TREATMENT

If you can't avoid airborne allergens, your symptoms often can be controlled by various medicines. There are medicines available without a prescription that can relieve allergy symptoms. If they don't give you much relief or cause unwanted side effects such as drowsiness and loss of alertness - your health care provider can prescribe newer non-drowsy antihistamines and topical nasal steroids. You can use either medicine alone or together. New allergy medications seem to come out daily and while often hard to pronounce their names - they are praised for their effectiveness in TV ads. Many of the current allergy and asthma medications are listed in the Medication Lists of the Investigation Forms. Still another treatment is immunotherapy, or a series of allergy shots. While allergy shots can help treat many allergies, medications that focus on symptoms are often sufficient. Whether you choose over-the-counter or prescription drugs, you need to understand the cause (triggers) for your allergic reactions along with your health profile, in order to select your most effective individualized treatment plan. The very inclusive Allergy Triggers checklists and the latest medicines in the Medication Lists can first show you what is triggering your allergies and next - what newer medications might help you more now.

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 Allergy Treatments:
You are luckier if you have allergies today, because drugs are much more effective - particularly the prescription type. However, more than half of allergists and 39 percent of primary care physicians said they prescribe more than one medication to their patients. Allergy sufferers' biggest complaint is that   oral antihistamines don't act fast enough. For this reason, patients end up switching medications or using additional treatments.

Different doctors may treat allergy symptoms differently. Despite clear parameters and recommendations from major allergy societies and national health organizations, there's still no consensus as to the best way to treat allergic rhinitis. Doctors who focus on symptom relief may tend to prescribe antihistamines, while those who view inflammation as the principal problem are more likely to favor corticosteroids. If your child has allergies or asthma, discuss treatment options with his or her health care professional. Many prescription and over-the-counter allergy medications can be used for children, although the dose will be adjusted for your child's age and/or size. Oral medicines will also need to be in a form that your child can easily swallow.                                  
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If you have moderate to severe allergy symptoms and you want to regain your usual comfort, you will require treatment to counteract the activity of mast cells and histamines. Histamines are responsible for immediate allergy reactions, such as itching, dripping from the nose or eyes, itching or redness of the nose or eyes, wheezing, sneezing, hives, or throat tightness. That is why antihistamines are the cornerstone of any allergy treatment. Ideally you can target your treatment to the site of the symptoms. For example, you might treat a skin rash that involves a small area with corticosteroid creams applied to the skin, treat nasal symptoms with nasal sprays and use eye drops for eye symptoms. Targeting the site of the symptoms helps to limit the side effects that may occur when allergy medications are taken by mouth. 

It can be important to act quickly. The antibodies that attach themselves to allergens set off a chain reaction involving armies of cells and chemical signals. The immune system can in this way accelerate the initial reaction to an allergen, so if your allergy symptoms are severe, the sooner you start your treatment after an exposure the better. Prevention is even a better allergy tactic by taking your medication before you encounter your allergen trigger. This way you can lessen or totally avoid your allergic reaction.
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Preventive Medications:
Take the right medication for you. That means a second-generation, non-sedating antihistamine. It's important to take it daily during gardening season (or when you are around your frequent bothersome allergens) even if you aren't having symptoms. That way you'll already be protected from pollen every day as well as when the urge to weed your garden - hits. The Medication Lists can show you what the latest medications are and their possible side effects.

Also, if you are subject to severe allergic reactions, you might consider keeping emergency medications together in a kit. Examples would include an immediate-acting antihistamine, your short-acting inhaler (if you have asthma), and an EpiPen (epinephrine) if your health-care provider prescribes it. Have these items readily available at home, at work, in the car, in your sports bag, on trips, etc. You might even consider wearing a Medic-Alert bracelet or necklace so that anyone who finds you unconscious or unable to speak can quickly identify that you need treatment for an allergic reaction. A Medic-Alert bracelet can also prevent you from being accidentally given a medication you are allergic to, if you are unable to communicate to medical personnel in an emergency.

People with severe allergies or asthma that are difficult to control with usual treatments and preventive measures may benefit from allergy testing and allergy shots (immunotherapy). This is covered in another section.  Pay attention to pollen reports in the news, so you can consider taking allergy medications way before your symptoms begin. 

