Treatment
(see also SELF-CARE)
Antihistamines and Decongestants
Oral decongestants alone may be helpful, including pseudoephedrine. Antihistamines are available as tablets, capsules and liquids, and may or may not be combined with decongestants. Common antihistamines include brompheniramine or chlorpheniramine, and clemastine. Non-sedating long-acting antihistamines include loratidine and fexofenadine.
Nasal sprays
For rhinorrhea, a nasal spray of cromolyn sodium (Nasalcrom) or a steroid nasal spray, such as flunisolide (Nasalide), beclomethasone dipropionate (Beconase, Vancenase), triamcinolone acetonide (Nasacort), and fluticasone (Flonase), may work so well that additional antihistamines or decongestants are unnecessary. It is important to remember that improvement may not occur for one to two weeks after starting therapy with steroid nasal sprays. Short courses of oral corticosteroids may usually be indicated when severe nasal symptoms prevent the adequate delivery of topical agents.
Immunotherapy
Immunotherapy involves giving gradually increasing doses of the substance (or allergen) to which the person is allergic. This works by making the immune system less sensitive to that substance, probably by causing production of a particular "blocking" antibody, which reduces the symptoms of allergy when the substance is encountered in the future.
Before starting treatment, the physician and patient try to identify trigger factors for allergic symptoms. Skin or sometimes blood tests are performed to confirm the specific allergens to which the person has antibodies.
Immunotherapy may be indicated for patients who are:
- Unresponsive to medical therapy
- Have side effects from medications
- Have recurrent sinusitis or otitis (an ear infection)
- Are unwilling or unable to use medication
- Prefer not to use medication on a long-term basis
RAST (a kind of allergy test) testing or skin testing to identify the offending allergens is often a prerequisite to immunotherapy. Immunotherapy is initiated with weekly injections of small amounts of antigen (allergen). The amount of antigen and the length of time between injections are slowly increased. Maintenance injections are usually given once every three to four weeks. The principal side effect of immunotherapy is a local reaction at the injection site, but the risk of anaphylaxis warrants caution.
Immunotherapy is not a cure for allergic rhinitis. Approximately 85 percent of all patients obtain long-lasting symptom relief from immunotherapy. After three to five seasons of adequate symptom relief, it may be possible to discontinue immunotherapy. Sixty percent of all patients continue to derive symptomatic benefit, with reduced need for medications after immunotherapy is discontinued. Environmental modification should be maintained during immunotherapy.
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