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Due diligence imperative in proper treatment of allergies

Allergic rhinitis, commonly known as hay fever, affects close to 50 million Americans but is often not taken seriously by patients or doctors. Patients needlessly suffer with congestion, runny nose and sneezing, among other complaints, without realizing how significant an impact the condition may be having on their lives.

Studies show that untreated allergies have a significant effect on quality of life. Allergic rhinitis results in poor sleep, fatigue and daytime sleepiness. Adults often find it harder to concentrate at work and suffer from greater absenteeism. Children may see a decline in school performance and are more likely to develop asthma, and they often face recurrent ear and sinus infections.

It is critical for proper allergy treatment that your condition is properly diagnosed by a board-certified allergist. An allergist spends three years studying the field of allergies and the complexities of the immune system before being able to sit for the board exam by the American Board of Allergy and Immunology. In recent years other types of doctors have attempted to learn what allergists know during a weeklong course. Seeing anyone but an allergist for your allergies may leave you vulnerable to treatment that may be inappropriate or ineffective.

The first step in treating allergies is to avoid or limit exposure to the allergens that are causing problems. The second step is to take an antihistamine, such as Zyrtec or Allegra, or a nose spray, such as Flonase or Nasonex, to help reduce and control your symptoms. There are many over-the-counter options available now and your doctor can help you select what will work best for you. Many patients find relief with these measures.

When allergen avoidance and medications don't help, the third step is to consider allergen immunotherapy. Allergen immunotherapy, most commonly thought of as allergy shots, is extremely effective and has been used for more than 100 years. Over time, the treatment has become more refined and exact and offers relief in more than 95 percent of patients who are compliant with the regimen. Not only does it offer relief, but in normalizing an overcharged immune system, it has been shown to substantially decrease the risk of allergic children who go on to develop asthma.

Allergy shots help by giving the patient small but increasing doses of what they are allergic to, altering the immune system so that it will tolerate the allergens. Patients who are taking certain blood pressure medications or have unstable asthma or cardiac disease may not be candidates for shots. The treatment itself carries a risk, albeit small, of anaphylaxis, so it must be administered in a doctor's office. Many scientists consider allergen immunotherapy to be the closest thing we have to a cure for allergies, as it has proved to offer long-term relief of symptoms even after therapy has ended.

Recently, a new form of immunotherapy has been approved by the Food and Drug Administration for ragweed and grass allergy: sublingual immunotherapy, or SLIT, in which a tablet containing the allergens is placed under the tongue. The FDA recently approved Ragwitek for the treatment of ragweed allergies. Grastek and Oralair have been approved for the treatment of grass allergies.

A tablet containing the allergens is placed under the tongue daily. The first treatment must be given in a health care setting under the supervision of a doctor due to the risk of anaphylaxis. Subsequent doses can be taken at home. The tablet must be taken every day, and treatment should begin 12 weeks before the onset of ragweed or grass season. The duration of treatment has not been well-established. Side effects may include, but are not limited to, throat irritation, itchy mouth or numbness in the mouth. Because severe reactions may occur, each patient is prescribed an EpiPen and instructed on its use. Some people with unstable allergic asthma or certain gastrointestinal allergies may not be candidates for this treatment.

The allergy tablets work the same way as allergy shots except there is a different route of delivering allergens to the immune system. This therapy has been used in Europe for several years. Roughly 20 to 30 percent of patients have seen a significant reduction of symptoms and a decrease in allergy medication use.

This treatment is appealing because there are no shots and the tablets can be taken at home. The disadvantages are that there is a risk of an allergic reaction and neither the duration of therapy nor the likelihood of long-lasting effect is known.

Another major drawback is that most people in Florida that have allergies are unlikely to be suffering only because of a grass or ragweed allergy. Most patients suffer with symptoms caused by multiple allergens such as pet dander, dust mites, mold and trees.

Another choice that has recently become available is sublingual immunotherapy delivered via drops under the tongue. However, it is important to note that sublingual immunotherapy via drops has not been approved by the FDA and is not covered by insurance. The only FDA-approved materials for sublingual immunotherapy are in pill form. Despite this, some practitioners are offering drops for a variety of allergic conditions. Because there are no standard guidelines in terms of dosage and schedule when using the allergy drops, the doctors offering this treatment are making educated guesses. Many drop treatment programs are inconsistent with established standards of practice that are designed to protect patients.

If you suffer from allergies, you need to make informed decisions about your care. Practitioners other than allergists and immunologists may assist in the diagnosis by ordering certain blood tests, but if anyone other than an allergist offers you skin prick testing or immunotherapy, insist on seeing a board-certified allergist first. With so many exciting new treatment options, it is paramount you know which treatments are right for you and your lifestyle.

Dr. Mona V. Mangat and Dr. Ami K. Degala are board-certified allergists and immunologists at Bay Area Allergy & Asthma in St. Petersburg. Find them at If you have a question for the doctors, email them at

Due diligence imperative in proper treatment of allergies 05/15/14 [Last modified: Thursday, May 15, 2014 6:24pm]
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