measure for allergies. However, an individual may unknowingly come in contact with the allergen leading to an allergic reaction.

For mild to moderate allergic reaction:  antihistamines are helpful.

Medications include-

  1. Antihistamines: Most common medicine used in mild to moderate allergic reaction.

Antihistamines include:

  • Fexofenadine
  • Levocetirizine
  • Cetirizine
  • Diphenhydramine
  • Desloratadine
  • Loratadine

  1. Decongestants:

Decongestant can be used to relieve a stuffy nose and sinus pressure. But decongestant can only be used for shorter time usually for three days. Longer time can cause a rebound effect, means once you stop the medicines your symptoms will actually get worsen.

Decongestants include:

  • Oxymetazoline
  • Pseudoephedrine
  • Phenylephrine
  • Cetirizine with pseudoephedrine

One should be keep in mind that history of  abnormal heart rhythm, heart disease, history of stroke, anxiety, a sleep disorder, high blood pressure, or bladder issues is important before commencing decongestant medication.

  1. Eye drops and nasal sprays:

Eye drops and nasal sprays can help relieve itchiness and other allergy-related symptoms for a short time. However, depending on the product, you may need to avoid long-term use.

Like decongestants, overusing certain eye drops and nose drops can also cause a rebound effect.

  1. Corticosteroids:

    Corticosteroids can help with inflammation and immune responses. These do not cause a rebound effect. Steroid nasal sprays are helpful for long-term use.It is very useful way to manage allergy symptoms. Nasal steroid medications are most effective medications.

  2. Immunotherapy:

Your doctor may recommend immunotherapy, or allergy shots, if you have severe allergies. You can use this treatment plan in conjunction with medications to control your symptoms. These shots decrease your immune response to particular allergens over time. They do require a long-term commitment to a treatment plan.

For severe allergic reaction/Anaphylaxis: If there is severe reaction or anaphylaxis one must inject adrenaline/ epinephrine in an appropriate dosage. If someone has adrenaline autoinjector then he can use it otherwise one has to attend the nearest hospital as early as possible. One must carry his adrenaline autoinjector all the time if an allergist prescribed it.

Management of anaphylaxis

Anaphylaxis is a medical emergency. It can be fatal if left untreated.

If someone has symptoms of anaphylaxis, you should:

  • Use an adrenaline/epinephrine auto-injector. Give another adrenaline injection after 5-15 minutes if the symptoms don’t improve and a second auto-injector is available

Dose of Adrenaline / Epinephrine

10-20 kg (~1-5yrs) – 0.15mg (green labelled on autoinjector)

>20kg (~>5yrs) – 0.3mg (yellow labelled on autoinjector)

Pregnant woman- 0.3mg (yellow labelled on autoinjector)

If do not have autoinjector or in hospital settings

Give INTRAMUSCULAR (IM) injection of Adrenaline/ Epinephrine as follows:

  • 1:1000 solution of Adrenaline in IM into outer aspect of mid-thigh in right site.
  • 0.01mg per kg up to maximum of 0.5mg per dose.
  • Repeat every 5 minutes as needed.
  • Call emergency number for an ambulance immediately
  • Remove any trigger if possible – for example, carefully remove any wasp or bee sting stuck in the skin
  • Lie the person down flat. The left lateral position is recommended for patients who are pregnant.

Prevention of Anaphylaxis

It is extremely crucial to alert all the time and follow few preventive measures to reduce the risk of anaphylaxis.

The following can help:

  • Identify any triggers – Attend any allergy clinic to know what the substances you are allergic to. This will help you to plan your management strategy.
  • Avoid triggers whenever possible – Once you identified the possible factors for triggering anaphylaxis then you can take avoidance measures to reduce the risk. For example if you are allergic to certain food then you have to shop very carefully.
  • Carry your adrenaline auto-injector at all times with you– use it in emergency situation.

Allergen Immunotherapy (AIT):

If you are suffering from any form of allergy and it is interfering with the daily activity, your Allergist may advice you to take allergen immunotherapy (AIT). In AIT, purified standardized allergen in small doses is introduced to body in a graded manner. This increasing dose of giving allergen over a period of time improves immune tolerance to a particular that allergen and thereby reduces symptoms of allergy produced by that allergen. But before starting AIT, your Allergist do certain tests to find out what are the allergens which you are allergic too. After finding out the causative allergen if you’re Allergist thinks that it will be responsive to AIT, then and then only AIT can be started.  AIT is a long term treatment, so it need cooperation on behalf of patient.

Allergen immunotherapy (AIT) consists of a buildup phase and a maintenance phase.

In buildup phase a standardized purified small amount of allergen is given as shot one to three times per week for about three to six months to let your body to tolerate the allergen.

During the maintenance phase, the particular allergen is introduced as shots every two to four weeks over the course of three to five years. It may take more than a year to get relief from allergy symptoms. After that your allergy symptoms may completely disappear or reduced to a greater extent. AIT may have some side effects. So your Allergist will tell you to wait for at least 30 to 45 minutes before leaving the clinic or hospital.

AIT is effective in

  • Treatment of Allergic Rhinitis
  • Treatment of allergic asthma

Around 1 in 4 people with allergic rhinitis also have asthma. Studies shown that allergen immunotherapy (AIT) for inhalant allergens reduces the rate of development of new onset sensitization to other inhalant allergens and the rate of progression from allergic rhinitis and asthma.

The allergen for which the AIT available include

  • House dust mite
  • Grass
  • Tree pollen
  • Cat dander
  • Ragweed

There are two types of AIT. These include

  1. Subcutaneous Immunotherapy (SCIT):

Subcutaneous Immunotherapy (SCIT) is an effective treatment for allergy. In SCIT a series of injections are given subcutaneously about once a week during the initial phase of treatment. The treatment is done for a period of one to three years.  Some physician continue SCIT for three to five years. SCIT can provide complete cure of allergy in some patients. Many individual experience symptoms free for several years after stopping treatment.

  1. Sublingual immunotherapy (SLIT):

In Sublingual immunotherapy (SLIT), purified standardized allergen in small doses in placed under tongue in a graded manner. This increasing dose of giving allergen over a period of time improves immune tolerance to that allergen and reduces symptoms. SLIT in an approved treatment for dust mite allergy.

Possible side effects include:

  • Itching in the mouth or ear
  • Irritation in throat
  • Anaphylaxis- rarely
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