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Antihistamines:                                   
Preparing to act at the earliest signs of symptoms is important for any allergy, but this is especially important for asthma. Asthma that is not treated quickly can become dangerous. If you anticipate nose or eye allergy symptoms because you expect to encounter your allergy, be sure to have an over-the-counter, immediate-acting antihistamine close at hand. Examples of inexpensive antihistamines include diphenhydramine (Benadryl), clemastine (Tavist) and chlorpheniramine (Chlor-Trimeton). Chlorpeniramine is the least sedating of the three. Loratidine (Clariton) is an antihistamine that causes less sedation than other over-the-counter medicines in this antihistamine group.

The newer, nonsedating antihistamines such as fexofenadine (Allegra), loratadine (Claritin and Alavert), cetirizine (Zyrtec), and desloratadine (Clarinex) have very little effect on the central nervous system because they are composed of larger molecules that can't get past the blood/brain barrier. Thus, they don't make you tired, irritable, or confused. While these drugs work fairly similarly, everyone's allergy symptoms are different and you may have to try several antihistamines before finding the one that works best for you. In addition to oral antihistamines, there is now an intranasal antihistamine, azelastine (Astelin), approved for both season and perennial allergic rhinitis and available only by prescription. It works quickly and provides targeted therapy, as opposed to oral antihistamines, which must make their way through your digestive system and bloodstream before arriving on the scene. It's also the only antihistamine approved for both allergic and nonallergic rhinitis, since it helps with congestion as well as runny nose (which oral antihistamines can't touch).
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Decongestant types:

You may want to use a decongestant along with an antihistamine in order to unclog your nose. Short-acting decongestants such as pseudoephedrine (Sudafed) relieve congestion and runny nose quickly. Be aware that even if this decongestant is OTC, some states control its use by requiring your identification and signature. This is because it is one of the ingredients in illegal drugs like Meth. Some medications already combine the two like the oral nonsedating drugs Allegra-D, and Claritin-D, and the less sedating acrivastine (Semprex-D) and Zyrtec-D. Unfortunately, if you use OTC decongestant nose drops and sprays for more than a few days, you can get a rebound effect. The more you use them, the more you need them, until they become ineffective altogether and you're even more congested than when you started taking them.  Men with prostate enlargement may have urinary problems while taking decongestants. Additionally, use with care if you're taking medication to manage emotional or behavioral problems such as antidepressants. 

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Steroids:
If you have severe allergies or allergic asthma, you're likely to be prescribed topical nasal steroids, which you sniff into your nose rather than inhale into your lungs. Steroid nasal sprays work by preventing mast cells and basophils from releasing chemicals that call in the cavalry, i.e., eosinophils and other inflammation-triggering cells, in response to the the mast cell reaction. They stop your allergic reaction. Your doctor will probably recommend a combination of antihistamines and nasal steroids if you have severe allergies or allergic asthma. Nasal steroids take a few hours to work and help significantly by reducing mucus secretion and nasal swelling. While nasal steroids are definitely safer than oral steroids, they do carry some slight risks and may have some side effects. That's why your doctor will put you on the lowest possible dose to treat your symptoms. (Nasal and inhaled steroids can cause headaches, nosebleeds, and dryness and irritation of the nose and throat - plus some other side effects.)

Inhaled corticosteroids (a class of steroids) are used to treat asthma and may take up to a month of daily doses to see any difference in your symptoms and derive the drugs' full benefits. Inhaled corticosteroids are typically prescribed in either a metered-dose inhaler (MDI), a dry powder inhaler, or a compressor-driven nebulizer, depending on the brand. (See the next Bronchodilators section for more information.) Oral steroids (such as prednisone and methylprednisolone) are rarely used and only in the short term - most often to treat a severe asthma attack. Corticosteroid inhalers are an extremely important treatment for asthma. They are able to dramatically reduce the frequency and severity of asthma attacks, if they are used as a regular asthma prevention medicine. Because corticosteroids have such broad effects on the body, the potential for side effects is greater than with other medications. The potential for side effects however, is greater with oral corticosteroids than with corticosteroid sprays, inhalers, lotions, creams or ointments.
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Bronchodilators:

Bronchodilator medications open (and keep open) the large and small airways in your lungs. They come in two forms: short-acting (also known as rescue medications), which are used when your asthma symptoms are worsening or you're having an attack, and long-acting - used on a daily basis to prevent your asthma from getting worse. These medications have very little effect on inflammation though, so they won't provide the kind of long-term relief you need for this chronic condition. If you have diabetis, heart disease, high blood pressure, hyperthyroidism, an enlarged prostate, or a history of seizures, discuss these conditions with your doctor and find out if bronchodilators are right for you.

