Allergic rhinitis, asthma, and eczema are caused by an adverse reaction to environmental substances, such as foods we eat, inhalants we breathe, and contactants that land on our skin. Grass, tree, and weed pollen are the most common allergens, but numerous other substances can trigger allergic responses including pet dander, dust mites, mold spores, insects, and foods. Antibodies bind to these allergens and trigger the release of histamine, causing allergic symptoms. When these responses occur in the nasal cavity, it is called allergic rhinitis, in the lower respiratory system it is referred to as asthma, and on the skin it is known as eczema. These three conditions all stem from abnormal responses to otherwise harmless substances. Allergic disease is very common, with estimates ranging from 20%-40% of the adult population affected. It is the third most common chronic disease across all ages, and the most common chronic disease of childhood. 8 million work days and 130 million school days are lost annually to allergy and asthma. 3.4 billion dollars are spent on allergy treatment per year, with half of that cost coming from prescription medications.
Common symptoms of allergic rhinitis include nasal congestion, runny nose, itchy eyes, face pressure, pain, headache, and cough. Allergies are a prime source of chronic sinusitis, causing the small drainage points for sinuses to close, leading to sinus infections. Allergic disease tends to follow a seasonal pattern, with trees usually pollinating in the spring, grasses in the summer, and weeds in the fall. Molds, dust mites, and pet dander are year round offenders because they are predominantly indoor allergens.
Treatment of allergic rhinitis usually involves avoidance, pharmaceutical treatment, or allergy immunotherapy. Avoidance involves treating sources of allergens by changing air conditioner filters, cleaning carpets and drapes, and using hypoallergenic materials when possible. Pharmaceutical therapy includes antihistamines (loratadine, cetirizine, or fexofenadine, all now over the counter) or nasal steroid sprays.
Frequently, patients have symptoms that persist despite avoidance and medication. For patients with symptoms unrelieved by allergy medications, or with year round symptoms, allergy testing is often recommended. Immunotherapy in the form of injections (allergy shots) or sublingual drops (drops applied under the tongue) represent the only real cure for allergies. Allergy testing involves depositing small amounts of allergen under the skin and measuring the response of histamine cells. The purpose of allergy testing is to determine if one is allergic to a particular substance and if so, how allergic. Based on the treatment results, vials are prepared that are specific for each patient. Immunotherapy gradually desensitizes patients over time, and represents the only cure for allergy. Allergy injections are given once a week for four to five years. Sublingual drops are administered daily in the patient’s home. With either method, patients can expect to experience improvement in symptoms three to six months into therapy.
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