Allergies
To see current pollen counts, CLICK HERE!Introduction to nasal allergy and immunotherapy.
About 20% of people in the United States suffer from allergies. While most people can acheive adequate control with over-the-counter medications, many people choose to pursue allergy shots or sub-lingual drops in order to retrain their bodies to tolerate their allergens. Allergies develop when the bodies immune system develops a particular antibody, called an IgE antibody, targeting that allergen. That antibody will then go and connect to a mast cell which sensitizes it to the allergens, such that, when the allergen is encountered, the mast cell releases several chemicals, such as histamine. The histamine is the target of many over-the-counter medications such as Zyrtec, Claratin, and Allegra. When a patient chooses to undergo immunotherapy with allergy shots or sub-lingual drops, the immune system re-learns a different class of reaction, creating a different antibody that no longer binds to the mast cell, thus no longer causing symptoms.Various sinus diseases can be related to nasal allergies. One of the most dramatic is allergic fungal sinusitis. Unfortunately, however, only 26% of people with confirmed chronic sinusitis improve significantly with immunotherapy which proves the complex nature of chronic rhinosinusitis.
If you suffer from allergies, make an appointment with Dr York today, CLICK HERE!
If Dr York has instructed you to use a nasal rinse, a video on how best to do this can be found HERE.
Further Reading
Review of Treatments
Avoidance TherapyFrequent pet washing, dust mite covers, air filters, dehumidifiers, etc have been shown to decrease the concentration of allergens in the air; however, in numerous studies, this has note translated to a decrease in patient symptoms. This seems to suggest that symptoms are more related to whether or not there is ANY allergen in the air, not so much on HOW MUCH allergen there is. Thus, measures to reduce the amount of allergen in the air have not shown an ability to reduce symptoms in numerous studies. Thus, the preponderance of evidence suggests that patients who are considering the purchase of expensive items such as air filters or dehumidifiers would be better served to invest that money in other proven treatments.
Medicines
Review of the literature shows four primary opportunities for improving patient care in the pharmacologic treatment of allergies.
- The first is
seen in population studies showing continued wide-spread use of sedating antihistamines (for example Benadryl or diphenhydramine). Unless it is
to be used concurrently as a sleep aid, care should be taken to avoid the use of these medications in favor of less sedating or nonsedating medications.
Sedating antihistamines- Diphenhydramine (Benadryl)
- Carbinoxamine (Clistin)
- Clemastine (Tavist)
- Chlorpheniramine (Chlor-Trimeton)
- Brompheniramine (Dimetane)
- Many studies have shown limited benefit to adding oral antihistamines to intranasal steroid sprays. Thus, the addition of an oral antihistamine is not necessary for the majority of patients using intranasal steroid spray and should be reserved for patients with inadequate symptom control on nasal steroid spray alone. Dr York frequently recommends that his patients perform short trials either adding an antihistamine, or stopping it if they are already taking it, and closely following their symptoms. If the patient cannot tell a difference in their symptoms, then they should cease taking the medication.
- Montelukast (Singulair) is not a recommended first line therapy for allergic rhinitis symptoms. It has shown a very limited benefit for allergic rhinitis symptoms in patients who do not also have asthma.
- For severe, recalcitrant disease, pharmacobiologics are available and can be considered. These are antibodies that interfere with the chemical mediators of the allergic pathway, such as IL-5 and IgE.
Future Directions
An important part of allergy treatment is confirming the clinical presence of allergy symptoms. It is becoming more and more clear that the atopic process is not as clear cut as IgE testing alone. One study recently showed that 54% of the general population has IgE sensitization to certain allergies. This is very interesting when we know that only 20% of the general population has allergic symptoms. Thus, the decision to pursue immunotherapy should be based on clinical symptoms in combination with positive IgE testing, and not simply on IgE testing alone.The future of allergy testing may very well lie in protein-specific testing. Currently, allergy testing is performed by liquefying all of the proteins, many hundreds, of a particular allergen and then testing for IgE (either by lab blood testing or skin prick testing) with all of the proteins present. In the future, we will have specific protein tests that will help narrow the focus to single proteins, or even parts of proteins, thus helping to identify a property known as cross-reactivity, where several different allergen sources display the same protein, and thus with only one IgE antibody, a person could be allergic to all of those allergen sources. This person could then be treated with only the one protein and be desensitized to them all. Additionally, this protein-specific testing may help us identify which IgE's are clinically significant, and which we can simply ignore.
If you suffer from allergies, make an appointment with Dr York today, CLICK HERE!