WHAT IS AN ALLERGY?
Allergies are a common condition affecting more than one out of every 5 people. Allergies are an abnormal response of the immune system triggered by a typically harmless substance. If you have an allergy, your immune system mistakes an otherwise harmless substance as an invader. This substance is called an allergen. The immune system overreacts to the allergen by producing Immunoglobulin E (IgE) antibodies. These antibodies travel to cells that release histamine and other chemicals, causing an allergic reaction. Since most allergens are found in the air, the reaction occurs most commonly in the eyes, nose and lungs. If the allergen is ingested, the reaction can occur in the mouth or stomach. Most allergies are inherited. Statistically, if one parent has allergies, then children will have a 25% chance of also developing allergies. Should both parents have allergies, there is a 75% – 80% chance that their children will also have symptoms.
Most allergic reactions result in mild symptoms that include sneezing, runny nose, watery eyes, itching or rashes. Moderate to severe reactions, called anaphylaxis, are rare but can be life-threatening. People with asthma are more likely to suffer from allergies.
TESTING
Allergy Testing
Identifying the offending allergens is the first step to determine the most appropriate course of therapy. There are two ways to test for allergies:
1) skin tests and
2) blood tests.
The doctor will review your medical history to determine which test is right for you.
Skin Testing
Allergy skin testing is performed on the back and arms. The testing done on the back consists of gentle pricks made with disposable plastic prongs with a small amount of the allergen extract on them. After a 20 minute wait, the results are read. If you are allergic, there will be a slightly raised area (wheal) that may or may not be itchy. The size of the wheal correlates with the severity of the allergy. The severity of the allergy then determines what allergens to test intradermally (under the skin) on the upper arms. The information from the skin testing can determine what you are allergic to with an incredible degree of accuracy, helping your doctor to determine the cause of your allergies.
Patients who are scheduled to have allergy skin testing must discontinue certain medications. The link below gives a list of medications that need to be discontinued.
Blood Testing
Blood testing (RAST) is a newer technology for diagnosing allergies. These measure the same allergy triggers as skin test and are useful in certain patients such as young children, and those who are on certain medications that prevent them from having skin testing. Occasionally both skin testing and blood testing may be used to identify allergens.
TREATMENT
Allergy Treatment
There are several ways to treat allergies, ranging from avoidance to medications to immunotherapy. Once the testing is complete, the doctor will discuss all options with you and a decision can be made that fits your lifestyle.
Avoidance
It’s not possible to completely avoid allergens, but you can reduce symptoms by taking some steps to limit your exposure to them. It helps to know exactly what you’re allergic to so that you can take steps to avoid your specific triggers.
Avoidance Strategies to Help Minimize Allergies
Medications
There are numerous medications available today for the treatment of allergies. Many people get relief from a combination of allergy medications. Some medications work better for some people and don’t work well for others. Some are safe to use in children, while others are only approved for adults.
Nasal corticosteroids. Available by prescription only, used to help prevent and treat nasal inflammation caused by allergies. Examples include fluticasone (Flonase and Veramyst), mometasone (Nasonex), Triamcinalone (Nasacort AQ) and budesonide (Rhinocort AQ). Nasal corticosteroids are a safe long-term treatment option for many people.
Antihistamines. Available both OTC and with a prescription and work by blocking histamine. Examples include diphenhydramine (Benadryl), loratadine (Claritin), cetirizine (Zyrtec), fexofenadine (Allegra), levocetirizine (Xyzal) and desloratadine (Clarinex). By prescription only, there are a few antihistamine intranasal sprays as well. These include azelastine (AstePro) and olapatadine (Patanase).
Leukotriene modifiers. Montelukast (Singulair) is used to block the action of leukotrienes (chemicals from the immune system that cause allergy symptoms). This can be used in combination with other allergy medications and therefore is sometimes added to antihistamine use to improve relief.
Nasal atropine. Ipratropium bromide (Atrovent) is a prescription nasal spray that helps relieve severe runny nose. It is not effective for nasal congestion or sneezing.
Immunotherapy
Desensitization involves the gradual delivery of the substances to which you are allergic. You are given increasing doses to increase your immune system’s tolerance to antigens. Over 85% of patients who receive regular immunotherapy experience significant relief from their symptoms. Immunotherapy treatment lasts anywhere from 2- 5 years.
Injections. There is a gradual increase of dose each week during the escalation phase until you reach a maintenance dose, where the dose strength is constant. Injections are given weekly in the office and the patient must wait a mandatory time of 30 minutes before leaving so that our office staff may monitor for any adverse reactions. Injections are covered by most insurance plans.
Sublingual drops. Like shots, sublingual drops slowly desensitize you to the allergens to which you are allergic. Drops are delivered daily under your tongue and can be taken at home. Each day you increase the dose strength until reaching the maintenance stage. At that point you will continue at the same dose for the duration of treatment. Sublingual drops are typically not covered under insurance.