ALLERGIES RESULT from the immune system's over-reaction to a foreign substance. Most allergies are due to a combination of
genetic factors and environmental exposures. The first step in coping with allergies is to reduce exposure to triggers.
"For outdoor allergens, the most important things are to stay indoors during the times when pollen counts are highest, and
to keep windows closed both at home and in the car," says Andy Nish, MD, president of the Allergy and Asthma Care Center in
Gainesville, Ga. "If someone has been outdoors for a long period of time, they might consider washing their hair and changing
their clothes when they come indoors."
Neeta Ogden, MD, a solo practitioner in Closter, New Jersey who specializes in allergy, asthma and immunology, notes that
pollen counts are usually highest in the early morning and early evenings, though it varies depending on the specific pollen.
She encouragers her patients to go online and sign up for a local pollen report they can receive via email.
In addition to outdoor triggers, many people are sensitive to allergens inside the home, such as dust mites, pets who release
dander, and molds, and these allergens tend to be present year-round. Dr. Nish recommends zip-up covers for mattress and pillows
and washing blankets in hot water to reduce exposure to dust mites. Pet dander can remain in a home for months. "It can be helpful to reduce dust-catchers and eliminate carpet, particularly in the bedroom," he says. "If someone is allergic
to an indoor pet, we encourage them to consider finding the pet a new home."
Antihistamines are typically used to treat allergies, since they relieve the irritating sneezing, itching, and runny nose
and may help reduce congestion.
"First-generation antihistamines such as Benadryl [diphenhydramine] or Chlor-Trimeton [chlorpheniramine] and others are inexpensive,
but even in usual doses they may cause somnolence, interfere with learning and memory, decrease work productivity, impair
performance, and increase the risk of on-the-job injuries," says Mark Abramowicz, MD, editor-in-chief of The Medical Letter on Drugs and Therapeutics, a non-profit newsletter that critically appraises drugs.
SECOND GENERATION ANTIHISTAMINES
The second generation of antihistamines, also called "non-sedating" antihistamines, generally doesn't have these side-effects,
because they do not cross the blood-brain barrier. Some of them, such as Claritin, Zyrtec, and Allegra, are now available
as generics. Claritin and Zyrtec, are available over-the-counter.
"Claritin (loratadine) and Clarinex (desloratadine) are nonsedating in recommended doses, but sedation may occur with higher
doses," says Dr. Abramowicz. "Allegra (fexofenadine) is free of sedative effects, even in higher-than-recommended doses, while
Zyrtec (cetirizine) is potentially more sedating than some other second-generation agents."
SHOTS EFFECTIVE FOR SEVERE ALLERGIES
Some Oral Drugs for Allergic Rhintis
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"Allergen-specific immunotherapy involving injection of gradually increasing doses of the causative allergen [also called
'allergy shots'] is effective in allergic rhinitis and allergic conjunctivitis [and in allergic asthma]," says Dr. Abramowicz.
"Standard subcutaneous allergen immunotherapy is limited by the potential for adverse effects, including anaphylaxis, and
the requirement for regular—usually monthly—maintenance dosing for several years, but the benefits can persist for years after
treatment is stopped."
According to Dr. Ogden, allergy shots are appropriate for people for whom medications no longer work, who have relatively
severe symptoms.
"The schedule is variable because we have to monitor each patient closely and see how they react, but for a patient with no
complications, it would typically be one shot a week for six months, then two shots a month, and after about a year only one
shot per month." Typically a patient continues receiving allergy shots for three to five years. "In my experience, the shots
are helpful and effective," Dr. Ogden says. "After the full series, hopefully the allergies will have gone away, and I do
see that in many of my patients."
Elaine Zablocki has been reporting on healthcare for more than 20 years.
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