Howstuffworks "Allergy Treatments: An Overview"

You probably know the type (or maybe you are the type...): the uncomplaining, "heroic" person who stoically endures seasonal or chronic allergy symptoms. These allergy sufferers typically have an extensive hankie collection or carry clumps of tissues in their pockets, muttering, "It's just a cold," when asked about their sniffling and sneezing.

This article will help those people -- and others -- decide when to get medical treatment for their allergies. In the following sections, we will discuss a number of areas to consider -- how to select a doctor, choosing an allergy medication and more. We will begin our discussion with a look at deciding the proper time to finally see a doctor.

Did You Know?Sinusitis is a potential complication of undertreated allergies, and people suffering from a sinus infection miss an average of four days of work each year. There are more than 18 million annual office visits to primary-care physicians resulting in a diagnosis of sinusitis. Other complications of under-treated allergies include fluid in the ear and orthodontic problems.

Knowing When to Say When

If you have allergies, even if they're mild, continuing to tough it out not only is unnecessary, it can have health consequences, too. First, allergies affect your quality of life. Untreated allergies can lead to sleep problems, concentration difficulties, decreased learning ability, halitosis, and orthodontic problems. Allergy sufferers often miss days at work or school. And, last but not least, constant allergies can make you feel tired and worn out. You can't function optimally when you feel miserable; decreased concentration can lead to an accident or injury.

Second, untreated allergies can lead to serious health problems. It's common for those with allergies to develop infections in the sinuses (sinusitis), throat, and ears. Tonsils and adenoids may become enlarged and diseased. Polyps, which are translucent, gelatinous growths in the nasal passages, can develop from the continuous nasal irritation and swelling that accompany allergies. Polyps are not that serious but will predispose you to future sinus infections, and they can cause nasal obstruction.

Allergies can also predispose you to developing sleep apnea (a potentially life-threatening disorder that causes a person o stop breathing during sleep). Untreated allergies can also result in other chronic respiratory problems, such as asthma, or skin problems, such as eczema and hives. Food allergies, drug allergies, and insect-sting allergies can even cause life-threatening anaphylactic shock.

Now that you've decided to see a doctor for your problem, it's time to address an area that keeps many people from seeing an allergist -- medical costs. The next section will explore the financial side of seeking allergy treatment.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Allergy Medical Costs

Allergies aren't cheap. Just look at these facts and figures from the American Academy of Allergy, Asthma, and Immunology:

In 1993, it was estimated that the total cost associated with allergic rhinitis in the United States was $3.4 billion; $2.3 billion of that was for medications, while $1.1 billion represented physician billing.
It is estimated that in 1998, increased absenteeism and reduced productivity due to allergies cost U.S. companies more than $250 million.
In 1996, overall health care expenditures attributable to sinusitis in the United States were estimated to be over $5.8 billion. Allergies are estimated to cost the U.S. health-care industry $18 billion per year.

Those figures are nothing to sneeze at. Allergies and allergy treatments are costly to both the sufferer and society. But you can reduce your own medical costs by allergy-proofing your environment. When diligently followed, allergen avoidance helps control allergy symptoms, which decreases the need for medications and/or helps the medications you already use work more efficiently. Another cost-saving measure is to stay healthy and reduce stress through proper diet, regular exercise, and relaxation. The fewer visits to the doctor for stress-related problems, the more time and money you have for other things.

Lastly, choosing an insurance plan that fits your budget and health requirements can help reduce costs. Many Americans have medical insurance, and most policies pay for allergy treatment to some degree. If you must make an insurance choice, knowing the difference between the types of managed care is important. Here's a quick look:

HMO: A health maintenance organization requires you to choose a "primary care" physician within their network, who in turn will refer you to an allergist or any other specialist. HMOs generally cost less, but you forfeit choice.

