If you are suffering with runny nose, sneezing, cough, itchy-watery-eyes and nasal congestion then you already know that allergy season is here. Allergy sufferers today have a lot of options to help control and even "cure" their symptoms.
The vast majority of allergy symptoms seen in hay fever are related to the release of histamine from immune cells in the body. That is why the mainstay of over-the-counter (OTC) treatment remains antihistamines. Antihistamine medications are great for treating runny, sneezy, itchy symptoms. The older antihistamines (such as Benadryl and Chlor-Trimeton) work well but tend to cause drowsiness.
Newer drugs such as Claritin (loratadine), Zyrtec (cetirizine) and Allegra (fexofenadine) offer similar benefits without the sedation. We now have generic equivalents available over the counter.
If itchy, watery, red eyes are the primary complaint there are newer OTC eye drops such as Zaditor that contain antihistamines that act locally.
Decongestants are added on to address nasal congestion and sinus pressure, but must be used cautiously in people with hypertension. Over the counter nasal sprays can offer some relief, but patients often become dependent on them so they can be used for only limited amounts of time.
When allergy symptoms are just too severe to be handled through lifestyle changes and over-the-counter remedies then you should consider seeing an allergist, who can identify the source of your symptoms and better target your treatment. When allergen avoidance is ineffective and medications are inadequate, immunotherapy may be a viable treatment option.
Allergy shots (medically known as subcutaneous immunotherapy, or SCIT) are a very effective form of treatment. Increasing doses of the allergy serum are given weekly over a period of months until a target dose or maintenance dose is achieved. Allergy injections have been used since 1911 with proven efficacy and long-term benefits but many patients find the time investment impossible to make and they continue to suffer through allergy seasons.
For those patients, we may have new therapies to offer.
Recently, there has been a growing interest in "allergy drops" (medically known as sublingual immunotherapy, or SLIT). Instead of allergy shots, allergens are placed in liquid or tablet form under the tongue. Increasing amounts of allergens are administered through this route on a daily basis. This treatment has been widely used in Europe for decades but has only recently been FDA approved in the United States. A large review of the data on SLIT shows that it is better than over-the-counter meds in improving symptoms but not as effective at SCIT. It is important to note that the only FDA-approved materials for SLIT are in a pill form. There are some practitioners using or offering allergy drops (SLIT). The same allergen extracts used for allergy shots are being used for SLIT. These allergens are FDA approved to be used for allergy shots only so the use of these allergens in drop form is not FDA approved and considered "off-label" use. This is why this treatment is typically not covered by insurance companies. There are no standard guidelines in terms of dosage and schedule when using the serum in this fashion. Therefore, those offering this type of treatment are making educated guesses on the correct dose and course of therapy.
SLIT has the potential to make allergy treatment easier and less painful but comes with its own inherent concerns. The tablet has to be taken every day and could have frequent side effects of mouth or tongue itching. If even one day is missed, the subsequent dose could lead to more severe side effects. There is also still a risk for severe allergic reaction with these tablets. If one of these reactions occurred at home that could lead to a dangerous situation for patients. Also, the studies have shown these pills to be helpful in patients who are allergic only to grass pollen. It is quite rare for patients to be allergic to grass pollen alone, especially in Florida.
It is exciting to know that there are many new treatments being studied to help patients who suffer with allergies. With so many options, it is best to talk with your allergist about which treatment options are a right for you and your lifestyle.
Dr. Mona V. Mangat is an allergist and immunologist in St. Petersburg at Bay Area Allergy & Asthma.