Allergies and asthma

Treatment and prevention of allergies

The most effective way to combat allergies and allergy symptoms is, of course, prevention. Elimination of the allergen from your diet and avoidance of those things in your environment that trigger symptoms is the best way to deal with allergies. This isn't always possible, however, and here, Women's Web examines the various methods of treating and preventing allergies.

Prevention

Some people's allergies are caused by airborne allergens. These people can combat their allergies by elimination and avoidance — they often relocate to an area where the allergens responsible for their allergies aren't present. Over time and through the activation of normal, immunologic mechanisms, these patients develop an increased tolerance to the allergens that trigger their allergic reactions.¹

Preventing hay fever and asthma

Patients suffering from allergic rhinitis (hay fever), seasonal allergies, and asthma are well advised to limit their exposure to outdoor and airborne allergens. This can be done through interventions. Interventions refers to the various ways of controlling allergies by reducing or eliminating symptoms. Patients can try to control their environment by protecting their homes from dust mites, cockroach waste and animal dander. Patients can avoid the offending allergens by closing windows, air-conditioning their homes and using air purifiers or filtering devices such as HEPA filters. It's strongly recommended they avoid going outside during the morning hours, when pollen count is at its highest. Because pollen can collect on clothes, people with hay fever or asthma should not dry their clothes outside.² They may also try to avoid allergens at work, particularly during the peak pollen seasons. Patients can also eliminate certain foods from their diet.³

Those with allergies to dust and dust mites should look to reducing their exposure to these allergens. Dust mites live in mattresses, mattress covers, pillows, blankets and sheets. Mattresses, pillows and box-springs should be encased in allergen-proof materials. Sheets should be washed at least once a week using hot water, not warm or cold. Blankets should also be washed regularly. As a means of reducing dust mites and mould allergens, use a dehumidifier. Vacuum furniture, curtains, mattresses and rugs regularly. Dust often, and clean picture frames, mirrors and windows frequently. To avoid attracting cockroaches, keep food stored in airtight containers and avoid leaving it out overnight.⁴

Hay fever and asthma are frequently treated using over-the-counter antihistamine such as Benadryl or Tavist. Sudafed is also often used to quickly relieve nasal congestion and runny nose. Those with itchy, irritated eyes may use a combination antihistamine/decongestant spray such as naphazoline. Asthma sufferers should keep an inhaler such as albuterol handy at all times. These inhalers provide immediate relief for wheezing and other asthma symptoms.⁵

Preventing skin allergies

Skin allergies and allergic skin rashes such as urticaria (hives), atopic dermatitis (eczema), and contact dermatitis are typically characterized by an itch-scratch-itch cycle. This cycle is often hard to break. The histamines released during an allergic reaction cause itching. Scratching releases more mast cells, which in turn, initiates the production of more histamines. In addition to aggravating a pre-existing itch, these new histamines can cause inflammation, aggravating a pre-existing skin rash. To prevent allergic skin rashes and to break the itch-scratch-itch cycle, patients can use antihistamines and use moisturizers such as Cetaphil, Eucerin, and Keri lotion. Prescription moisturizers are also available. Moisturizers help prevent dryness and inflammation and reduce the risk of developing cracked, inflamed skin. Dry skin may actually prompt the immune system to develop a skin rash. Antihistamines fight the symptoms of a rash and will help keep it from progressing.⁶

Patients can take further steps to combat allergic skin reactions by avoiding sudden or extreme temperatures that may dry the skin. Patients are urged to wear soft, lightweight clothing made of natural fibers that don't irritate the skin. They should also avoid harsh soaps and hot water when bathing. Milder soaps such as Dove or Cetaphil are recommended. Instead of rubbing, pat yourself dry after bathing and apply moisturizer while your skin is still slightly damp. Moisturize after hand washing and use a humidifier during the winter months to keep skin from becoming too dry.⁷