Allergy DropsAlthough in its experimental stage, sublingual allergy drops are gaining attention as an alternative to immunotherapy injections. Also known as sublingual/swallow immunotherapy, or SLIT, these drops work much like allergy shots -- a weakened dose of allergen extract is introduced and, it is hoped, the body builds up immunity. Unlike shots, no needle is involved, and you don't need to visit the doctor's office on a regular basis to receive treatment. Instead, the patient is given a small vial of allergens and places drops under the tongue three times a day. SLIT treatment is controversial in the United States and has not been approved by the Food and Drug Administration (FDA), although it has been approved in many countries in Europe. Few allergists in the United States use or recommend SLIT treatment; most are awaiting further studies on its comparative efficacy as well as patient follow-through.

PPO: A preferred provider plan allows you to choose any doctor/specialist as long as that physician is part of their approved preferred physician plan. You can select physicians not listed in the plan, but you'll pay extra. PPOs cost more than HMOs, but the reward is choice and flexibility.

POS: A point of service plan is a cross between an HMO and PPO. Like an HMO, you'll need a primary care physician. However, as with a PPO, you can select any doctor outside that plan, although you'll pay more.

No matter which health insurance plan you choose, be inquisitive about the policy since there is no predicting the extent of your allergy treatment. For some people, allergies may be controlled with one visit to an allergist and one antihistamine prescription. For others, a commitment to several years of allergy shots may be necessary. Since treatments vary, allergy sufferers should cover all angles with insurance policy questions, including the following:

Will I have the freedom to choose my own allergist? If not, how far away is the allergist I must see?
Are allergists on the plan's network certified by the American Board of Allergy and Clinical Immunology?
Will my insurance cover allergy tests and allergy shots? How much will my insurance pay for allergy tests and weekly allergy shots?
What percentage does the insurance pay for prescription drugs? (This can play a major factor in decision-making. Few, if any, prescribed allergy medications come in the less expensive "generic form.")
Does insurance cover special allergy medication or equipment such as EpiPens? Specialized skin creams? Anti-inflammatory drugs?
Will insurance cover alternative therapies? If so, must I first obtain a written prescription from my allergist?

Average Costs of Drug Treatments

It is hard to predict the exact cost of prescription allergy medication since costs vary depending on your insurance coverage and where you purchase the medications. Because discount warehouse stores buy in bulk, they often have cheaper prices. The costs listed below represent an average of what you might expect to pay per month.

Prescription Antihistamines

Clarinex: 30 (5 mg) tablets: $77
Allegra: 30 (180 mg) tablets: $76
Zyrtec: 30 (10 mg) tablets: $63

Nasal Sprays

Beconase AQ: 25 gm: $90
Flonase: 50 mcg: $70
Nasacort AQ: 55 mcg: $68
Nasarel: 29 mcg: $49
NasalCrom: 13 ml: $10; 26 ml: $16 (This is nonprescription and won't last a month.)
Rhinocort Aqua: 32 mcg: $70

Immunotherapy Costs

Out-of-pocket expenses for allergy shots depend on several factors, notably insurance coverage, the number of extracts needed, and the number of allergy shots you need per week. On average, the cost of one allergen extract for one year is around $310 (no insurance). However, many people suffer from multiple allergies, requiring one extract for, say, pollen and another for pet dander. Biweekly or weekly visits to the allergist differ in cost depending on the doctor's fee schedule and your insurance company's policies. Remember this is a four-year plan, whereas medication costs can go on and on and on.

With a strong working knowledge of when to seek treatment and how costly it will be, it is time to select the right doctor for you. In the next section, we will talk about the qualities you should seek in a care provider.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

The brand name products mentioned in this publication are trademarks or service marks of their respective companies. The mention of any product in this publication does not constitute an endorsement by the respective proprietors of Publications International, Ltd. or HowStuffWorks.com, nor does it constitute an endorsement by any of these companies that their products should be used in the manner described in this publication.

Selecting a Doctor

It can be difficult to choose a doctor who will treat your allergies. Should it be your general practitioner (GP)/internist? Or should it be an allergist, a doctor who specializes in allergy treatment? This section will help you select the right doctor..

