Which Allergy Treatment is Best for You?

There are a lot of options for treating your allergies but only immunotherapy can keep your symptoms from returning.

Fall is hay fever season so there is a good chance you are experiencing some allergy symptoms. After all, over a quarter of Americans suffer from significant allergies. And for many, the symptoms begin in adulthood. So the question is, what should you do about them? To a large degree, that depends on their severity and your tolerance for discomfort.

Officially, the first course of action is avoidance, which means keeping away from your allergy triggers. In theory that makes sense but it’s often undesirable and all but impossible. For instance, say you’re allergic to the family pet. Are you going to get rid of it even though everyone in the family — including you — loves it? Now consider tree, weed and grass pollen. Even if you move far away from the source of the pollen that’s bothering you, a good stiff breeze will send it flying right to you — tree pollens travel hundreds of miles. 

When symptoms start, a majority of people turn to the next courses of action: over-the-counter medications and natural remedies, including nasal irrigation products. Sometimes these measures work very well at relieving symptoms short term. The key here is “short term.” What these products do is overcome your current reaction to allergens. That’s great if you get occasional and/or mild symptoms. There are two “howevers,” though.

The first is the side effect “price tag.” Medications often cause side effects, like drowsiness, that can significant reduce your productivity. And they may not work right away, if at all; doctors now recommend you start taking medications weeks before your symptoms normally start for maximum effectiveness. Even if you do that, the only potential benefit is symptom relief. So you are supposed to take meds in anticipation of symptoms you don’t have yet just to get temporary relief from this year’s onslaught.

The second “however” is even bigger. Let’s say, best case scenario, the medication or natural remedy overcomes your symptoms today. Excellent. But tomorrow when you encounter your allergy trigger — be it pollen, pet dander, mold, etc. — the symptoms start up all over again. You’ll be taking the medication, or using the remedy, for the rest of your life. That’s a lifelong commitment to meds.

There is another option: immunotherapy. This natural treatment exposes your immune system to small amounts of the pollen — or other allergens that your body thinks are enemies — until your immune system learns to accept those allergens as normal. When the body stops trying to fight them off, your allergy symptoms decline and often disappear. In other words, immunotherapy actually makes you better. Every day on immunotherapy is a step towards an allergy-free life.

Immunotherapy doesn’t work overnight. It typically takes a few weeks to two months for treatment to start working. For best long term results, you should continue treatment for three to five years. There are three types of immunotherapy: allergy drops, allergy shots and tablets.

Allergy drops have been popular throughout the world for over 60 years. In the comfort of your home, you simply place a few drops of serum (which is composed of the allergens that trigger your symptoms) under your tongue every day. The drops are convenient, easy, safe, nearly side-effect-free and suitable for allergy sufferers of all ages. The best drops formulations are ones that are designed specifically for you. You start with a low dose and ramp up to a higher dose when your body is ready.

Allergy Shots have been used successfully in the U.S. for decades. Healthcare providers administer the shots to you in their offices on a regular basis, often weekly or bi-weekly. Health insurance policies usually cover many of the out-of-pocket costs associated with allergy shots. Both shots and drops can be formulated to address multiple allergies at once. So, for instance, if you’re allergic to cat dander and tree pollen, you can be treated for both at the same time. Like drops, shots start at a low dose and ramp up.

Tablets are a new form of immunotherapy. Each one is made to combat a single allergen. Unfortunately, most people are allergic to more than one thing. But the companies that makes these tablets have targeted the most severe allergens, like ragweed and grass pollen. Tablets start at full dose, so you get a large amount of allergen under your tongue from day one, ready or not.

So which sounds right for you? If you’re symptoms are mild and very sporadic, and over the counter medications do a good job of hiding them for you without too many side effects, you may choose to go that route. But if they’re more severe, you’re tired of the recurring battle with symptoms, you have side effects with the drugs, or you just don’t want to take medication for the rest of your life, immunotherapy might be your best bet. Either way, you should ask your doctor for an allergy evaluation. You should always be armed with information and a definite diagnosis of allergies before taking even the stuff you can buy over the counter.  Once you have answers about the cause, you and your doctor can discuss the right treatment.

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Anaphylaxis, The True Allergic Emergency – What You Need to Know

Anaphylaxis, which comes from the Greek term “reverse protection,” is the most

There are many possible signs of anaphylaxis…

dangerous type of allergic reaction. It is described as a type 1 Hypersensitivity reaction that involves release of IgE triggered, most often, by a food, medication or insect sting. Anaphylaxis is a frightening reaction where a patient, who moments before appeared fine and healthy, almost within seconds can be wheezing, hypotensive, and covered with hives.