Preventing food allergies

Heredity plays a role in the development of allergies. If you have a history of food allergies, your child is at high risk of developing food allergies. Women with food allergies are strongly urged to breastfeed until their baby is at least one year old. Because allergens pass through breast milk, lactating women should avoid highly allergenic foods. If breastfeeding isn't possible, be sure to discuss alternatives (e.g., formula) with your pediatrician. Cow's milk isn't recommended for children under 1 year of age.⁸

Babies should not start on solid food until they are at least 6 months old. Introduce new foods slowly, starting with small portions and be sure to watch for any reactions in your child. Symptoms such as gas, vomiting, diarrhea, fussiness or rash may indicate an allergy. Monitor any such reactions for several days before introducing the next food. Avoid introducing egg whites or fish until your child is at least 2 years old, and avoid giving your child nuts or peanut butter until age 3.⁹

If either you or your child has food allergies, be sure to read food labels carefully. Beware of both food allergens and related food products. Ask questions when ordering in restaurants. Teach children about foods to avoid and explain why they're harmful. Be sure to educate care givers and babysitters about your child's food allergies and about what to do in the event of an emergency. Be sure cafeteria staff and your child's school nurse are aware of your child's food allergies. Explain about any special dietary needs. If your child has experienced an anaphylactic reaction in the past, discuss with your doctor or health care provider whether your child should have an EpiPen. This device contains epinephrine in a self-injectable syringe; it can save your child's life in the event of an anaphylactic reaction.¹⁰

Preventing medication allergies

If you've ever had a reaction to a particular medication, you should discuss with your doctor or health care provider whether it is an allergy. If indeed it is an allergy, be sure to tell anyone from whom you seek medical advice about your allergy. Most health practitioners ask about drug allergies, medications, and pre-existing conditions when prescribing medication to avoid contra-indications, allergic reactions, and possible harmful drug interactions. If you have allergies to multiple medications, keep a list to remind yourself of which medications you can take safely, and be sure your family members know about your drug allergies. You may also want to consider wearing a Medic Alert® bracelet or necklace. If ever you're unconscious or unable to speak, paramedics and other medical personnel will immediately know about your allergy.¹¹

Preventing insect venom allergies

If you've had a past reaction to insects and if you find nests and beehives in your yard and eaves, an exterminator can help you remove them safely. When outside, drink from a cup, rather than from a can or from a partially open container—bees and hornets can occasionally become caught inside closed containers. If you do get stung, be sure to act right away. Taking an antihistamine can reduce the chance of the sting's forming a large welt. Have Benadryl or other similar tablets or liquid on hand at all times. Taking these medications immediately after a sting will begin to dull the reaction. Be sure to consult a health care provider the same day you're stung and discuss with him or her whether you should carry an EpiPen.¹²

Allergy medications

Allergy symptoms, particularly if moderate or severe, require treatment to counteract the activity of mast cells and histamines. Mast cells release chemicals known as mediators. The best known mediator is histamine, the chemical responsible for the itchiness, swelling, and redness which often characterize allergic reactions.

Antihistamines

It follows, then, that antihistamines are central in the treatment of allergies. Typically, treatment is targeted to the site of the symptoms. For instance, allergic conjunctivitis (inflammation of the eye) is treated using eye drops to reduce inflammation, tearing, and itchiness. Skin rashes are commonly treated using corticosteroid creams applied to the skin. Allergic rhinitis and hay fever are typically treated with nasal sprays to reduce nasal itching and to relieve runny nose and congestion. Targeting the site of symptoms limits the possible side effects of allergy medications ingested by mouth.¹³

Examples of antihistamine medications include:

• Diphenhydramine such as Benadryl
• Chlorpheniramine such as Chlor-Trimeton
• Fexofenadine such as Allegra
• Loratadine such as Claritin
• Cetirizine such as Zyrtec

Common side effects of antihistamines include drowsiness and dry mouth.