Finding the Right Doctor

You can certainly start the road to treating your allergies by visiting your GP or internist. After all, the two of you have an established relationship and the doctor is familiar with (or at least has records of) your medical history. That's true for the pediatrician, too, if your child is the one with the allergies. Your primary-care doctor can help determine if your symptoms are the result of an immune-system reaction (that is, allergies) or a non-immunological problem, such as an infection, an intolerance, or a specific disease.

Many general practitioners are knowledgeable about allergies and asthma and are quite capable of treating them. Sometimes, however, your primary-care doctor will recommend that you see an allergist -- a physician that specializes in the diagnosis and treatment of asthma and allergies. After completing medical school and a three-year residency in internal medicine or pediatrics, allergists then complete a two-year fellowship in allergy and immunology. A board-certified allergist is a physician who has done all that, plus passed a comprehensive exam in their specialty. You may also decide to seek the expertise of an allergist if your primary care doctor has not been able to adequately control or treat your symptoms.

When to See A Doctor

If you're experiencing any of the following, be sure to promptly make an appointment with a physician:

You should make an appointment if you recently required emergency treatment for anaphylaxis, a severe and potentially life-threatening allergic reaction characterized by swelling of the throat and constricted airways.
You are experiencing warning signs of asthma such as struggling to catch your breath, wheezing, and coughing, especially at night or after exercise; shortness of breath; or tightness in your chest (severe shortness of breath, chest tightness, or breathing difficulty requires immediate medical attention).
Your nasal problems are causing secondary symptoms, such as chronic or recurrent sinus infections, nasal congestion, or difficulty breathing.
You experience hay fever or other allergy symptoms several months out of the year.
Antihistamines and other over-the-counter medications do nothing to control your allergy symptoms or create unacceptable side effects, such as drowsiness.
Your symptoms are interfering with your ability to carry out daily activities.
Your symptoms decrease the quality of your life.

You may also want to consider seeing a specialist:

To get specific advice on environmental control.
If you think you may be a candidate for immunotherapy (allergy shots).

Now that you know what kind of doctor to select and when to make an appointment, it is important to know how to talk with your doctor. The next section will concentrate on the questions to ask yourself before making your first doctor's appointment.

How to Choose an Allergist Beginning treatment with a new doctor can be intimidating. These tips will help you pick an allergist who is right for you:

Ask your family doctor for his/her recommendation.
Ask respected friends and family for physician recommendations. Inquire about what they were seen for, the method of treatment, and how the doctor responded to concerns and questions.
Consult the American Academy of Allergy, Asthma, and Immunology (AAAAI) Physician Referral and Information line at 1-800-822-2762 or their online referral directory at www.aaaai.org for information.
Make sure the doctor is board certified.
Find out whether the doctor participates in your medical insurance plan.

Visiting a Doctor

Your visit with the doctor will produce the best results if you prepare for it ahead of time. That means you need to do some investigative work first. This section will cover the preparation before making your first visit to your physician or allergist.

How to Prepare for the Doctor's Visit

Pretend you're a medical journalist researching a topic -- only the topic is yourself! Take out a pen and a piece of paper and make notes about the what, where, when, and how of your symptoms.

Here are some questions to ask yourself or your child:

What? What are your symptoms? Try to be specific even if it sounds unpleasant or ordinary, i.e., "I cough up yellow mucus" or "I sneeze whenever I rake leaves." As you list them, rank them according to their severity: 1 is mild while 10 is unbearable.
Where? This question requires some observation. Do you sneeze when you visit Aunt Betty and her three cats? Do you break out in a rash after eating Chinese food? Do your eyes swell shut after a walk in the park? Closely examine your living quarters and take notes: Are the pillows ancient? Is mom's lovely macrame a dust collector? How many house-plants populate your home?
When? When did the symptoms first occur? What time of day is most problematic? Are certain times of year worse than others? Do symptoms occur hourly, daily, monthly, or seasonally?
How? How does this problem affect you? Do these problems interfere with your life and to what extent? Do they affect your ability to play sports? Work? Stay awake? Eat out? Kiss your sweetheart?

