Allergy Medications and Immunotherapy

Treating hayfever, rhinitis, eczema, hives and other allergies

For allergic individuals, taking measures to reduce exposure to allergens whether in the home, workplace or outdoors, can be a very effective way to minimize symptoms. Advantages of this approach include the low cost and lack of potential side-effects that may be a factor when using medications or other treatments.

Having said that, the modern antihistamine drugs for instance are now virtually side-effect free for most people. In the past, the older generation of antihistamines unfortunately produced unwanted side effects such as drowsiness and short term memory loss, due to their unselective effects on neurotransmitters (brain chemicals). Obviously, this was a serious drawback as it affected the patients ability to drive, operate machinery and even concentrate on their work or studies.

Antihistamines are the most effective and practical medications for the immediate relief of allergic symptoms in mild to moderate cases but there are also other options. We will now take a look at these other options along with more details of some of the modern antihistamine drugs.

Antihistamines

Antihistamine drugs work by reducing the effects of a chemical called histamine, which is responsible for most of the symptoms during an allergic response. Histamine is released mainly by cells called 'mast cells' when they come in to contact with an immunecomplex which is an allergen (e.g. pollen) bound to an antibody (a defense protein produced by the immune system). Histamine can also be released during physical trauma and in response to stings and insect bites.

Antihistamines are effective in treating the following:

• Hayfever (seasonal allergic rhinitis)
• Other nasal allergies
• Itch and itchy rashes including urticaria or hives.
• Insect bites and stings
• Allergy, including severe forms

As we've already mentioned, older antihistamines tended to cause quite serious side-effects such as drowsiness which was a real drawback. This also meant patients had to avoid alcohol and other drugs with a sedative action. The modern antihistamines don't have any of these drawbacks. They usually come in tablet form which can be taken once a day and give a full 24 hours of relief from symptoms. It is also safe to consume alcohol while taking these drugs. The available evidence also suggests they are safe during pregnancy but be sure to read medicine directions carefully and consult with your physician. These drugs are also available in capsule and liquid forms and in severe allergic reactions, injections may be given by your doctor.

Taking these medicines orally makes life for the allergy sufferer very simple as the drug treats symptoms in the nose, eyes and throat all at once, something nasal sprays and eye drops obviously can't do on their own.

Listing of modern, non-sedating antihistamines:
 

The eye drops may sting a little at first, especially if the eye is inflamed, but this is nothing to worry about and should soon pass. The reason for this isn't actually the medicine itself, but the antiseptic which is added to make sure the drops are safe, even for people with other eye problems. After a few days, your symptoms should have reduced as the drops start to work and the stinging should be less of a problem. If the stinging persists however, you may wish to try antihistamine tablets instead as these should also clear up any eye symptoms without the inconvenience of eye drops.

Nasal sprays rapidly clear up nasal symptoms in most people, including itching, running and blocked nose. There may be a little stinging or discomfort initially but this is not as bad as with eye drops and is generally not a problem for most people. Again, if nasal sprays cause discomfort or you find them inconvenient, it is well worth seeing how you do on antihistamine tablets.

Advantages of nasal sprays and eye drops are that they treat the symptoms locally. Some people, especially those with chemical/drug sensitivities, may prefer this approach to taking a antihistamine tablets which affect the whole body. The flip side of this is that the effects of sprays and drops don't tend to last as long as oral medicines.

Examples of anti-allergy and antihistamine nasal sprays and eye drops include:
 

As with most antihistamine medicines in tablet/liquid form, these medicines are typically available over the counter at your local pharmacy or supermarket.

Steroid nasal sprays
If you find you are not getting as much relief as you want from the above options then a steroid nasal spray is an option. These tend to be the most effective of the nasal sprays, especially for combating a blocked nose. A tip which may improve their effectiveness even further when used for seasonal rhinitis (hayfever), is to start treatment before symptoms start to appear. This approach is effective because of the way that steroids work. In effect, the steroids work to reduce inflammation in the nose that starts to build up even before you are aware of any symptoms. When the pollen count really hits high levels your nasal passages will be less sensitive and therefore react less to the pollen. For this approach to be most effective, it is recommended that treatment start about 2 weeks before the expected start of the hayfever season.

People generally have concerns about using any steroid medications, and rightly so, they are powerful chemicals and in many instances, entail serious side-effects. In the case of nasal sprays however, the risks really are very small indeed and if you are really suffering, it really is worth considering them. The dose used is very low as you are only targeting the nose, not the whole body. The types of steroids used in nasal sprays also break down very quickly in the body, so once in the bloodstream they are not active long enough to cause problems. Any worries in the past about steroid sprays damaging the lining of the nose have now been shown to be unfounded as well. Studies have shown that in fact, the nasal passages of people who have used steroids long term are in better health than those of people who have suffered the inflammation the steroids are used to treat.

As many visitors to this website may have fungal/yeast infections (thrush) it should be noted that if you are susceptible to these infections you will have an increased risk of acquiring infection in the nasal passages if you choose to use steroid sprays. If you are susceptible to fungal infection, you should certainly try the other, safer alternatives, before choosing steroid sprays.

