There is no one single treatment for all allergies.
Each person should have medication and treatment adapted to the symptoms which he presents.
Avoidance measures, when they are possible, remain essential and first line treatment. Avoiding any contact with known allergens will certainly decrease the appearance of the symptoms.
Treatmentswill help to prevent and treat symptoms.
Desensitising is the only prophylactic and curative treatment, but only for certain allergies.
Allergen avoidance: what you can do
The main principle of avoidance measures is from the outset to try and identify the allergen responsible for your symptoms. Then, if possible, you need to avoid being in contact with the allergen in question or reduce the contact time you have with the allergens. Avoidance measures depend on the kind of allergy (dust mites, animals, pollens, drugs....) Controlling the indoor environment, home and professional buildings, reduces the exposure to certain allergens.
Because of the nature of allergens being widespread in our environments it is not possible to completely eliminate them from our lives. Avoidance measures help improve the frequency and intensity of the symptoms
A wide range of medicines can prevent and relieve allergic symptoms.
Anti-histamine medicines stops the release of histamine, an inflammatory substance, released during allergic reactions.
- It is prescribed for various symptoms of allergy: rhinitis, conjunctivitis, urticaria and eczema etc
- It does not have a major effect on asthma.
Antihistamine medicine can cause side-effects among which the most known one is drowsiness. Second generation antihistamines can cause fewer side-effects, but for some allergic people they can still suffer from these side-effects.
Some antihistamines are contraindicated at certain stages of pregnancy. Always speak with your GP or pharmacist.
There are many antihistamine drugs available without prescription and work very well. For some allergic people stronger drugs are required and will be prescribed by your GP.
Steroids have anti-inflammatory properties. They are prescribed in various forms: tablet, syrup, creams, injection, inhaler and nasal spray.
They are used for various allergic symptoms and the treatment of asthma.
- For asthma : inhalers are normally used to treat and control asthma symptoms. In severe cases steroid tablets or injections are used.
- For allergic rhinitis: nasal sprays and tablets are effective.
- For urticaria: tablets, injections and or creams are used for acute symptoms.
- For eczema: creams and or tablets are used.
Most steroid drugs prescribed for asthma and rhinitis are in very low doses and delivered locally as inhalers or sprays. Their side effects are minimal and benefits huge. Only when prescribed in large doses orally and for long periods of time do steroids have side effects.
Steroids in tablet form
- Steroids drugs prescribed in tablet form for a short period and for acute episodes , do not have side-effects if given therapeutic amounts.
- It is when steroids are given in larges doses and for a long time i.e for several weeks or months that side effects occur: side effects include putting on weight, possible thinning of the skin.
Steroid ointment or creams
- They are prescribed for the treatment of skin conditions such as eczema. Your GP or specialist prescribes steroid creams as the correct advice is essential when applying it to the skin as these creams can weaken and thin the skin. They must not be used continuously for long periods of time.
Leukotrienes are mediators released during allergic reactions. Antileukotriene medicine fights the effects produced by these substances. They are used more and more often in the treatment of asthma and rhinitis.
These treatments can be applied to the nose, eyes or lungs.
- Nasal treatments include drops and sprays containing steroids, antihistamines and anticholinergics for example sodium cromoglycate.
- Eye drops also come as antihistamine, anti inflammatory and anticholinergics. An ophthalmologist can only safely prescribe steroid drops, as their side effects can be harmful without the correct monitoring.
Treatments for asthma
- Bronchodilator drugs such as salbutamol have a fast, but short action. It works by dilating the bronchi when it is in spasm.
- The patient usually feels relief within 15 minutes of taking the medication and gets relief for up to 4 - 6 hours.
- Bronchodilator drugs are also used before exercise and activity. This helps prevent the bronchi from narrowing and going into spasm thus avoiding an attack.
- There are long acting bronchodilators that are also used for the treatment of asthma. They last for up to 12 hours and are often combined with steroid inhalers. Long acting bronchodilators are used more for the management of asthma symptoms rather than for acute immediate relief.
Inhaled steroid drugs
Many mild asthmatics require just a bronchodilator inhaler for occasional relief of symptoms. Those with more moderate and severe asthma that have many triggers, a steroid inhaler are a basic and important treatment for asthmatics. Steroid inhalers are usually used for months and or years at a time.
Steroid inhalers work by reducing the inflammation and mucous production in the lining of the lungs. As a result asthma symptoms become controlled and the aim is that people lead a normal and full life.
Inhalers come as an aerosol or in dry powder form.
