Control versus cure
There is no real “cure” for allergies after diagnosis; so control is the next line of defense. Avoidance is certainly the first step, but this is not always possible. While one can avoid taking a specific medication, how do we avoid pollen or dust, and yet still live a normal life? Treatment, therefore, aims at achieving a certain balance: avoid or minimize contact and treat symptoms with the least potent yet most effective medication. For some individuals, immunotherapy (see below) can make a tremendous difference in their body’s sensitivity to a specific allergen.
Dust Mite Control
While it is not possible to completely eliminate dust mites, the following measures can substantially reduce them. Dust mites love fabric; so minimize upholstery, carpeting, bedding and/or make sure that what you have is washable (and that you wash it often). Choose hardwood floors over wall-to-wall carpeting. Eliminate scatter rugs (they are also a safety/slipping hazard). Those kept should be washable. Dust before vacuuming. Use washable curtains and shades, not blinds (they collect too much dust). Check with your allergist about room/home filters (especially the HEPA, or high energy particulate air filter). Avoid upholstered furniture; when possible, choose wood furniture instead. Go with simple, rather than ornate designs where dust can collect. Wear a dust mask when cleaning, or better yet, have someone else do the dusting and vacuuming. Encase pillows and mattresses in plastic slipcovers, taping over the zipper. Limit bric-a-brac, especially in the bedroom — keep surfaces clear of clutter. Choose bookcases with doors. For children with allergies, keep toys in covered see-through plastic containers on shelves when not in use.
In the summer, avoid fans (which stir up the dust, and bring allergens in from the outside) and choose air conditioners instead. With forced air vents, use a filter, or cover the vent with cheesecloth, and remove and wash it frequently. Clean all filters frequently. Clean all air ducts yearly.
The fine, dust-like quality of pollen makes it difficult to see. Limit outdoor activity to times of lower pollen counts when possible. Wash hands after petting animals that have been outside — pollen settles on their coat. Shower and shampoo hair after being outside to rid hair and skin of pollen. Change into fresh clothing, and wash clothing that has been outside. Try to separate “indoor” shoes from “outdoor” shoes, to limit trekking the pollen throughout the house. Use air conditioners, not fans, in warm weather to avoid bringing in the “outside” air.
Antihistamines and decongestants are the two main allergy medication categories. Antihistamines block the action of histamine, the substance released when mast cells recognize the presence of allergens. Antihistamines relieve redness, inflammation, itchiness and watery eyes. Most antihistamines also have a sedating effect — they make you sleepy. Non-sedating ones are available, most by prescription. A dry mouth is also a common side effect. Ophthalmic solutions can relieve red, irritated eyes. It helps to have liquid antihistamines as well as those in pill/capsule form, as they are more easily swallowed during a stronger allergic reaction.
Decongestants reduce nasal congestion by constricting blood vessels. Nasal sprays work more rapidly than oral decongestants, but “rebound” is also quite common. After a few days of taking nasal decongestants, there is a “rebound effect” in which the congestion that had cleared comes back. More medication only makes the congestion worse. Discuss this side effect with your physician to understand how to limit the amount of medication you use.
Bronchodilators widen the bronchial tubes in the lungs. They are used to decreased allergy symptoms such as coughing, wheezing and shortness of breath. Agitation is a common side effect.
Steriodal medications in oral or inhaled nasal forms are used to decrease inflammation. Nasal steriods are more effective than oral forms. Long-term use (more than one week) needs to be carefully monitored by a physician, because of potential systemic side effects. Low dose topical steroid medications are used for rashes.
Certain sufferers of allergic asthma cannot easily control symptoms by avoiding triggers and using medication. In these cases, immunotherapy (allergy desensitization shots) may offer relief and even help prevent development of airway inflammation and the resulting chronic airway sensitivity.
According to the American Academy of Allergy, Asthma and Immunology (AAAAI), allergen immunology works like a vaccination. Through exposure to small, injected amounts of a particular allergen in gradually increasing doses, your body builds up immunity to the allergen(s) that trigger an allergic reaction. This means that when you encounter these allergens in the future, you will have a reduced or very minor allergic response and fewer symptoms.
Immunotherapy appears to work best for allergies to pollen, mold, cat dander, insect stings and dust mites. According to the AAAAI, potential side effects during treatment may include swelling at the site of the infection and in rare instances a more serious allergic reaction, resulting in asthma symptoms or an anaphylactic reaction. Asthma symptoms include cough, wheezing and shortness of breath. Symptoms of an anaphylactic reaction can include hives, sneezing, watery nasal discharge, itchy eyes, swelling in the throat, wheezing or a sensation of tightness in the chest, nausea, dizziness or other symptoms.
Immunotherapy, also known as allergy shots, involves injecting small doses of the allergic substance to help build the production of antibodies, thereby strengthening the resistance against the allergen. This approach has been helpful for pollens, molds, mites, insects and animal dander. A schedule is prepared by the physician of weekly shots, increasing gradually the strength of the allergen injected, based on the previous week’s response. Patients are asked to wait about 20 to 30 minutes after the injection to make sure there are no adverse effects. The site is inspected after the waiting period, with any redness, bumps or swelling noted. The area affected is measured and the next dose is based on those results.
For patients with multiple allergies, several shots can be given, following the same procedure. Very fine needles are used for the injections, and the needle only goes just below the skin’s surface. While the needle rarely causes discomfort, the solution being injected can be irritating and cause itchiness or a stronger reaction. An allergist may prescribe immunotherapy for children to be administered in the pediatrician’s office. In that case, the office personnel should have CPR training and be equipped to handle rare, severe reactions.