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Allergy Treatment

Mark E. Reiber, MD, FACS, FAAOA

Where do you start?

There's a staggering array of medications claiming to offer relief. Television ads tell you just what to ask from your doctor. There are air purifiers, mattress covers, and duct cleaning services all claiming to save you. Then there are so-called natural remedies, with claims of miraculous success without side effects. Family members and co-workers are quick to offer suggestions, but this advice is rarely what is best for you.

Frustrated and confused, you may turn to books, the internet, and even strangers who may claim to have the ideal solution. Beware You may just decide to “try everything”, but this rarely works either. Time, money and energy are wasted, and frustration reaches a point where you feel there is no hope. So what is the best approach? Well, here are a few suggestions.

Stop looking for miracles:

Allergy is a chronic disease meaning it can be controlled, not cured, much like diabetes.

Don't switch from one medication to the next, looking for the "ideal" cure. There's no magical cure without cost, side effects, or effort. It doesn't exist now, and never will. Remember, "If it sounds too good to be true, it is".

Beware:

Whenever there is a problem without a perfect solution, there are people waiting to take advantage of the situation. In the allergy field, there is a wide range in the quality of care available.

Be careful, and check with reputable sources before agreeing to any treatment. Remember, no treatment is free of side effects, and all take time to succeed.

Find a treatment with which you can live:

Allergy treatment can be like dieting. Strange fads and inconvenient treatments not part of your daily routine will never be the answer.

Give it time:

Find a plan and stick with it. Make adjustments only when necessary. Decisions about success or failure shouldn’t be made over short periods. Don't change your plan every time you get sick.

There are three treatments for allergy:

1) environmental controls, 2) medications, and 3) immunotherapy or allergy vaccines. In order to better explain the role of each, I created the"house fire theory of allergy".

The House Fire Theory:

Consider treating allergies like trying to keep from being burned in a house fire. First, limit the fuel for the flames, environmental control. Secondly, throw buckets of water at the flame, medications. Finally, put on fire protective clothing, like a fireman's suit, immunotherapy.

Tool One- Environmental Control: Get rid of the fuel for the fire:

This is theoretically the most successful form of treatment. It can be as simple as removing a pet or controlling humidity in your home.

Avoiding or limiting exposures is always helpful, but often not enough. Most severely allergic patients can't use this as the sole form of treatment, but it shouldn't be neglected.

Environment controls are mostly for indoor antigens such as dust mites, molds and pets. Techniques do not have to be expensive, but it is important to learn what to do before taking any measures so as not to waste money.

Do not become discouraged. Improvement is the goal, not total avoidance.

Tool Two- Pharmacotherapy: For controlling symptoms:

Medications are most effectively if given before exposures. There are several classes of medications, including nasal steroids, antihistamines, decongestants, leukotriene inhibitors, and mast cell stabilizers. Combinations can be tailored to symptoms for maximum effect.

Tool Three- Immunotherapy: Building up tolerance:

I have told my patients for years immunotherapy is like saving for retirement. You invest regularly but do not see benefits until the future. For immunotherapy, this might take 6-12 months. If immunotherapy is your retirement savings, then allergy medications are your paycheck to provide immediate temporary help. Our goal is eventually to build up enough tolerance with immunotherapy (savings), so we can stop medications (paychecks).

In conclusion, while allergies may seem frustrating and difficult to manage, treatment always comes back to: environmental control, medications and immunotherapy.