Allergy: Medical Management

Allergies can usually be taken care of at home, but in some cases it requires professional help...

Posted by Admin on 13 March 2020

Allergies can usually be taken care of at home, but in some cases it requires professional help. If allergies cause you to wheeze, breathing problems, or generalized edema, you should see an allergist to avoid self administration of inappropriate medications or remedies.

With the advent of technology and evidenced-based research comes along the development of better and wider variety of treatments with lesser adverse reactions—antihistamines with less potential for drowsiness, allergy injections providing immunity to a specific allergen and so on. But medical management depends on a number of factors: the severity of reaction, the offending agent, and even the time elapsed. However, generally, the main goal of treatment is to relieve the symptoms and prevent life-threatening complications. Therapy may include one or more of the following interventions:

Pharmacologic Therapy

Antihistamines

Mast cells are located in the skin and mucous membranes. When mast cells are stimulated by allergens, powerful chemicals are released resulting into a series of events and eventually causing symptoms of hypersensitivity. To be exact, one of those chemicals is histamine. In order to produce symptoms of hypersensitivity, histamine binds to H1 receptors that are predominantly found in the skin, blood vessel and airway linings. As a result, it causes redness, itching, increased permeability of blood vessels leading to localized leakage of fluid (hives), increased mucus secretions, and narrowing of the airways.

Antihistamines are the major class of medications used in managing mild allergic disorders. These drugs bind specifically to H1 receptors, thereby preventing the action of histamine.

First-generation antihistamines are widely available and economical. However, adverse drug reactions are more common in this class.

  • Diphenhydramine (Benadryl)
  • Hydroxyzine (Atarax)
  • Chlorpheniramine (Chlor-Trimeton)
  • Promethazine (Phenergan)

Newer generations are called second-generation or non-sedating antihistamines.

  • Loratadine (Claritin)
  • Cetirizine (Zyrtec)
  • Ofenadine (Allegra) –third generation

Side effects include nervousness, tremors, dizziness, dry mouth, palpitations, anorexia, nausea and vomiting. The major side effect is sedation, although newer generations are less associated with such side effects.

Oral forms of the drug are given at the first appearance of symptoms so that they can prevent the development of new symptoms by countering the effects of histamine. They are however, contraindicated for pregnant and lactating women, newborns, children, and elderly. There are also certain disease conditions that are aggravated by taking antihistamines. Therefore, one should take cautionary measures and consult a doctor.

Adrenergic Agents

For allergies, adrenergics causes constriction of mucous membranes, which in turn relieves pressure and promoted drainage of the nasal passages. Potential side effects include increased blood pressure, palpitations, irritability, restlessness, and tremors.

Topical forms cause fewer side effects than oral administration; however the use of drops and sprays should be limited to a few days to avoid rebound congestion. The following are examples of adrenergic agents:

  • Phenylephrine
  • Naphazoline
  • Tetrahydrozoline
  • Pseudoephedrine

Epinephrine (EpiPen, Adrenalin)

Synthetic epinephrine provides relief from respiratory distress from asthma attacks or even anaphylactic shock. It is administered in very small amounts by injecting subcutaneously (beneath the skin), usually in the upper extremity or thigh.

Mast Cell Stabilizers

These class of drugs acts by inhibiting the release of histamine, which can cause an allergic reaction. Its most common side effects is coughing and sneezing which are mild.

Cromolyn is a mast cell stabilizer that is used before exposure to allergens to prevent the onset of symptoms and treat them once they occur. This is used for chronic allergic rhinitis and is administered by inhalation. However, the effects may take a week or so to occur.

Corticosteroids

Corticosteroids are used because of their anti-inflammatory actions that can relieve major symptoms of allergic reactions. These medications include beclomethasone, dexamethasone, fluticasone, and triamcinolone. They are administered via inhalation, and full benefits may not be achieved for several days to 2 weeks. Because of this, they have little or no value in acute therapy for sever reactions such as anaphylaxis.

Corticosteroids suppress host defenses, so they must be used in caution in patients at risk for infection.

Immunotherapy

Allergen desensitization or immunotherapy consists of administering increasing concentrations of allergen over a long period. Specifically, extracts of the offending agents are injected in very small concentrations and increased, usually at weekly intervals, until a maximum tolerated dose is achieved. This eventually reduces the symptoms of hypersensitivity.

Any recipient of immunotherapy is at risk for developing anaphylaxis, and therefore, the procedure is performed usually at a physician’s clinic.

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