Treatment of allergy by the modern system of medicine involves a systematic and multifaceted approach. It varies according to the type of allergy as well as the individual involved and severity of the disease. For a better understanding of the treatment, the following measures can be outlined:-
□ Preventive aspects of treatment
□ Anti-allergic medicines
□ Steroids
□ Allergy injections
Preventive Measures
As the old saying goes “Prevention is better than cure”, the best form of treatment of allergy is to “nip it in the bud”. This form of treatment involves avoidance of the allergens which are responsible for causing allergy. This is a very effective, economical and safe form of management with no adverse effects of medications. For this, allergy testing should be performed first to confirm the suspected allergens. Once the allergens are identified, the following measures can be taken for the prevention of further episodes of allergy.
□ Those who are allergic to plant pollens or seasonal moulds should avoid outdoor activity during peak pollen hours, i.e., late mornings to early afternoons (11 a.m to 3 p.m). In Indian conditions hot, humid and windy days are bad for people with dust allergy.
□ For those who are allergic to grass pollens, wearing a surgical type mask while mowing the lawn or gardening may help in averting symptoms of allergy.
□ Keeping the windows closed throughout the day and using an airconditioner can prevent airborne pollens from entering indoors.
□ To prevent house dust-mite allergy, specially constructed pillow, mattress and box-spring covers made of fabrics or plastics that act as a barrier for allergens should be used.
□ All sheets, mattress pads, pillow cases and blankets should be washed every week in hot water to kill the dust mites.
□ The carpets may be removed or treated with tannic acid spray or vacuumed frequently with vacuum cleaners with attached filters.
□ For prevention of pet allergy, the animal should be kept outside the house and the carpet and all rooms should be thoroughly cleaned.
□ To avoid presence of indoor fungi and moulds like Aspergillus, Penicillium and Alternaria, leaky roofs, ceilings, flooded basements and damaged plumbing should be repaired. Dehumidifiers are also useful.
□ Extermination of household pests like cockroaches, mosquitoes, houseflies, rats, etc., is essential. Traps, bait and hygiene control are necessary but sprays may aggravate asthma.
□ The mainstay of treatment of skin, insect, drug and food allergy is discontinuation of contact with the offending agent. Thus, the identification and avoidance of the allergic substance remains the key to resolve the problem. Careful education should be provided regarding sources of the allergen and how to avoid it.
□ Educating the person as well as the family members is a useful measure in controlling different types of allergies. In case of food allergy, when eating out, the contents of the prepared food should be enquired. At home even, warning stickers should be placed on foods with the offending antigen for food-sensitive individuals.
Anti-allergic Medicines
Depending on the type, there are several medications for treatment and control of allergy. They are as follows:-
□ Antihistamines
□ Medicines for asthma
□ Antibiotics
□ Local (topical) agents
Antihistamines
In the process of allergy, certain chemical substances called mediators are released from the body. Of these, the most important mediator is known as Histamine.
The basic medical treatment of allergy lies in reducing the effects of histamine, i.e. sneezing, itching, running nose, breathing problems, swelling of the skin, nose, lungs, etc. Most of the histamine effects occur when histamine binds to the affected tissues or organs via histamine receptors. There are three types of histamine receptors (HI, H2 and H ) of which Hj receptors are most important. A list of commonly used antihistamines is given for easy reference.
Commonly Used Antihistamines
Pharmacological Name – Popular Brand Name
Pheniramine maleate – Avil
Chlorpheniramine maleate – Cadistin
Dexchlorpheniramine maleate – Polaramine
Diphenhydramine – Benadryl
Cyproheptadine – Practin
Dimethindene maleate – Foristal
Embramine – Mebryl
Azatadine maleate – Zadine
Astemizole – Stemiz
Terfenadine – Trexyl
Cetirizine – Alerid
Levocetirizine – Levorid
Clemastine fumarate – Tavegyl
Loratadine -Loridin
Hydroxyzine – Atarax
Methdilazine – Dilosyn
Desloratadine – Deslor
Fexofenadine – Allegra
Ebastine – Ebast
Ketotifen – Ketasma
Mizolastine – Elina
Flunisolide – Syntaris (spray)
Azelastine – Azep (spray)
These antihistamines are quite successful in controlling the main and early symptoms of allergy but they have certain side-effects. The usual adverse effects are headache, drowsiness, giddiness, dryness of the mouth, blurring of vision, diarrhoea, stomach-ache, flatulence (gas) and fatigue. The adverse effects are lesser with newer antihistamines like Cetirizine, Fexofenadine, Joratadine, Azelastine, etc.