Some steroid nasal sprays are available over the counter and common types include:
 

Steroid eye drops
Steroids are also available as eye drops to treat allergic eye symptoms. As with steroid nasal sprays, they tend to be even more effective than their antihistamine counterparts. These are not recommended in most situations however as the potential side-effects are much more serious and more likely than with steroid nasal sprays. Some of these possible effects include increased pressure in the eyes (glaucoma), cloudiness of the lens in the eye (cataracts), and damage to the transparent front covering of the eye, known as the cornea. Blindness is a possible end result of all three of these problems.

Consultation with your doctor is a must when considering using steroid eye drops.

Decongestant sprays
Decongestant sprays are recommended for use over short periods of a few days, where they can be very effective. They work very rapidly to relieve symptoms. If used for prolonged periods however, they are likely to cause more severe congestion than you started with, known as 'rebound congestion'.

What happens is that you will get a good deal of relief initially but then the effect starts to wear off fairly rapidly and your nose becomes blocked again. It's then tempting to use the spray more and more just to be able to breathe at all. Over time your nose will be more blocked than ever.

By all means use decongestant sprays for short term relief as they are great when used in this way, just don't overuse them. If you find your nose is has become more blocked than before when using a decongestant, simply discontinue use and wait for your nose to return to how it was before. You can always switch to a different kind of nasal spray to bring relief too.

A situation where a decongestant spray may be particularly useful is if your nose is too blocked for another medicine, such as a steroid spray, to get to where it is needed to be effective. You can use the decongestant to clear your nasal passages so that your steroid spray will be more effective.

Examples of decongestant nasal sprays include:
 

All of these are available OTC.

Other treatments that may be used if necessary

Decongestant tablets
Decongestant tablets can definately be helpful. They are effective at relieving a blocked nose. The risks of their use however, are considered potentially serious by many authorities. There has been some evidence that on rare occasions, decongestant tablets can lead to devastating side-effects. When used as a slimming aid, there is strong evidence that at least one of them, phenylpropanolamine, can cause strokes due to bleeding in the brain. At the lower dosages used in allergy/cold medicines, the risks are obviously less but it is still a risk. These risks are especially relevant to those with high blood pressure. Other side-effects include insomnia.

On the plus side, decongestant tablets don't cause the problems of 'rebound congestion' associated with nasal sprays but the other side-effects are surely enough to make anyone think twice.

Other nose sprays

The following nasal sprays are sometimes used if the main first line treatments above are ineffective. Sometimes they may be used as an 'add on' treatment in addition to one or more of the above treatments if symptoms are not fully controlled.

Sodium cromoglicate nasal spray - Like steroid sprays, it takes a while to build up its effect, and needs to be taken regularly. It is thought to work by stopping the release of histamine from certain cells. One disadvantage is that it needs to be taken 4-5 times a day (steroid sprays are taken 1-2 times a day).

Ipratropium bromide nasal spray - Can be helpful if your symptoms include a lot of watery discharge. It has no effect on sneezing or congestion however.

Steroid tablets & injections

In some instances, a short course of steroid tablets or even an injection(s) may be prescribed by your doctor. In a situation where it is important to be at your best, for example, for students sitting exams who have severe hayfever symptoms which are not eased by other treatments, steroids may be the only choice. Steroids usually work well to reduce inflammation. A short course is usually safe. However, you should not take steroid tablets or injections for long periods to treat hayfever/rhinitis as serious side-effects may develop.

For those with non-seasonal allergies, for which the other treatment options have been ineffective, your doctor may prescribe a longer course of steroids whilst keeping you under close supervision. It is likely that some form of desensitization therapy will also be suggested so that you do not need to remain on steroids indefinitely with their potentially serious side-effects, including complications of immunesupression and toxic effects on the liver.

Desensitizing injections

A widely used type of immunotherapy designed to reduce the strength of allergic reactions through a process of desensitization. They can be effective for many allergic patients. They are mainly used for those with severe year round allergies, such as to house dust mite, pets etc. They may occasionally be used in severe cases of hayfever when the other available treatments haven't been as effective as expected.

Advice from an allergist/immunologist or other allergy specialist is strongly recommended before you embark on this therapy. It is a time-consuming and potentially expensive treatment and there is a very small risk of death from the treatment due to a strong allergic reaction. You should therefore find an allergy specialist that you feel comfortable with to administer the treatment and discuss the risks fully with you beforehand.

The other thing the expert may be able to do for you is to help you really get the best out of all the other treatments, and you may find that you then don't want desensitizing injections.

To reduce the risk of severe adverse reaction the injections are often given in a hospital environment so that you can have swift and efficient treatment if you have a life-threatening allergic reaction. This makes the treatment safer but also a lot more time consuming.

On the horizon is a new form of desensitization. therapy that should be much more practical and less time consuming. Researchers are currently working on this technique that involves placing the allergen under the tongue.