Harold Kaiser (Practicing Allergist and Clinical Professor of Medicine, University of Minnesota Medical School) gives expert video advice on: What kind of medications are used to treat allergies?; Does using an EpiPen hurt? and more...
How are allergies treated?
After we've talked about avoiding things, and the problem is still ongoing, we talk about treatment. There are two kinds of treatment for allergic disease. First, there are drug treatments and there are a whole bunch of drugs that are really terrific and helpful. And then there are allergy injections, or immunotherapy, for those patients who need more help than the drug treatment and the avoidance provides. So, again, three general categories for treatment for allergic disease: avoidance, medications, and immunotherapy or allergy injections. That covers most treatments.
What kind of medications are used to treat allergies?
Depends on the allergy. For example, lets talk about allergic rhynitis or hay fever, which is perhaps the most common allergic condition that the physicians sees. Anti-histamines are used, decongestants are used, inhaled nasal corticosteroid type medications are used to treat the allergy. There are other medications called look and try modifiers, which are chemical blockers for some of the chemicals that contribute to the allergic disease. There are drying agents for those patients who have excess mucus production and a whole bunch of combination of those. So there are different ways to treat allergies.
What are "antihistamines"?
Antihistamines are medication which blocks histamine. Histamine is the chemical which is one of the most common chemicals that cause the allergic reaction. For example: If I'm allergic to dust and I inhaled some dust then my body will send signals and start a series of events. A cascade of events wherein white blood cells of the body will release certain chemicals. Among these chemicals are histamine, glucotrines, bradykirin, chemokines and the like. Histamines are chemical which cause the allergic reaction in the body.
What are the two classes of antihistamines?
There are generally two classes of antihistamines, the sedating and non-sedating. The sedating antihistamines are the ones that have been around since 1938 or 1940. I think they were first used clinically in 1946. They include the combinations such as benadryl and chlotrimeton and things that we prescribed until about 15 or 20 years ago when another class of non-sedating antihistamines came in. These are therapeutically equivalent, but don't cause the side effects that the first generation anitihistamines, the sedation caused such as the cognitive skill impairment, the drowsiness, and the dry mouth. The sedating antihistamines worked but the price of the side-effects was enormous and people would have to decide whether they really wanted to take this for their allergy. They would feel better but feel hung over or I just don't drive very well with this. The new antihistamines, the nonsedating antihistamines names like Celdane, Clareten, allegra, or zeretech are now available that have the therapeutic effects without the side effects of first generation antihistamines.
What is a "decongestant"?
A decongestant blocks congestion. In other words, think of an allergic reaction in the nose. The nose will run, the nose will plug up, the nose will get stuffy. The stuffiness or the congestion is not well treated with antihistamines. The antihistamines work well against the mucus secretion, against the itching and against the itchy eyes, but certain other classes of medications are necessary to block the congestion. Decongestants may be locally applied, like Afrin or Neosinephrin, by a spray, and more commonly it's taken by mouth. Sudafed is a decongestant - the most common one used in the United States. There are other decongestants available also, and often a combination of an antihistamine and a decongestant are used in the treatment of allergic disease.
What is "immunotherapy"?
Immunotherapy is a fancy word for allergy injections. Let me explain what allergy injections are, and what they do. A substance to which the allergic patient is prepared. Think ragweed, or grass pollen, or cat dander, or house dust mites. The substance is prepared, and again this is, we know how to do this and there are pharmacy companies who make these substances, and the patient is then started on a series of injections. Initially weekly, then every other week, then every three, and then every four, sometimes even longer. And gradually over time you can have three expectations from allergy injections. Number one, the symptoms will improve, the nasal congestion, the sneezing, the coughing and wheezing. Number two, the medication will work better on you. In other words, the medicine will work the same but essentially the body will be more responsive to the medicine. The body will be working better. Thirdly and equally important, especially in a young person, is that instead of going downhill and developing ongoing and progressive troubles, immunotherapy or allergy injections will prevent the further development of troubles in a certain percentage of patients.
Is it safe to take beta-blockers if I am taking allergy medication?
Beta blocker (the better name for which is beta agonist blocker) is a medication which is more commonly used in cardiac disease and also for things like migraine. It is also used for stage fright. It is an anti-hypertensive medication, and has a lot of uses. But it is not a good medication for patients who have allergic disease or asthma because it negates the potential effect of epinephrine or adrenaline in treating allergic reactions. In other words, it is tougher to treat allergies in patients who are taking beta-blockers. This can cause everything from inconvenience to life-threatening reactions if they have an asthmatic anaphylactic-type reaction. So the general advice is that patients who have allergies should not be taking beta blockers. In patients who are on immunotherapy, those who are getting allergy injections should not be getting beta blockers.
What is a "corticosteroid"?
Corticosteroids are cortisone like medications that are the most potent allergy medications that are used. They're used in many forms from inhalation in the nose and in the lungs, to injection, to pills and the like. They're often used after the more common medications are used which have not had a good results. In other words in patients that have allergies and are taking an antihistamine and a decongestant but are still not getting good relief, then an inhaled nasal corticosteroid may be inhaled, or a cortisone type medication by mouth (pills) would be helpful or could be helpful. The problem with inhaled corticosteroid or oral corticosteroids is that they have greater potential for side effects than the other medications, and the side effects with chronic use can be serious. They might include things like high blood pressure, ulcers, development of diabetes, cataracts, and skin changes such as acne. They're not a trivial medication.
What is an "EpiPen"?
An "EpiPen" looks like a ballpoint pen except it has got pre-filled syringe with some epinephrine, which is the chemical name for adrenaline, and a small needle. It's also self-injecting. So if you take the EpiPen and hit yourself anywhere, like on the thigh, with four lbs of pressure (which is not very much or here or there), then the needle will come out and you will give yourself a little shot of adrenaline. If you are having allergic reaction, the adrenaline is the first line of therapy for that. And this obviates the patient who can't give themselves a shot. Most of us have trouble giving ourselves a shot. It's a very nice device and anyone who is at risk of having a severe allergic reaction, an anyphalactic reaction to a stinging insect, or to a peanut or the like, should have an EpiPen available to them.
Does using an EpiPen hurt?
An EpiPen is a trivial hurt. It's like sticking a pen in yourself. It's like a diabetic getting an insulin injection. It's not painful like a shot of penicillen in the butt, it's a little shot with a little needle, and it's better than dying. Using n EpiPen is better than winding up in the emergency room. It's better to hurt a little bit.
Are the alternative methods of treating allergies?
If alternative methods of treating allergies don't harm the patients then I think they're helpful, I have no problem with accepting them. But I can't recommend them and I tell patients that to my knowledge there is no proof to suggest that these alternative treatments work effectively on allergies or asthma. Some alternative medications, including some herbs, may cause harm so read the labels carefully. I can't recommend them at this time because there's no good hard evidence to validate their beneficial claims.