Living with Allergies

The goal of treatment is to reduce the symptoms associated with allergic rhinitis.  The simplest way to accomplish this is to avoid the triggers that are known to cause your allergy symptoms.  Although this approach to allergy management appears basic on the surface, in reality it is nearly impossible to completely avoid all allergens that can trigger your allergies. 
Even though it is difficult to completely avoid all allergens that could trigger your allergies, steps can be taken to reduce the chances of having an allergy “flare-up” (known as an exacerbation).  The first thing that can be done that can assist you in allergen avoidance is finding out exactly which allergens cause your disease.  Your physician can perform a technique known as skin-prick test to assist in the identification of the allergen triggers you are sensitive to.  Skin testing involves placing a small amount of liquid containing a specific allergen on the skin and then scratching it into the skin surface to observe whether redness and swelling occurs [Sanico and Valentine, 2003].
Once you have identified the triggers that are responsible for your disease, ways to reduce your symptoms may include: limiting your time outdoors when pollen counts are high, closing windows, or using air conditioning.  Additionally, frequent dusting and vacuuming of the home, avoiding contact with animals, or frequent grooming of your house pets, may also aid in reducing your allergy symptoms.

Treating Your Allergies

Since it is often difficult to avoid allergen triggers during normal daily activities, pharmacologic management is the mainstay in the treatment of allergic rhinitis.  Pharmacologic management of allergic rhinitis can be accomplished with both over-the-counter as well as prescription medications.  The most commonly used drugs to treat allergic rhinitis are antihistamines (oral and intranasal), decongestants, corticosteroid sprays, leukotriene modifiers, and cromolyn nasal sprays. The most appropriate medication depends on the type and severity of symptoms and should be identified with the help of your physician.

  • Topical Corticosteroids:

These are prescription drugs that are customarily administered in the form of nasal sprays.  These agents are generally considered to be the most effective form of treatment for nasal allergy symptoms and hence are indicated as first line therapy for moderate-to-severe allergic rhinitis [Plaut and Valentine, 2005].  They reduce local inflammation in the nose and thus most nasal allergy symptoms.  These drugs are more effective than antihistamine sprays in relieving nasal congestion and sneezing.  Nasal corticosteroids have relatively few side effects, the most common of which is mild nasal bleeding and are generally considered safe when used at the recommended doses. [Willsie, 2002].

  • Antihistamines:

These medications substantially reduce symptoms of nasal itching and watery eyes as well as moderately relieving sneezing and runny nose. They have little effect on nasal congestion, and may cause drowsiness depending on the type of antihistamine.  Antihistamines are usually classified as either short acting or long acting and are available orally or intranasal sprays [Plaut and Valentine, 2005].

  • Oral Antihistamines:

Short acting antihistamines: These agents are readily available as over-the-counter (non-prescription) preparations. These agents are effective in providing relief for mild to moderate symptoms of allergic rhinitis.  However, with the possible exception of loratadine (Claritin®), they also cause drowsiness thereby impairing one’s ability to perform some tasks such as driving or operating machinery, and may impact learning in children [Kay, 2001].
Long acting antihistamines:These types of antihistamines are usually available only by  prescription. Although they have similar efficacy to the non-prescription antihistamines, they are usually more helpful by virtue of their longer duration of action.   Additionally these medications cause less drowsiness and would not be expected to interfere with learning compared to the short acting antihistamines [Plaut and Valentine, 2005].
Intranasal antihistamines:  These antihistamines are typically prescription medications and usually require administration twice to several times daily. These medications relieve nasal symptoms such as itching, runny nose, and sneezing but may be less useful against nasal congestion.  These agents typically have a bad aftertaste and may cause drowsiness in some individuals [Quraishi, 2004].

  • Decongestants: 

Decongestants constrict small blood vessels that have become swollen in response to circulating histamine. There are both oral and intranasal preparations available.  The use of intranasal decongestants should be limited to only a few consecutive days of use since longer administration can result in loss of effectiveness and “rebound” swelling/congestion of nasal tissue.  Oral forms of these agents can act as stimulants and have also been associated with increased blood pressure and heart rate as well as headache  [Willsie, 2002].

  • Leukotriene modifiers:

Leukotrienes are substances that, like histamine, can trigger the symptoms of allergy. Montelukast (Singulair®) is a prescription medicine approved to help relieve the symptoms of seasonal and perennial allergies. This leukotriene inhibitor represents the first member of a new class of anti-inflammatory medications.  It is conveniently taken in pill form and stops inflammation by blocking the location on the cell where leukotrienes work.  The medication usually begins to work within 1-2 days and has minimal side effects [Quraishi, 2004].

  • Cromolyn Nasal Sprays:

Cromlyn acts to prevent the release of histamine and other harmful chemical substances from mast cells.  It can act as a preventive form of treatment if begun several weeks before the beginning of the allergy season and has also been found useful to manage symptoms when administered several hours prior to an anticipated exposure to a known trigger such as a cat or dog.  These agents are usually well tolerated and the most common side effects are local: sneezing and nasal burning [Willsie, 2002].

  • Immunotherapy:

Immunotherapy, or allergy shots, may also be used to treat allergic rhinitis however this treatment usually take months or years to become fully effective and thus are usually reserved for patients that have severe allergies and are poorly controlled on prescription medications.