The More Info, The Better

The answers to the questions above will provide the doctor with a good understanding of your allergic symptoms. But there are a couple other pieces of the allergy puzzle that you'll have to provide so the picture is complete.

They are:

Your family's medical history. Does anyone in your immediate family have allergies? If so, what kind? Beyond that, be aware of undiagnosed symptoms in your family. If dear, stubborn Dad constantly sniffles and sneezes yet always claims "it's a cold," make a note of that, too.
Medicines that you take. Make a list of all the medications you take or have taken and any reactions you have had to them. Be sure to include prescription, over-the-counter, and herbal products.

Remember, the better informed you are, the better able the allergist will be to assess your condition. Medical students are often told that 80 percent of the diagnosis comes from patient history, while 20 percent comes from exams and lab tests. The information you provide, then, or for that matter the information you neglect to offer, will impact the precision of the doctor's diagnosis and treatment.

Did You Know?More than 14 million visits to office-based physicians each year are attributed to allergic rhinitis.

Your First Appointment

Whether you see your primary-care physician or an allergist, the first appointment will start with a conversation. All the investigative reporting you did will come in very handy at this point. The doctor will ask you a lot of questions about your symptoms, your medical history, your family history, your household, and even your work environment.

After you've talked, the doctor probably will examine you. The doctor will be looking for clinical signs of allergies and their complications (such as fluid in the ear, sinusitis, and wheezing). The results of the medical history and the exam will give your doctor a good idea of the nature of your allergies and what the most effective treatment might be. The doctor will discuss the findings with you. Sometimes, however, the doctor will want more information, information that only allergy tests can provide.

Allergy testing is indicated if:

Symptoms are present for 3 or more months a year.
Symptoms don't respond well to medications or there are unacceptable side effects from medications.
The patient would like to decrease medications.
There is a need to know about specific allergies. (For instance, before you kick your dogs out of the bedroom, you'd like to be certain that they're the cause of your symptoms.)
You have complications from allergies.
You have required oral steroids or steroid shots for allergies in the past.

Your doctor will most likely run some allergy tests after consulting with you. There are different kinds of tests. So you know what to expect, we will cover the basic allergy tests in the next section.

Fact or Fiction? Chiropractors and AsthmaMyth: Chiropractors can treat asthma effectively.

Fact: Asthma results from an overreaction of the immune system. Because of this, allergy/immunology specialists are often the best physicians to treat asthma and allergies. These doctors are pediatric or internal medicine physicians who have elected to do an additional two years of training to become specialized in the treatment of these diseases.

A Guide to Allergy Tests

There are several kinds of allergy tests, the most common of which are skin tests and blood tests. If your doctor wants to do skin tests, you may need to schedule another appointment for them, as they take some time to administer and read. You'll also have to schedule an appointment if you've recently taken an antihistamine or other medication, as they can interfere with the results.

This section explains the various types of allergy tests and what they can tell you and your doctor.

Scratch or Prick Tests

These skin tests involve applying a small diluted drop of the suspected allergen to the skin and then scratching or pricking the skin so that the allergen is absorbed. Typically, many allergens are tested at one time, and most allergists use panels based on the allergens found in their community. The arm is used for a smaller number of tests; the back is used for more extensive tests. If you are allergic to a particular allergen, you will have a reaction to it in the form of redness and/or a bump in less than 20 minutes. The doctor or an assistant will inspect the scratch areas and write down a number corresponding to the size and extent of the reaction. Skin tests aren't painful, but they can be itchy. Occasionally the arm swells.

Intradermal Tests

Another type of skin test, the intradermal test, involves injecting a minute amount of the irritant allergen under the skin. Intradermal tests are more sensitive and can better identify substances to which you have a weak allergy. Most board-certified allergists do scratch tests first and then follow up with intradermal testing. Although people often fear this kind of testing because of the needle, the needle is small and is barely slipped under the skin.