This is also an inhaler medication that works in a similar way to bronchodilators. It is effective for moderate to severe asthma and other respiratory diseases. .
These medications have been super seeded with many newer generation drugs however, they do have a place for other chronic and severe respiratory diseases.
Antileukotrienes are drugs which act by blocking the action of leukotrienes in the airways. Leukotrines are mediators of inflammation in the respiratory tract. Antileukotriene medicines are useful in the prevention of asthma caused by exercise and activity. They come in tablet form and are never used as a stand-alone treatment for asthma.
A new class of medicine, the Anti-IgE, are prescribed to asthmatics presenting severe asthma with an allergic origin.
They are prescribed when there is excessive bronchial hyper secretion of mucous in the lungs. It is more commonly used for chronic and severe respiratory conditions.
They are prescribed when there is an infection in the nose or lungs. They are also prescribed for ear and throat infections.
This is used more for chronic lung conditions where there is excessive production of fluids and mucous in the lungs.
Mode of action of desensitising
- Desensitisation or specific immunotherapy , is the only treatment which can possibly cure certain allergies.
- It consists in gradually re-introducing the person to the allergen. This is done by administrating repeated and increasing doses of an allergenic vaccine. Further doses are given until an effective amount is given.
- The allergic person presents with fewer allergic reactions in the presence of the allergen(s) to which he is sensitive.
- This treatment is recommended by the WHO. The World Health Organisation specifies that from now on it must be an integral part of the way in which we deal with allergic diseases.
- Unfortunately, more than 80% of those who could make good use of it do not know that this type of treatment is on offer.
- Allergic people who use this treatment must meet specific criteria, as not all allergic people cannot be desensitised.
- A doctor must also make sure that the patient is able to commit to a prolonged and constraining treatment.
Pre-conceived ideas about desensitising
- Desensitising does not contribute in any way to the appearance of other allergies! On the contrary, it prevents the occurrence of other allergies.
- Many people still think that to be desensitised to pollens will reveal another allergy, to dust mites for example.
- On the contrary, one of the objectives of desensitising is to prevent the appearance of other allergies.
This treatment can last from 3 to 5 years, which can seem long. But let us not forget that allergy is a chronic disease, as well as hypertension, and diabetes for example, requiring long term treatments.
Unfortunately not all allergic people cannot benefit from this treatment.
Before beginning desensitising treatment, it is important that your specialist explains the advantages, constraints, side-effects and risks of failure. Also if no improvements are seen after a year or a couple of pollen seasons then treatment will be suspended. It is often advised to encourage patients to spend time thinking about it before committing to the programme.
Less injections: the new tablet treatment
- This method, already used in more than 70% of cases, consists in depositing some drops of the allergenic extract under the tongue then to let it melt for 2 minutes without swallowing.
- Local reactions, itching or small discomfort in the mouth can be observed.
- Episodes of rhinitis, coughs, or even asthma or urticaria are exceptional.
- To this day, no severe reaction has been observed.
- All studies show good tolerance to this product.
In the future tablets which dissolve under the tongue will be offered to some people who are allergic to pollen.
Desensitising with injections is the oldest and well known method. It consists of injecting amounts of the allergenic extract in the top of the arm using syringes and fine needles. A specialist doctor in a hospital/clinic environment performs these injections.
- Local reactions may occur where the injection took place. Redness and a sore painful swelling may occur.
- Some rare reactions, are rhinitis, an asthma attack or urticaria. They occur in general a few minutes after the injection or just after leaving the clinic. According to the type of reaction your doctor will prescribe anti-histamines, bronchodilators and steroids.
- Severe reactions, are rare and exceptional, such as an anaphylactic shock. Urgent treatment of epinephrine is required as a matter or urgency.
It is necessary to remain for 20 to 30 minutes after the injection and to avoid taking part in sports for several hours following.
Desensitising to wasp or bee venoms
It is only carried out in the form of injections.
The first part of the treatment is performed in hospital, during a half or a full day. Monthly injections then follow.
Results of desensitising
- The earlier desensitising is performed, the more chances there is a cure for the allergy.
- Desensitising reduces the risks of new allergies
- Desensitising children can be offered.
- Desensitising avoids the appearance of asthma in people presenting with allergic rhinitis
- Desensitisingdecreases the consumption of symptomatic drugs.
- Desensitising to dust mites and pollens is successful in 60 to 70% of the cases.
- There are excellent results in desensitizing to venoms of wasps and bees with more than 90% success..