Corticosteroids

The key to combatting allergic reactions is to act quickly since the body's immune system can accelerate the initial reaction to an allergen. When you suffer an allergic reaction, white blood cells known as eosinophils are attracted to the site of the reaction, causing a more intense reaction. The result is often swelling or inflammation.¹⁴ When you develop a severe reaction such as this, you need powerful treatment in the form of corticosteroids. Corticosteroids may be appied to the skin, taken orally in pill form, or injected. They work by calming the entire immune system, not just histamines. However, because of their many side effects (i.e. weakened immune system, increase in blood sugar levels, temporary psychosis), high-dose corticosteroids by mouth or injection are reserved for severe allergic reactions (anaphylaxis).¹⁵

Immunotherapy (allergy shots)

If you have moderate to severe allergy symptoms that persist throughout the year, if you suffer significant side effects from allergy medications, or if you have severe allergic reactions to insect venom or antibiotics, you and your doctor may wish to discuss immunotherapy. The purpose of immunotherapy, or allergy shots, is to teach your body's immune system to stop overreacting to allergens. Immunotherapy is designed to help reduce or eliminate chronic allergy symptoms and to prevent anaphylaxis triggered by indoor and outdoor allergens. Allergy shots are ineffective in reducing the symptoms of food allergies.¹⁶

It's believed allergy shots work by gradually stimulating production of IgG, immunoglobulins that help prevent allergens from prompting the production of IgE (see Allergies). Injection of allergens prompts the production of IgG molecules which seek them out and bind with them. As a result, IgE antibodies are unable to recognize allergens and to prompt mast cells from initiating an allergic reaction. When mast cells are prevented from producing histamines, symptoms such as swelling, itching and inflammation are significantly reduced. As a result, allergy shots can limit or even eliminate the need for allergy medications.¹⁷

Unfortuantely, allergy shots must be administered regularly over a period of a few years, and they are don't always work for everyone. It may take a few months before symptoms begin to improve. In the beginning, patients receive weekly injections of small doses of an allergen. As the body begins to recognize the allergen, the immune system doesn't produce a reaction. Over time, smaller doses of allergen are injected less frequently until eventually, you need only an monthly maintenance dose.¹⁸

After receiving an allergy shot, your doctor or allergist will want to monitor you in his or her office for 20 minutes to a half hour—to ensure you don't have a reaction. Reactions are usually simple, such as hives or irritation at the injection site. Occasionally, however, patients may have a more severe reaction such as asthma or anaphylaxis. Although rare, such reactions may be life threatening and require immediate medical attention.¹⁹

---

1. What are Allergies? Asthma and Allergy Foundation of America. (2004)
2. Prevention. Aetna™ InteliHealth® Inc. (2004)
3. What are Allergies? Asthma and Allergy Foundation of America. (2004)
4. Prevention. Aetna™ InteliHealth® Inc. (2004)
5. Prevention. Aetna™ InteliHealth® Inc. (2004)
6. Prevention. Aetna™ InteliHealth® Inc. (2004)
7. Prevention. Aetna™ InteliHealth® Inc. (2004)
8. Prevention. Aetna™ InteliHealth® Inc. (2004)
9. Prevention. Aetna™ InteliHealth® Inc. (2004)
10. Prevention. Aetna™ InteliHealth® Inc. (2004)
11. Common Allergy Medications. Aetna™ InteliHealth® Inc. (2004)
12. Common Allergy Medications. Aetna™ InteliHealth® Inc. (2004)
13. Common Allergy Medications. Aetna™ InteliHealth® Inc. (2004)
14. What Are Allergies And Who Is At Risk? Aetna™ InteliHealth® Inc. (2004)
    
15. Common Allergy Medications. Aetna™ InteliHealth® Inc. (2004)
16. Allergy Shots (Immunotherapy). Aetna™ InteliHealth® Inc. (2004)
17. Allergy Shots (Immunotherapy). Aetna™ InteliHealth® Inc. (2004)
18. Allergy Shots (Immunotherapy). Aetna™ InteliHealth® Inc. (2004)
19. Allergy Shots (Immunotherapy). Aetna™ InteliHealth® Inc. (2004)