Each type of skin test has advantages and disadvantages. The scratch/prick tests let the doctor test a large number of allergens at once. Intradermal tests provide more accuracy in determining certain allergens. Both tests are typically used to determine common allergens, such as cat dander, mold spores, and weeds. They are not always valid for food or chemical allergies.

Whether you take a scratch or an intradermal test, you won't be able to leap out of the doctor's office afterward. You'll be required to wait at least 30 minutes in case you develop a stronger reaction.

Patch Tests

Patch tests are most often used to determine the source of contact dermatitis. The doctor will apply square adhesive patches, each containing potential allergens, to your back. Patients usually wear these patches for about 48 hours because reactions to them can be slow to develop. You can't take a bath or shower while the patches are in place. Like the scratch and prick tests, the area exposed to the allergen will be swollen and red if you're allergic. Some itching might occur.

Blood Tests

Blood tests are often performed on people who have had life-threatening allergic reactions or who have extensive rashes or skin problems that make skin testing impractical. If you have food allergies, blood tests can reveal the specific allergens. Called RAST (or radioallergosorbent test), the blood test measures the amount of IgE antibodies your body has produced as a result of exposure to a certain allergen. No test is perfect, and RAST can both over-diagnose and miss certain allergies.

Additionally, it is more expensive than skin testing. RAST tests can vary from lab to lab. Recent data suggest that the CAP RAST is the most reliable form of this test.

Double-Blind Food Challenge

Another way to detect food allergies is with the food challenge. The proteins found in food are hidden in gel capsules, and the patient is given those capsules as well as placebo capsules. Reactions to the various capsules are noted. This test eliminates subjective conclusions on the part of the patient or the doctor because neither knows which capsules contain the food proteins before the patient takes them (that's why it's called "double blind"). However, the test is time-consuming, complicated, and expensive, and the physician may not note delayed reactions.

A less intrusive method, although time-consuming and susceptible to patient subjectivity and error, is the trial-elimination method. A limited selection of foods are eliminated from the diet over a course of three days to three weeks. Each food is then gradually restored to the diet and any reactions are noted.

All allergy tests, while effective, can provide misleading results. The results always must be interpreted in the context of the patient's history. That's why your history and your detective work are so crucial to the proper diagnosis.

However, there are also tests you should avoid, due to their questionable effectiveness.

Allergy Tests to Avoid

Some allergy tests remain questionable in the eyes (and research) of the medical profession. Many are based on treatments whose safety and effectiveness are unproved. This section will cover a few of the allergy tests that are considered questionable. Before starting any treatment, it is best to consult your doctor.

The Cytotoxic Test

In this food allergy test, a patient's white blood cells are mixed with the food antigen. The cells are examined for any changes, which determine a food allergy. Problems: The test may show a negative result if the food wasn't eaten recently. The expertise of the technician reading the results can affect the test's accuracy. Lastly, it is expensive.

Applied Kinesiology

The allergen is placed in the hand of the patient and the tester pushes on the other arm to determine muscle response. If the person is allergic to the allergen, the tester will be able to push the arm down with little resistance. If the person isn't allergic, the tester will have great difficulty pushing the arm down.

The Pulse Test

In this test, the pulse rate is measured following exposure to a particular allergen.

The Provocation-Neutralization Test (also known as the Intradermal Provocation Technique or Sublingual Provocation and Neutralization)

The provocation part: Progressively stronger doses of an allergen are given via injection (intradermal) or under the tongue (sublingual) until symptoms appear. The neutralization part: Doses are decreased until symptoms disappear.

The IgG RAST Test

Advocates of this test claim this is another allergy response, but this has not been proved. In fact, IgG responses are often protective. This is one of the tests used to measure the effectiveness of venom immunotherapy. The meaning of the test is questionable at best and subject to misinterpretation.