Medicines for Asthma
Asthma is a disease associated with narrowed breathing pathways which leads to spells of breathlessness, giddiness, cough, noisy breathing and other symptoms. There are several medicines which are used in controlling Bronchial Asthma. A list of medicines with their popular brand names is given below:-
Commonly Used Medicines for Asthma
Pharmacological Name – Brand Name
Salbutamol – Asthalin, Ventorlin
Theophylin + Etophylin – Deriphylin
Terbutaline – Bricanyl
Bambuterol – Bambudil
Ketotifen – Asthafen, Ketasma
Montelukast – Emlucast, Ventair
Zaferlukot – Zuvair
Mechanisms of action of the above medicines are as follows:-
□ Improve functioning of the lungs by bronchodilatation (increasing elasticity).
□ Decrease number of eosinophils in the blood which are responsible for the allergy.
□ Remove mucus and dust from the lungs.
□ Facilitate easy breathing.
□ Control the symptoms of allergy.
□ Prevent symptoms of asthma and allergy following exercise or due to intake of painkillers like aspirin.
□ Improve symptoms of allergy in the nose and sinuses.
Antibiotics
In almost all types of allergy, there is a superadded infection in the due course of time. This is due to the entry of bacteria in these areas. Depending on the condition and the type of bacteria, the antibiotic is selected and needs to be given for a period ranging from one week to six weeks. The commonly used antibiotics are Amoxycillin, Septran, Clarithromycin, Azithromycin, Cefuroxime, Levofloxacin, Cefixime, Cefpodoxime, Clindamycin, etc.
Local (topical) Agents
In the treatment of allergy, certain medicines are directly applied at the affected site for early and better results. These are known as local or topical agents. They come in the form of nasal drops and sprays, inhalers, eye drops and ointments, skin creams, lotions, etc. A list of some of the popular brands of topical agents is given in the table below:-
Popular Local (Topical) Agents
Nasal drops/ sprays – Inhalers Eye drops/ ointments – Skin Creams
Otrivin – Asthalin – Locula – Neosporin
Dristan – Beclate – Cifran – Betadine
Endrine – Bricanyl – Genticyn – Furacin
Ifiral – Budecort – Chloromycetin – Flucort
Flomist – Foracort – Ensamycin – Betnovate
Efcorlin – Metaspray – Silverex – Clobate
Role of Steroids in Allergy
Steroids or corticosteroids are currently the most important class of medicines used to treat allergy. The mechanism of action of steroids by which they combat allergy are as given on the next page:-
□ By modulating the function of white blood cells in order to minimise the symptoms of allergy.
□ By inhibiting production of chemical mediators which cause allergy.
□ By reducing mucus secretion in the airways.
□ By decreasing inflammation of the airways and improving aeration.
Corticosteroids are available in different forms as oral medicines, injections, nasal drops/sprays, inhalers, eye drops, skin creams, etc.
Some of the popular brands of steroids are Wysolone, Betnesol, Decadron, Cortisone, Kenacort, etc.
The steroids are wonderful medicines except for their side-effects which include weight gain, high blood pressure, ulcers in the stomach, cataracts, softening of bones, stunting of growth, psychological changes and aggravation of diabetes. However, these side-effects only occur after prolonged use of these medicines.
Allergy Injections
Some people who do not respond to the above measures may benefit from allergy injections also known as allergen immunotherapy. The candidates for this therapy are as follows:-
□ Those who do not respond to allergen avoidance.
□ Those who do not respond to anti-allergic medicine.
□ Those who develop severe side-effects of medicines.
□ Those who cannot adhere to complex regimen of multiple medications.
□ Those who suffer from multiple allergies.
The basic concept or goal of allergy injections is to help the body in producing more of immunoglobulin (Ig)G to counterbalance the excessive levels of immunoglobulin (Ig)E which are common in allergic individuals.
In this method, the doctor injects a serum containing allergenic substances such as dust, pollen, animal dander, food extract, etc., just below the skin surface. The cells that make IgE antibodies are located on the skin surface while the cells that make IgG antibodies are located in the liver, lymph nodes and spleen. This method bypasses the skin surface and the serum enters the body to produce IgG instead of IgE.
These injections are given in increasing doses once or twice a week for two to three months and then once a month for two to three years. About 80% of people experience improvement after one to two years and the effects persist for several years. People with dust allergy benefit the most from this treatment.