Allergy

Updated 23 May 2018

Treating allergies

There's no cure for allergies. The best way to control or treat an allergy is to avoid the triggering substance.

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Allergies are treated by education, avoiding or reducing exposure to allergens, medication, and immunotherapy.  

Education
Education is really important for people with allergies. After reading the articles in this section, you’ll know what an allergy is and how allergies are diagnosed and treated. 

But there’s so much more to know.

Practical steps that can change your life include learning how to use your nasal sprays and pumps properly, finding out when and how to apply ointments for eczema, learning to recognise and treat a severe reaction, and knowing which foods to avoid because they contain certain proteins.  

Bring your medication, devices and spacers with you to every doctor’s visit and ask your healthcare practitioner to demonstrate how they should be used. Also visit Allergy Foundation Centre (AFSA) for more information, or join their Facebook page.

Avoiding allergy triggers
Depending on your specific allergies, some preventive maintenance at home could help control the environment, and reduce your risk of allergic reactions. The most important step is to limit exposure to environmental tobacco smoke, which is a non-allergic trigger of symptoms in people with allergies.  

Not everyone needs to avoid all allergens. If you’re not allergic to something, you won’t benefit by removing it from your environment. That’s why it’s important to get your sensitisation (skin or blood) tests done. 

Also remember that skin and blood tests only tell you about the possibility of allergies, and that these tests need to be interpreted carefully by someone with expertise. Not all “positive” tests actually mean you’re allergic to the allergen.

Use the guide below to reduce your exposure to specific allergens:

• House dust mite allergy. Use special mattresses and pillow covers to control your exposure. Frequent vacuuming, using a vacuum cleaner with a HEPA filter and an Allergy Foundation of South Africa Seal of Approval, gets rid of dust mites and other airborne allergens.

Consider using an air conditioner in your home and car, and changing the filters often. Get rid of old bedding, toys, clothing and other items that may be carriers of dust and mould. Remove overstuffed furniture and carpets.

• Pet allergy. If you have a pet allergy, you should try to avoid pets. If this isn’t possible, make sure that pets are kept outdoors, off the furniture, and banned from the bedroom. Install an air filter in your home, and brush your pet outside to remove loose hair and other allergens (better yet, ask someone else to do it). 

• Pollen. If you you’re allergic to pollen, the most effective measure is to limit your outdoor activity between 5am and 10am, as pollen levels are at their highest during this time. Delegate raking of leaves and stay away from freshly cut grass.

• Mould. If you’re allergic to mould, it’s best to keep the number of houseplants in your home to a minimum, as they promote mould growth. Store firewood outside and eliminate straw and jute from your home. Air-conditioners help control humidity, which can limit the growth of mites and moulds, and eliminate spores from the air.

Medication
The most common treatments for allergies are:

• Asthma pumps. There are two major types of asthma medications: those that are used every day to control inflammation, and thus prevent symptoms from occurring (controller pumps), and those that are merely emergency medication used to treat symptoms during an exacerbation (reliever pumps).

• New antihistamines. These block the release of histamine by the body’s mast cells in body tissue (histamine causes the allergic reaction). Older antihistamines often have the side effect of causing sedation, so ask your doctor to prescribe one of the newer products.

• Nasal corticosteroids. These control inflammation and stop allergic reactions. At the same time, these anti-inflammatory substances reduce nasal swelling and mucous secretions. 

• Topical creams or skin ointments for the treatment of eczema. Emollients keep the skin moist and prevent flares, while topical steroids heal the inflammation in the skin.

• Antibiotics may also be necessary to treat complications such as the ear, skin and sinus infections that are common in children with allergies.

• Decongestants shrink swollen nasal tissues, thereby relieving congestion. These drugs are sometimes combined with an antihistamine to help control nasal symptoms effectively. They shouldn’t be used continuously for more than a week, as they may worsen the nasal mucosal swelling.

If you’ve had a severe allergic reaction in the past, you should always carry an adrenaline auto-injector to treat anaphylaxis and give yourself an injection when necessary. It’s important to get medical treatment immediately.

While waiting for medical help to arrive, lie down with your legs raised above chest level to increase the blood flow to your heart and brain.

Other treatments
No nutritional or herbal treatments, or vitamin and mineral supplements, have been proven to be successful in treating allergies. If you’re allergic to pollen, you should be especially careful of herbal remedies, as they may contain the very substances that activate your allergic symptoms.

Unless you’re allergic to a specific food substance, you don’t have to change your diet to prevent an allergic reaction. Remember: an allergy isn’t caused by a nutritional deficiency; instead, it’s a reaction of the immune system.

Taking vitamin and mineral supplements will not help to prevent an allergic reaction. 

Allergen immunotherapy
With this type of therapy, your doctor gives you the substance that you’re allergic to every day to try to trick your body into becoming resistant to the allergy. This treatment needs a lot of dedication, because it must be done regularly for at least three years.

Immunotherapy is the only medical treatment that may be able to cure allergies because, once you’ve undergone immunotherapy in its entirety, you become resistant to that allergen. Even when you then come into contact with the allergen, you won’t experience any symptoms.

Allergen immunotherapy is only effective in some people. Its success depends on the type of allergy, the specific allergen you’re sensitive to, and whether you also experience symptoms with more than one allergen.

If you get hay fever, it’s worth knowing that immunotherapy is available for grass pollens, tree pollens, weed pollens, house dust mite, some moulds, cat, dog and horse. The allergen may be given as drops under the tongue at home, or as injections by a doctor.

If you experience severe reactions to bee or wasp stings, immunotherapy is available in the form of injections only.

Immunotherapy to medication and foods allows some people to become temporarily able to tolerate it, but allergists cannot “cure” either medication or food allergies completely. 

When to visit your doctor
Make an appointment with your GP or allergist if:

• Your symptoms have a significant impact on your quality of life.
Your symptoms become more frequent or severe.
You’re not responding well to your prescribed treatment.
Your allergies lead to difficulty breathing, wheezing, coughing, chest tightness, nasal congestion, and/or chronic sinusitis.
You struggle with mediation side effects (e.g. drowsiness).


Reviewed by Prof Mike Levin, Head of Division of Asthma and Allergy at the University of Cape Town. MBChB; FCPaed; MMed; PhD Diploma Allergology; EAACI UEMS Allergy exam, FAAAAI, FACAAI. March 2018.




 

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Dr Morris is the Principal Allergist at the Cape Town and Johannesburg Allergy Clinics with postgraduate diplomas in Allergology, Dermatology, Paediatrics and Family Medicine dealing with both adult and childhood allergies.

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