While the labryinth of allergy tests is hard to get through, it can also be a tough task to choose an allergy medicine. The next section will give you the information needed to select an appropriate medication.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Choosing an Allergy Medication

Allergy medicines can be nonprescription or prescription drugs, expensive or reasonably priced, fast-acting or time-released. They come in pill, capsule, liquid, and nasal spray forms. New drugs seem to arrive on the shelves almost monthly, while established drugs sometimes are removed from the market after they're belatedly found to have dangerous side effects.

Allergy Terms to
Know Definitions
Histamine: A compound released by cells of the immune system in an allergic reaction. Characteristics of histamine release include, but aren't limited to, itching, sneezing, runny nose, stimulation of stomach secretions, dilation (expansion) of blood vessels, increased mucus secretion, decrease in blood pressure, and contraction of airway muscles.

Antihistamine: A drug used to counteract histamine by blocking the binding of histamine to its receptors.

Antihistamines

Antihistamines are the primary and first line of defense against allergy symptoms, such as sneezing, runny nose, and itchy eyes and throat. They have a long track record, more than 50 years, and have proved to be effective at controlling allergy symptoms, particularly when begun before symptoms start.

Antihistamines work by preventing histamine, a chemical that is a main player in the body's allergic response, from binding to its receptor. Antihistamines are less effective after symptoms are present but can still temporarily diminish their severity. Some antihistamines work quite well even after symptoms are present. However, they can lose their effectiveness if used daily for long periods of time.

Over the Counter or Prescription?

Allergy sufferers often turn to over-the-counter (OTC) medications first. That's because they're readily available at any drugstore and don't require a visit to the doctor. There's nothing inherently wrong with using an over-the-counter product. But there are several important considerations.

At-Work Risks
and Antihistamines
A clinical study conducted by the Group Health Cooperative of Puget Sound found that people on OTC sedating antihistamines are 50 percent more likely to have a work-related accident than people on non-sedating antihistamines.

First of all, over-the-counter antihistamines are for temporary use and should never be self-administered as part of your own long-term allergy treatment program. Even limited use can cause side effects. Some over-the-counter antihistamines are sedating, meaning that they cause drowsiness and slow your reflexes, impairing your ability to drive, operate heavy machinery, or participate in any activity that requires quick reflexes. Alcohol can aggravate these effects. Other side effects include dry mouth, dry sinuses, dry eyes, and stomach upset.

Second, while antihistamines work like linebackers, blocking histamines trying to cause an allergic touchdown, OTC antihistamines often come with their own referee: a decongestant (listed as pseudoephedrine on the label). Decongestants help unstuff problem areas, mainly the nose, but they come with their own set of side effects, too, including nervousness, insomnia, elevated blood pressure, heart palpitations, and for men, prostate problems. While some believe these side effects offset the drowsiness caused by the antihistamine, they can be dangerous, particularly if you have a preexisting medical condition. Most doctors recommend using only single-ingredient products. If you're sneezing and itching, use an antihistamine. If you're all clogged up, use a decongestant for a day or two. (And always be sure to read and follow package directions.)

How to Choose an OTC Antihistamine

It's best to go to the drugstore as an informed consumer so you can make the best choice in an OTC antihistamine. Here's how the name brands differ from one another:

Medication Interaction
Warning
Popping pills indiscriminately can open up a can of worms, or in the worst-case scenario, it can open up a coffin lid for you. Always read the labels of OTC and prescription medicines to check for drug interaction precautions. When talking to a doctor, list all medications and supplements you use -- OTC, prescribed, herbal, homeopathic. (It helps to write them down.) Should any doubts or uncertainties exist, pick up the phone and call your pharmacist or doctor. A quick check could save you from a life-threatening experience.

Chlor-Trimeton and Dimetapp belong to the alkylamine family, which are not too sedating or drying.

Benadryl and Tavist belong to the ethanolamine family and are very sedating and drying.

