How to Treat Allergies:

Mark E. Reiber, M.D., F. A.C.S., F.A.A.O.A.

Where do you start?
Once you determine allergies are a problem, it’s time start making decisions. Where do you begin? How do you sort through the many options and find what is right for you?

Store shelves are stocked with a staggering array of medications claiming to offer relief and 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 from the ravages of allergies. 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 of what you should do, 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! There is plenty of misinformation and unscrupulous people waiting to take advantage of your desperation.

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:
First, understand the problem. Allergy is a chronic disease and that means it can be controlled, not cured. People realize that arthritis and diabetes are not cured, and that control is not always optimal. A diabetic won’t tell his doctor that insulin doesn’t work for him simply because his sugar levels run high occasionally. An arthritis patient doesn’t stop taking anti-inflammatory medication because her joints still swell at times.

Unfortunately, this is what allergy patients do. They’ll switch from one medication to the next, looking for the “ideal” cure. They quickly discount helpful treatments as failures if they get less than total or permanent relief.
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 quality of care available. There are practitioners offering less than reputable treatments making outlandish claims.

Be careful, and check with reputable sources before agreeing to any treatment. Take advice from family and friends with the proper amount of skepticism. Remember, no treatment is free of side effects, and all take time to succeed.

Treating allergy is like investing money, aim for the long term, manage your risk, and leave the get rich quick schemes to the foolish.

Find a treatment with which you can live:
Allergy management can be like dieting. Many diets have quick effects, but no diet is truly successful without lasting results. In order to keep weight off, the plan has to be easily incorporated into your life style. Strange fads and inconvenient allergy treatments that can’t be a part of your daily routine will never be the answer.

Be patient:
Find a plan and stick with it. Make adjustments only when necessary. Decisions about success or failure shouldn’t be made over short periods of time or based on single events. Remember, patients without allergies catch colds and get sinus infections on average once or twice a year, and so will you. So don’t change your plan every time you get sick.

There are three treatments for allergy:
All allergy treatments can be broken down into one of three areas: 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 while standing in a burning house. There are three things you can do.
First, limit the fuel for the flames, environmental control. Allergens are the fuel triggering the reactions causing symptoms (“the explosion”).
Secondly, you can throw buckets of water at the flames. Medications are these buckets of water. Highly effective for small fires, they are rarely enough for larger ones. Relief is fast but has no lasting benefits.

Patients often say “I tried antihistamine X, and it just doesn’t work”. “Does a bucket of water put out a fire?” A small fire, yes, but for larger fires it will take other measures. The antihistamine is probably working, but it may not be sufficient to do the entire job.

Finally, the third way to limit getting burned is to put on fire protective clothing, like a fireman would wear. This increases your tolerance for heat. Over time, by taking allergy shots or drops you develop this tolerance or “protective armor”. You raise the threshold for exposures at which symptoms will begin.

Now, let’s look at each one of these three methods in more detail.

Tool One- Environmental Control: Get rid of the fuel for the fire:
This is potentially the most successful form of treatment. It can be as simple as removing a pet or controlling humidity in your home.
If one can avoid or limit the exposure to allergens, then symptoms will never begin. Most severely allergic patients can’t use this as the sole form of treatment, but it’s still important. Unfortunately, it is often 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 block symptoms most effectively if given before exposures. There are several different classes of medications, including nasal steroids, antihistamines, decongestants, leukotriene inhibitors, and mast cell stabilizers. Combinations can maximize effects and be tailored for symptoms and side effects. A qualified allergy specialist is best suited to determine what is right for you.

Tool Three- Immunotherapy: Building up tolerance:
I have told my patients for years that immunotherapy is like saving for retirement in a 401K. You invest regularly for a benefit that isn’t realized until the future. For immunotherapy, this might take 6-12 months before benefits are felt. If immunotherapy is your retirement savings, then allergy medications are your paychecks, providing relief to spend for today. Our goal is eventually to build up enough tolerance with immunotherapy (savings), so we can stop medications (paychecks).

In the financial world, you wouldn’t save for the future when you couldn’t pay today’s bills. In the allergy world, we don’t give allergy shots or drops when you are severely ill from your allergies. We don’t want to add more allergens to the “fire” at times when you are having the most problems.
So in conclusion, while allergies may seem frustrating and difficult to manage, treatment always comes back to the three areas of environmental control, medications and immunotherapy.  Each of these is covered in greater detail in other overviews.

2/11//08