Control versus cure
There's no real "cure" for allergies. So control is the best defense. Avoidance is the first step, but it's not always possible. How do we avoid pollen or dust and still live a normal life? Treatment aims to achieve a certain balance: avoid or minimize contact and treat symptoms with the least potent yet most effective medication. For some people, immunotherapy can make a big difference in their body's sensitivity to a specific allergen.
Dust mite control
- Dust mites love fabric. So minimize upholstery, carpeting, bedding and/or make sure that what you have is washable (and that you wash it often).
- Choose hardwood floors over wall-to-wall carpeting.
- Get rid of scatter rugs. Any scatter rugs you have should be washable.
- Use washable curtains and shades, not blinds (they collect too much dust).
- Check with your allergist about room/home filters especially HEPA filters.
- Avoid upholstered furniture. When possible, choose wood furniture instead. Go with simple, rather than ornate designs where dust can collect.
- Wear a dust mask when cleaning, or better yet, have someone else do the dusting and vacuuming.
- Encase pillows and mattresses in plastic slipcovers, taping over the zipper.
- Limit bric-a-brac, especially in the bedroom. Keep surfaces clear of clutter.
- Choose bookcases with doors. For children with allergies, keep toys in covered see-through plastic containers on shelves when not in use.
- Use a dehumidifier to keep the humidity below 50 percent.
In the summer, avoid fans (which stir up the dust, and bring allergens in from the outside) and use air conditioners instead. With forced air vents, use a filter, or cover the vent with cheesecloth, and remove and wash it frequently. Clean all filters frequently. Clean all air ducts yearly.
Pollen Control
- Limit outdoor activity to times of lower pollen counts when possible.
- Wash hands after petting animals that have been outside. Pollen settles on their coat.
- Shower and shampoo hair after being outside to rid hair and skin of pollen.
- Change into fresh clothing, and wash clothing that has been outside.
- Try to separate "indoor" shoes from "outdoor" shoes, to limit tracking the pollen throughout the house.
- Use air conditioners, not fans, in warm weather to avoid bringing in the "outside" air.
Medication
Antihistamines and decongestants are the two main allergy medication types. Antihistamines block the action of histamine, the substance released when mast cells recognize the presence of allergens. Antihistamines relieve redness, inflammation, itchiness and watery eyes. Ophthalmic solutions (drops) for the eye can also relieve red, irritated eyes. Many older antihistamines have a sedating effect. They make you sleepy. Newer, non-sedating ones are available, most by prescription. A dry mouth is also a common side effect. It helps to have liquid antihistamines as well as those in pill/capsule form, as they are more easily swallowed during a stronger allergic reaction.
Decongestants reduce nasal congestion by constricting blood vessels. Nasal sprays work faster than oral decongestants, but "rebound" is also common. After a few days of taking nasal decongestants, there's a "rebound effect" in which the congestion that had cleared comes back. More medication only makes the congestion worse. Discuss this side effect with your doctor to understand how to limit the amount of medication you use.
Bronchodilators relax the muscles around the air tubes in the lungs. They decrease allergy symptoms such as coughing, wheezing and shortness of breath. Agitation and nervousness are common side effects.
Steroid medications in oral or inhaled nasal forms are used to decrease inflammation. Nasal steroids have fewer side effects than oral forms. Long-term oral use (more than one week) must be carefully monitored by a doctor, because of potential systemic side effects. Low-dose topical steroid medications are used for rashes.
Immunotherapy
Some people with allergic asthma can't easily control symptoms by avoiding triggers and using medication. For them, immunotherapy (allergy shots) may offer relief and even help prevent development of airway inflammation and the resulting chronic airway sensitivity.
Allergen immunology works like a vaccination. Through exposure to small, injected amounts of a specific allergen in gradually increasing doses, your body builds up immunity to the allergen(s) that trigger an allergic reaction. This means that when you encounter these allergens in the future, you will have a reduced or very minor allergic response and fewer symptoms.
Immunotherapy works best for allergies to pollen, mold, cat dander, insect stings and dust mites. Potential side effects during treatment may include swelling at the site of the injection and in rare instances a more serious allergic reaction, causing asthma symptoms or an anaphylactic reaction. Asthma symptoms include cough, wheezing and shortness of breath. Symptoms of an anaphylactic reaction can include hives, sneezing, watery nasal discharge, itchy eyes, swelling in the throat, wheezing or a sensation of tightness in the chest, nausea, dizziness or other symptoms.
Immunotherapy involves injecting small doses of the allergic substance to help produce more antibodies, which strengthens the resistance against the allergen. This approach has been helpful for pollens, molds, mites, insects and animal dander. The doctor makes a schedule of weekly shots, gradually increasing the strength of the allergen injected, based on the previous week's response. Patients are asked to wait about 20 to 30 minutes after the injection to make sure there are no adverse effects. The site is inspected after the waiting period, with any redness, bumps or swelling noted. The area affected is measured and the next dose is based on those results.
People with multiple allergies can get several shots, following the same procedure. Very fine needles are used for the injections, and the needle only goes just below the skin's surface. While the needle rarely causes discomfort, the solution being injected can be irritating and cause itchiness or a stronger reaction. An allergist may prescribe immunotherapy for children to be given in the pediatrician's office. In that case, the office personnel should have CPR training and be equipped to handle rare, severe reactions.
This article was reviewed and updated June 2007.
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