Actifed belongs to the piperadine family and is less sedating but somewhat drying.

Claritin (loratidine) is non-sedating and is not drying.

When selecting and using an OTC antihistamine, follow these guidelines:

Read the labels and follow all directions.

Do not exceed the recommended dosage.

Do not take them for a prolonged period of time.

Consult the pharmacist and check for any drug interactions with your chosen product.

Focus on your symptom and buy a drug designed to treat that symptom. Drugs that attempt to relieve every symptom can expose you to unnecessary medications and risks.

Overuse of
Nasal Sprays
Over-the-counter decongestant nasal sprays (Afrin, Neo-Synephrine, Otrivin, Duration Nasal Spray, etc.) should only be used for short-term (as in two to three days) symptom relief. Use them for a longer period and you might suffer a nasty rebound effect. In addition, used too long, these medicines lose their effectiveness. Not only that, but overuse can irritate and inflame the mucous membranes in your nose, making you more congested than ever. If you experience rebound, you'll be tempted to squirt more stuff up your nose. Resist the urge, or you'll start a vicious cycle of congestion. Always abide by the warning labels of OTC nasal sprays and stick to the time-use limitations.

Be especially careful if you're a senior citizen. Elderly people are more susceptible to side effects of antihistamines and may suffer blurred vision, light-headedness, dry mouth, confusion, and drowsiness.

Do not take OTC antihistamines if you have breathing problems, heart problems, high blood pressure, diabetes, glaucoma, prostate gland problems, difficulty urinating, peptic ulcer, or liver or kidney damage. Women who are pregnant or nursing should always consult their physician before taking any drug.

For a quick solution to short, seasonal suffering, OTC antihistamines help relieve symptoms. However, if they don't sufficiently lessen your symptoms or if the side effects increase your suffering, consult a doctor for long-term solutions.

Prescription Antihistamines

Many prescription antihistamines are non-sedating, work longer and faster, and have fewer and less noticeable side effects than their drugstore siblings. Those benefits mean that prescription antihistamines, particularly those called "second generation antihistamines" such as Allegra (fexofenadine), Clarinex (desloratadine), and Zyrtec (cetirizine), are generally safer to use and will fit better with your lifestyle because you'll have to take them only once or twice a day. Allegra, Clarinex, and Zyrtec come as single-ingredient products or in combination with decongestants.

The benefits of prescription antihistamines can come at a cost, as they sometimes are more expensive than their OTC counterparts.

However, some prescription antihistamines, such as Allegra and Flonase, are available as generics and are less expensive. Since you'll need fewer pills if you're taking a prescription antihistamine, they may not be quite as expensive, comparatively, as they first seem. And if you have prescription-drug insurance, some or all of the cost may be covered.

Astelin, a prescription antihistamine nasal spray, is one of the newest forms of allergy treatment. It reduces the symptoms of allergic rhinitis without drowsiness and without many side effects. It is another therapeutic option.

There are other allergy treatments than just prescription medication. Among them are nasal sprays, skin treatments and eye drops. We will take a look at all three in the next section.

Driving and Antihistamines
Don't think drunk drivers are the only danger on the road. Ordinary allergy sufferers who take OTC antihistamines can be just as dangerous, according to a study reported in the Annals of Internal Medicine. (The study was funded by research organizations and pharmaceutical companies.)

The study concluded that taking the recommended dosage of OTC antihistamines (notably ones containing diphenhydramine, such as Benadryl) could impair a person's driving ability even more than being legally drunk. A more alarming outcome of the study, however, was the fact that those taking OTC antihistamines didn't feel drowsy or impaired. Self-assessment, then, is no indicator of drowsiness.