While many bronchodilators are prescription drugs, some, such as Primatene Mist and Bronchaid, are available over the counter. They pose the same risk as their strong prescription counterparts, so again, ask your doctor first, particularly if you have the health issues just mentioned. Whether you use the metered-dose inhaler (MDI), a 'holding chambers and spacers' device, a dry-powder inhaler or a nebulizer - it's important to read the directions carefully otherwise the medicine may wind up in your mouth and not your lungs.

Albuterol (Proventil, Ventolin) is the standard inhaled 'airway opener' short-acting beta2-agonist used in the U.S. A longer lasting 'airway opener' is called salmeterol (Serevent), which takes awhile to work. Remember also that these beta2-agonists have very little effect on inflammation. These days you can get a corticosteroid or other anti-inflammatory drug (like fluticasone) with a beta2-agonist 'airway opener' drug (salmeterol) - in one medicine called Advair.
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Leukotriene Modifiers:
Leukotrienes are among the molecules that mast cells, eosinophils and macrophages release when they encounter asthma triggers. They are partly to blame for the increased mucus production, airway constriction, and inflammation of asthma and for the runny and stuffy nose of allergies. Leukotriene modifiers such as montelukast (Singulair) are particularly useful for preventing exercise-induced asthma and asthma triggered by allergens. This medicine reduces mucus production, congestion and to a lesser extent sneezing and itching. It is an option for people with mild rhinitis who can't tolerate or don't respond to antihistamines or steroids, especially when there's substantial congestion.  

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 Immunization against Allergies:

Immunotherapy, or a series of allergy shots, is the only available treatment that has a chance of reducing your allergy symptoms over a longer period of time. You would receive subcutaneous (under the skin) injections of increasing concentrations of the allergen(s) to which you are sensitive. These injections reduce the level of IgE antibodies in the blood and cause the body to make a protective antibody called IgG. An easier way to explain the shots is that they teach your immune system to react to your usual triggers without generating allergy symptoms. Allergy shots are generally considered for people with perennial and seasonal allergies to airborne allergens, such as pollens, pet dander, dust mites, and mold, or to insect stings; those whose symptoms are not well controlled with medication; those who want to avoid long-term use of medication; and those who are willing to make the long term commitment to treatment. This treatment method is not currently used for food allergies, because injections to treat food allergy have a high risk for causing a serious reaction. Drug development is in progress for food allergy treatment. A safe allergy shot solution to treat peanut allergy may be available in upcoming years.

You may need to get shots for as long as five years. About 85 percent of people with allergic rhinitis will see their symptoms and need for medicines drop significantly within 12 months of starting immunotherapy. Those who benefit from allergy shots may continue it for 3 years and then consider stopping. While many are able to stop the injections with good results lasting for several years, others do get worse after the shots are stopped. If your symptoms don't get better after one year, your doctor will probably stop the treatment.
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 Immune-modifying Agents:
This medication targets the underlying causes of inflammation. Xolair is a genetically engineered drug called a monoclonal antibody. It works by stopping an allergic reaction before it starts by blocking the IgE antibody that causes the reaction. Everything else in the allergy arsenal treats only the symptoms of allergies or blocks your reaction to specific allergens. Xolair appears effective, but the high cost limits its use to severe cases that don't respond to other treatments. Ideally, as more drugs in this class are approved and are used more widely, the price hopefully will come down.

Concluding:
From all the previous medications described, it can be seen that intense scientific investigations are going on to treat and prevent allergies and asthma. Everyone's allergies are a bit different than someone else's. People often respond differently to the various allergy medications and it's necessary to find the 'ones' that work best for you. Talk over the various newer allergy medications with your health provider. Some may help you more than the medications you are currently taking.  Many are listed in the Medication List in the Investigation Forms section of this site. Combination therapies (drugs) also continue to be developed that make it easier for people to treat all of their allergies and asthma. Of course it would be great if we didn't need medications to treat our allergic condition. Therefore, allergy prevention still has a very important role for us, in avoiding our allergens.
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