The foods most commonly associated with anaphylaxis in children are peanuts and tree nuts; in their adult counterparts it’s usually shellfish. The confusing part for patients and clinicians is that a food allergy can develop after eating a particular food on many occasions. However, once that threshold has been crossed, even a minute amount of that food can cause an explosive reaction. If a food is the suspected cause of anaphylaxis, but the specific food unclear, it’s wise to evaluate the patient through several steps.

Initially, I would recommend a panel of food allergy blood tests. ImmunoCap is a common one used by most labs to evaluate IgE reactions to specific foods. The results range from zero to six, with a score of at least two indicating a positive reaction. If there is a positive reaction to peanut, the allergy should be further explored by ordering a UKnow Peanut test which analyzes the proteins Ara h1,2&3, as well as Ara h8. My article in Consultant for Pediatricians, “Pinpointing the Proteins in Peanut Allergy,” explains why these proteins are important to predict the severity of peanut allergy. If, for some reason, the blood test is negative, I would recommend referral to an allergist for skin testing and/or oral challenge in case there is a hidden allergen that requires more extensive testing.

Any medication can cause an anaphylactic reaction however the common culprits are antibiotics and non-steroidal anti-inflammatory drugs. Many antibiotics are mold-based, which may be part of the reason for their allergenicity. In the past, beta-lactam antibiotics such as penicillin and related cephalosporins were the most likely offenders but today we also see anaphylaxis to the widely used category of quinolone antibiotics. To complicate matters, it is not unusual for a patient to have multiple antibiotic sensitivities; there is a genetic component to this reaction. While Pre Pen can be used to diagnose penicillin allergy (talk to your AllerVision representative for more information), there is no such test for most antibiotics, and a drug challenge may be required for conclusive diagnosis.

Non-steroidal medications, such as Advil, Motrin and Alleve, work by blocking the cyclo-oxygenase pathway and trigger release of leukotrienes which are potent mediators of anaphylaxis. In my experience, patients allergic to NSAIDS are usually unaware of the source of reaction until they suffer several episodes of anaphylaxis. Be on high alert for NSAID hypersensitivity when evaluating a patient for anaphylaxis or urticaria. Unfortunately, a drug challenge is the only conclusive test NSAID hypersensitivity.

The clinical diagnosis of anaphylaxis can be complicated. The World Allergy Organization recently came out with new criteria. Essentially, it includes exposure to a possible or known allergen and the finding of two or more clinical signs: urticarial, bronchospasm, gastrointestinal distress and cardiovascular collapse. In case of cardiovascular collapse, no additional signs are needed — call 911 and immediately transport the patient to the hospital.

While anaphylaxis is fairly rare with allergy injections, and exceedingly rare with allergy skin testing, it is important that you and your staff be prepared just in case. When a patient is in your office, the question of whether or not to treat a potential reaction is simplified, and doesn’t include an extensive review of the clinical findings nor consideration about number of signs. If you place an allergenic substance on the patient’s skin, or inject them with a substance you know they are allergic to, and they have a reaction anywhere other than the local site of exposure, TREAT THEM! Common signs to look out for are itching of hands and feet, or clearing of throat that wasn’t happening when the patient came in to the office. If you apply antigen to one area of the body, and the patient has symptoms somewhere else, you have to assume that the reaction has gone systemic and you should treat accordingly.

The initial treatment of anaphylaxis is unambiguous: epinephrine intramuscularly into the lateral thigh. Don’t play around with Benedryl! Don’t give a cortisone shot! Anaphylaxis progresses immediately, and neither antihistamine nor steroid drugs act on the spot to reverse the severe pathophysiological reaction. Deaths resulting from anaphylaxis happen when epinephrine is not administered in under 3o minutes from the onset of symptoms. If you are giving allergy injections in your office, you MUST have the patient wait 20 minutes in the office to make sure they don’t have an immediate allergic reaction. If they develop ANY sign or symptom within that time, administer epinephrine. The EpiPen is convenient for an office because it contains the 0.3 ml of epinephrine with the needle size for an intramuscular injection. It also comes as the EpiPen Jr. for children or infants less than 66 lbs. Once epinephrine has been given, the patient must be monitored for several hours to make sure there isn’t a biphasic reaction; this usually takes place in a hospital.

Anaphylaxis can be the most frightening of clinical reactions. The good news is with quick recognition and prompt treatment with epinephrine, you can be a real hero!

– Dr. Dean Mitchell