We all know how debilitating allergies can be. Up to 60% of people in the UK are affected by some kind of allergy. This could be something minor like a mild allergic rhinitis to pollen, or something more severe such as a nut allergy causing anaphylaxis. Understanding the root cause of these allergic reactions through accurate allergy testing is the first step toward effective management and even treatment.
Although allergies are usually managed by avoiding the allergen or symptomatic relief, advancements in medical science have improved the options. For example, immunotherapy for allergies is now a very viable treatment option that can greatly alleviate your symptoms, thus increasing your quality of life.
Let’s first take a look at the traditional medication, and then we will move on to talking about immunotherapy in more depth.
Traditional Allergy Medications
Antihistamines are the cornerstone of allergy medication. They date back to 1937 when the first antihistamine was invented. As the name suggests, they block histamine, a substance your body makes during an allergic reaction. Available in pills, syrups, eye drops and nasal sprays, they can relieve sneezing, itching, runny nose, and hives.
Common examples of antihistamines in the UK (and abroad) include Cetirizine, Loratadine, and Fexofenadine. The brand names will differ from country to country, but the active substances will be the same. In fact, the composition is the same between a generic £3 antihistamine and the branded ones that can be up to 4 times more expensive. Here’s an example:
While highly effective, some older antihistamines such as Chlorphenamine, may cause drowsiness.
Decongestants help relieve nasal congestion and are often used in combination with antihistamines for comprehensive allergy relief. They come in oral forms, such as pseudoephedrine, and nasal sprays containing Xytometazoline or other similar substances.
The important bit to remember with nasal decongestants it to only use them a few days at a time (3-4 days) to avoid rebound congestion.
Nasal steroid sprays
Nasal corticosteroid sprays are considered one of the most effective treatments for allergic rhinitis.
They reduce inflammation inside the nasal passages and thus improve symptoms like nasal congestion, sneezing, and runny nose.
Fluticasone, budesonide, and triamcinolone are examples of widely used nasal corticosteroids. The majority can be bought over the counter from pharmacies or supermarkets. The more potent ones may require a prescription.
While not as commonly used, Montelukast is an example of a leukotriene receptor antagonist that helps manage both asthma and allergic rhinitis symptoms. This is more often used in the treatment for asthma, but can also be used by a specialist to treat persistent urticaria that hasn’t responded to other medication.
Immunotherapy for Allergies
Allergy Immunotherapy, also known as allergy shots, is a long-term treatment option that can significantly reduce or even eliminate the symptoms of allergic reactions. This treatment is especially beneficial for individuals suffering from severe allergies or those who cannot find relief through traditional medications.
The immunotherapy is available in two forms, allergy shots or sublingual tablets. The availability depends on what allergy you are trying to treat.
How does immunotherapy work?
Whether you go for the immunotherapy injections or sublignual tablets, the mechanism is similar. Small amounts of allergen are inserted into the body at regular intervals. The goal is to desensitize the immune system to the allergen over time, reducing the severity of the reaction or potentially preventing allergic reactions altogether.
The process is divided into two phases: the build-up phase, where the allergen dose is gradually increased over 3 to 6 months, and the maintenance phase, where a consistent dose is administered typically over 3 to 5 years.
The total duration of allergy immunotherapy can vary depending on the indication. In the long term, many individuals experience long-lasting relief even after the treatment has concluded.
Immunotherapy risks and success rates
While allergy shots are effective and have been widely studied, they carry the risk of allergic reactions, ranging from mild to severe.
Their administration must always be done by a healthcare professional in an environment that can deal with medical emergencies, should they arise.
Success rates vary, but many patients experience substantial improvement in their allergy symptoms and a reduced need for medication.
Alternative treatments for allergies
Some individuals may prefer to seek alternative treatments for their allergies.
These options may be preferred by those looking for natural remedies or those who have already tried the conventional treatments mentioned above, and they haven’t worked.
While the evidence for these is limited and non-conclusive, I thought they’d be worth mentioning:
- Herbal remedies
- Acupuncture: Clinical trials have shown mixed results, but some patients report improvement in their symptoms without the side effects associated with medications.
- Probiotics: Emerging research suggests that the balance of bacteria in the gut can influence allergic responses. Taking probiotics to alter the gut microbiota has been explored as a way to manage allergies, though more research is required to establish effective treatments.
Lifestyle changes to manage allergies
Managing your environment can make a huge difference in your symptoms. You may need to adjust your daily habits and the work and sleeping environment to minimise exposure to allergens. Here are a few practical lifestyle changes that may help reduce your allergy symptoms. I am mainly focusing on the reduction of allergies caused by aeroallergens such as pollen, dust, mould, cat and dog dander, and so on. These are the most common and also the most challenging to avoid.
I have further split these lifestyle modifications into three categories:
- Reduction of exposure to Indoor Allergens
- Reduction of exposure to Outdoor Allergens
- Managing Pet Allergies
Reduction of exposure to Indoor Allergens
- Keep the house clean: Use a vacuum with a HEPA filter regularly and dust with a damp cloth to reduce dust mites and pet dander. If you notice any mould building up behind furniture, walls or around the windows, ensure you clean this professionally. Mould can return, especially if the underlying problem is not fixed and if indoor humidity is too high. This brings us to the next point.
- Control indoor humidity: Keep humidity levels below 50% to inhibit mold growth and dust mites. Both of these aeroallergens love high humidity environments, which unfortunately can be very common, especially in the winter months.
- Use air purifiers: Air purifiers with HEPA filters can remove some of the airborne allergens from indoor environments.
Reduction of exposure to Outdoor Allergens
- Avoid high pollen days: You can find out what the pollen count is today by entering your postcode into our pollen tracker. This can help you plan your day by staying indoors and keeping windows closed during high pollen days.
- Wear protective gear: If you do have to venture out, sunglasses and hats can help keep pollen out of your eyes and hair. Consider changing clothes and showering after being outdoors to remove pollen.
Manage pet allergies
- Pet free zones: It can be tricky to live with a pet if you are allergic to them. If you are getting a lot of allergy symptoms at night for example, you could try turning your bedroom into a pet free room. This would reduce the amount of cat or dog dander that is present in the air, carpet, mattress or bedding. This is vital if you have a dog allergy or if you are allergic to cats.
- Regular pet grooming: Bathing and grooming your pets regularly can reduce the amount of dander that sheds into the air.
In conclusion, we know that allergies can significantly impact our daily life. With the right combination of treatments, lifestyle adjustments, and professional guidance, individuals can manage their symptoms effectively.
Whether through traditional medications, immunotherapy, alternative treatments, or making informed changes to daily routines, there are numerous strategies available to improve our quality of life if we are affected by allergies. While the first step of managing your allergy effectively is to get tested, long term management is also important. Working closely with an allergist can provide a personalised and effective approach to allergy management, ensuring long-term relief and well-being.