PRINCIPLES OF MANAGEMENT OF ALLERGIC DISORDERS

You or your child has an allergic disorder.  To help you make an informed decision which best fits your health needs, what follows is a discussion of the basics of treating these disorders.

Three methods for treating allergies are avoidance, medications, and immunotherapy.

Avoidance of things to which you are allergic is the most logical way to control your symptoms, and is most useful for some animal and food allergies.  Avoidance is not particularly helpful for allergies to pollens, mold, dust, and stinging insects.  Unfortunately, avoidance is often relative and not absolute, for it is difficult to avoid Grandmother’s cat!  In situations like these, taking anti-allergic medication before exposure might prove sufficient.

The second approach includes medications which are available in several forms.  The most commonly used are the antihistamines.  There are many different types available at your pharmacy which can be purchased without a prescription.  All of these are members of the first-generation class of antihistamines, which may cause drowsiness.  The prescription antihistamines offer much more flexibility because they are available in several chemical forms which give us the option of trying drugs from different classes, and thus with different side effects.  The most common side effect associated with antihistamine usage is drowsiness.  These medications may be taken on an as needed basis or regularly each day.  Some of the new preparations, the so-called second-generation antihistamines don’t cause drowsiness.

Another class of medicines, the anti-inflammatory drugs, include cromolyn and the steroids.  Cromolyn is now available without prescription under the trade name of Nasalcrom and is a spray applied to the nasal passages three to four
times each day to help prevent the release of chemical mediators from the Mast (allergy) cell and thus minimize your allergy symptoms.  The other group of medicines in this category are the steroids which are the most effective anti-inflammatory drugs we use.  There is much misunderstanding about this class of
medication.  They can be used orally for a few days, with complete safety, or applied to the nasal passages in the form of a spray for extended periods of time with equal safety.  By reducing inflammation, steroids decrease allergy symptoms.  Both cromolyn and steroids are preventative medications and must be given on a regular basis to be effective.  Sporadic use is not effective and is a waste of money.

The third approach is immunotherapy, or allergy shots, which is the most definitive and long-term solution to treating allergic disease.  Immunotherapy is reserved for patients in whom avoidance and medications have not proven effective, or in patients who experience unacceptable side effects to medications.  Studies have shown that, in the properly chosen patient, immunotherapy is effective in 94% of the cases, with patients describing significant and substantial improvement within six to eight months of starting therapy. Please refer to the immunotherapy packet for more information.