||Information for patients with allergy and related
in the Southwest
Seasonal advice, treatment and prevention
Allergy Advisor - Seasonal Update WINTER/ SPRING/ SUMMER/FALL
Limiting Exposure to Allergens in the Home
Prevention of Allergy and Asthma in Children
Treatment of Allergy and Asthma
Skin Testing and Allergy Injection Treatment
Inhalers for Asthma
Spacers for Asthma Inhalers
Inhalers for Rhinitis
Tricks for - children to swallow pills
- eye drops
Treatment of Allergy and Asthma
Allergic rhinitis and asthma may be effectively treated by a number of medications
supplemented by allergen avoidance, and by allergen immunotherapy (allergy injections) when medications
and avoidance are inadequate. Rational basis for treatment rests on the
understanding of the mechanisms that underlie allergic inflammation (see Mechanisms of Respiratory Allergy). Treatment is most
effectively given by an allergist who is certified by the American Board of Allergy and
Oral Drug Therapy of Allergic Rhinitis
- Drugs for allergic rhinitis may include antihistamines,
decongestant drugs, and anti-inflammatory nasal sprays and eye drops.
- Antihistamines work best for itching, sneezing and nasal discharge, whereas nasal
stuffiness responds better to decongestants such as pseudoephedrine,
phenylephrine and phenylpropanolamine. Antihistamines and decongestants are
frequently combined in the same medication.
- Over-the-counter, non-prescription antihistamines are often effective, but they are
usually sedating and may increase risk of accident when driving or operating hazardous
machinery. Antihistamines that are not classed as "non-sedating" can
reduce the reflex reaction time or speed of performance and impair classroom learning even
when there is no obvious drowsiness. It is often necessary to restrict their use to
bed-time dosing. Alcohol greatly increases the sedative effects of antihistamines.
- Does the medication available over the counter contain a potentially sedating
antihistamine? Look for any of the following active ingredients:
cetirizine (mild sedation)
diphenhydramine (moderate to severe sedation)
Loratadine, available over the counter, is non-sedating for adults in 10 mg doses.
- The newer non-sedating prescription antihistamines do not have these risks but their
improved efficacy is still under investigation. Some prescription-only
antihistamines may be sedating: ask about them when given new prescriptions.
- Phenylpropanolamine use in high doses has been associated with hemorrhagic stroke
(bleeding in the brain) in women. Men may also be at risk, but men have not been
studied extensively for incidence of stroke after taking this drug. In the USA,
preparations containing phenylpropanolamine have been withdrawn from the market.
Nasal Spray Therapy of Allergic Rhinitis
- Nasal decongestant sprays, particularly
the long acting type, may become ineffective with regular use, and cause rebound nasal
congestion that is worse than the pre-treatment situation. Occasional use once a day
does not carry this risk. Regular use should be for no longer than one week.
- Anti-inflammatory nasal sprays e.g., nasal
corticosteroids, do not cause rebound congestion and are not "habit
forming." Nasal steroids are safe and are more effective in preventing and
treating symptoms of allergic rhinitis than are any of the antihistamines. Other
types of nasal spray that are not steroids or decongestants may be effective for some
patients: these include ipratropium and olopatadine.
When drug therapy is inadequate, allergen immunotherapy (allergy injections) given by a
qualified allergist is usually indicated and often reduces the need for medications.
- Acute sinusitis usually does not require antibiotic therapy unless it persists for more
than a week. When antibiotics are prescribed it is vitally important to continue the
treatment until all of the prescribed medication has been taken, because the main cause of
antibiotic drug resistance, an increasingly serious problem, is caused by stopping
antibiotic treatment too soon. If sinus infections recur several times a year,
consultation with an allergist may help to find a cause such as allergic rhinitis.
- Nasal ("sinus") irrigation or snorting with water or saline solution is
commonly used for chronic rhinitis and/or sinusitis, and has been shown to be more
effective than saline nasal sprays in giving relief from persistent nasal stuffiness and
thick nasal discharge. Irrigation is done by flowing water or saline into one
nostril and draining from the other.
- In the Tucson area (and possibly elsewhere) this could be dangerous if done with water
that has not been sterilized, because of the recent discovery of Naegleria fowleri
in ground water. This is a species of amoeba that has caused fatal brain
infection (meningoencephalitis) in children and young adults after swimming in lakes
commonly contaminated by the amoeba. Although no cases of brain infection have yet
been attributed to nasal irrigation with unsterile water, the possibility exists in
Tucson. If you irrigate the nose with solutions made with
tap water, be sure to sterilize it by boiling first.
- Diagnosis and management of asthma requires testing of lung function by spirometry,
which is a test of the rate and volume of forcefully exhaled air.
- Treatment of persistent asthma with over-the-counter medications or with unsupervised
occasional use of prescription medications is a risk for irreversible lung damage and, in
some cases, death.
- Although oral medications such as theophylline, Accolate and Singulair are useful for
treatment of some patients with asthma, most patients need inhaled medications. Recognition of
the different types of inhaled medication is important.
- Warnings that asthma needs immediate medical care is
- a canister of bronchodilator (rapid reliever) lasts for only 4 weeks or less
- when asthma causes night time awakenings once a week or more often
- when there is increasing shortness of breath on exercise
- when the peak expiratory flow measured by a peak flow
meter falls to or below 50% of your personal best value
- Persistent asthma requires treatment by regular dosing with anti-inflammatory medications (also called controller
medications), taken every day as prescribed, with the goals
- sleeping every night with no awakenings by asthma symptoms
- no limitation by asthma of physical activity, e.g., running or stair climbing
- reduction of use of rapid-relieving bronchodilator
drugs (so-called reliever medications) to twice a week or less
- return of lung function measurements to normal
- attaining a desirable lifestyle not limited by asthma, with no lost time from school or
Do not reduce your anti-inflammatory medication dose or frequency without
consultation with your physician, even if all the goals are achieved.
Persistent asthma, when not accompanied by a significant component of allergy, is best
managed by a Board- Certified allergist or a Board-Certified pulmonologist.
Asthma and allergy medications
National Heart Lung and Blood Institute Expert Panel Report 3 Guidelines for the
Diagnosis and Management of Asthma 2007 (written for health
Rachelefsky G, Garrison P: Free your child from asthma. McGraw Hill,
New York, 2006
Calderon MA. Alves B. Jacobson M. Hurwitz B. Sheikh A. Durham S. Allergen injection immunotherapy for seasonal allergic rhinitis.[Review] [316 refs] Cochrane Database of Systematic Reviews. (1):CD001936, 2007.
Disclaimer: This site is for educational
purposes only. Any information that you have found in this web site is not
intended to replace medical care or advice given to you by your own physicians. You should
consider consulting your local medical library and other web sites for additional
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Content Owner: Michael J. Schumacher, MB, FRACP, The
University of Arizona