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Do you suffer from constant sneezing, runny nose, or nasal congestion?
Do you get itchy, watery eyes when around pollen or certain animals?
Do you have chronic cough, headaches, or ear issues?
If you answered yes to any of these questions, you may be suffering from inhalant allergies. Inhalants are small particles of pollen, mold, dust, or animal dander that are released into the environment. In genetically predisposed individuals, the immune system responds improperly to this material and creates an inflammatory reaction. This inflammatory reaction can occur in several areas of the body including the eyes, nose, sinuses, ears, lungs, and skin. This leads to the classic nasal and eye symptoms listed above, referred to as allergic rhinitis, but can also initiate or worsen asthmatic symptoms (cough, shortness of breath, wheezing). A pollen allergy that occurs with trees, grasses, and weeds has long been known as “hay fever”. Hay fever is most prevalent with tree and grass pollens in the spring and summer as well as weed pollen that is released in the fall. Mold and dust allergies commonly occur year-round, while cat and dog allergies are usually identified when there is contact with the offending animal. Allergies are known to affect greater than 10% of the American population, and their incidence continues to rise. Allergic rhinitis remains a leading cause of missed work productivity, and if left untreated, can lead to more severe and chronic health problems such as asthma and chronic sinusitis.
How are allergies diagnosed and treated?
Allergies are typically diagnosed by history. The initial treatment often consists of avoiding the offending inhalant and starting medication. Typical medications that are used in the initial treatment of allergic symptoms are non-sedating antihistamines (Zyrtec, Claritin, Allegra, etc.) and nasal sprays. Nasal sprays can consist of a topical antihistamine spray (Patanase, Astelin) or a topical steroid spray (Nasonex, Flonase, etc.). In patients who do not respond to medications or if the diagnosis of allergy is uncertain, an allergy skin test is often performed. The allergy skin test usually takes less than 1 hour and is almost always tolerated in adults and children. It can be done with minimal discomfort under the right conditions. Skin testing allows the appropriate identification of inhalants that are causing the symptoms and helps tailor a treatment plan. Patients who continue to suffer with debilitating symptoms despite medical and conservative therapy are often recommended for allergy shot treatment, and less commonly, sublingual immunotherapy (allergy drops).
Allergy shots – proven relief and treatment.
Allergy shots, also known as immunotherapy, have been the cornerstone of allergy treatment for decades. Allergy injections have been proven to desensitize the immune system and eliminate the inflammatory response created by the inhalant particles. Immunotherapy is typically performed weekly for 3-5 years from the time of the initial allergy test. Patients typically experience symptom relief within 3-6 months of beginning the shots and then continue to improve slowly over the course of treatment. Many patients can be safely placed on home immunotherapy after a period of time. In the majority of patients, a long-term cure is achieved and the need for continuing allergy medications is avoided.
Allergy drops (sublingual immunotherapy)
Sublingual immunotherapy describes a technique whereby the allergy solution containing the pollen particles are placed under the tongue. A portion of this solution is then absorbed into the body where an immune response can be generated. This is the same route of drug administration as many other prescription medicines, including nitroglycerin given for chest pain. Sublingual immunotherapy has been used safely in Europe for decades, and medical studies demonstrate its effectiveness for certain inhalants. The drops are taken daily at home using a metered dose vial, which makes the therapy more convenient in certain individuals. This type of therapy eliminates the weekly physician visit. It is also felt that the risk of an anaphylactic reaction is diminished with sublingual immunotherapy. Sublingual therapy can be used for:
- Any healthy patient over the age of 4 who is unable or unwilling to undergo weekly injections in the physician office.
- Children who are needle phobic and difficult to inject.
- Patients taking medications such as beta-blockers in whom allergy shots pose an increased risk for a systemic reaction.
- Stable patients who have a very mild allergic asthma who are poor candidates for allergy shots.
The downsides of sublingual immunotherapy are:
- The treatment is typically not covered by insurance and requires an out of pocket expense.
- The therapy is given DAILY instead of weekly and many patients find this frequent dosing regimen difficult to maintain. Sublingual immunotherapy is ideal for people with a hectic work or travel schedule who cannot comply with office shots.
- Sublingual immunotherapy has not been studied as extensively as allergy shots, and considerable research is still necessary to ensure its long-term efficacy. Concerns remain over the duration of treatment success and whether treating multiple inhalants at one time is as successful as standard allergy shots.
Dr. Gunnlaugsson will discuss the variety of treatment options with each patient and determine which intervention will provide the highest likelihood of symptom relief.