What does this mean to the poor allergy sufferer? Never drive while using OTC antihistamines, even if you feel alert. Not only are you a danger to yourself and others, but you may also be slapped with a DUI (driving under the influence) ticket if pulled over. Laws differ from state to state, but many DUI laws apply to drivers impaired by OTC medications used to treat allergies and cold symptoms.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

The brand name products mentioned in this publication are trademarks or service marks of their respective companies. The mention of any product in this publication does not constitute an endorsement by the respective proprietors of Publications International, Ltd. or HowStuffWorks.com, nor does it constitute an endorsement by any of these companies that their products should be used in the manner described in this publication.

Allergy Nasal Sprays, Skin and Eye Treatments

If your allergies are causing irritation in a particular part of your body -- the nose, the skin, or the eyes -- there are treatments designed specifically to alleviate these symptoms. Here's what you need to know:

Nasal Sprays

Antihistamines and decongestants aren't the only kinds of medication that can be delivered via nasal spray. Corticosteroids are hormones produced by the adrenal glands, but they can be synthetically manufactured. Allergy medications containing corticosteroids have the ability to interfere with the allergic reaction and prevent symptoms.

Overuse of
Nasal Sprays
Repeated use of some nasal inhalants can cause a perforation of the nasal septum (the mucous membrane-covered bone and cartilage partition dividing the nostrils). To help prevent problems when using a steroid nasal spray, direct the spray away from the septum, or toward the outer wall of the nostril. If nosebleeds develop, stop using the medication and call your doctor. Also, have your doctor examine your nose regularly.

Corticosteroid sprays are used to reduce inflammation and congestion of nasal passages, while sprays that contain cromolyn sodium, which is neither an antihistamine nor a corticosteroid, are used to inhibit the allergic response.

Nasal steroid sprays are prescription only, but NasalCrom, a spray that contains cromolyn sodium, can be purchased over the counter.

Many allergists prescribe corticosteroid nasal sprays, also called steroid nasal sprays (brand names include Beconase, Flonase, Nasacort, Nasonex, Nasarel, and Rhinocort), to give their patients long-lasting freedom from stuffiness or sneezing. Although improvement may be noticed less than a day after treatment begins, it may take up to seven days to reach peak effect.

Corticosteroid nasal sprays are not habit-forming, but they are not entirely free of side effects, which my include nasal irritation and burning, sore throat, and nose bleeds. However, the incidence of these side effects is low. Most of these sprays require only one application a day, making them as convenient as prescription antihistamines.

Nasal Irrigation
Nasal irrigation is a nonmedical, safe way to clear the nose of mucus and soothe irritated membranes. It controls symptoms of congestion and especially postnasal drainage. Store-bought nasal saline sprays also help moisturize the nose and are nonaddictive.

Corticosteroids also decrease nasal itching, sneezing, runny nose, and nasal congestion and are now considered the first line of treatment for allergies. Antihistamines are "second line" treatments.

Cromolyn sodium (NasalCrom) is a nasal spray that inhibits the allergic response by preventing the release of histamines. Cromolyn sodium nips symptoms such as sneezing and nasal congestion in the bud, before they start.

However, patients must have patience to use this spray. NasalCrom is a relatively weak medication and must be used four times a day. It may take up to 60 days for NasalCrom to achieve its full potential, so it helps to start using it before allergy season begins. Side effects may include nasal burning and stinging.

Skin and Eye Allergy Treatments

While there are pharmacies full of decongestants and antihistamines, allergy relief for skin and eye irritation is not as readily available. There are a few products out there, however, and some precautions you should know about using them.

The most effective way to prevent contact dermatitis is to avoid whatever bothers the skin, be it soap, a cleaning agent, or a certain material or metal. Avoidance is easier said than done since the skin comes in contact with hundreds of substances daily.

Did You Know?
Antihistamine use can affect the results of allergy skin tests.

For atopic dermatitis, or eczema, wear non-latex gloves when doing the dishes and using cleaning agents. Keep your skin moist by using a moisturizing cream or petroleum jelly, especially after bathing because it locks in the moisture. Don't use a lotion that contains alcohol or water because those ingredients can dry out the skin.

Most dermatologists and allergists prescribe topical (meaning applied to the skin) corticosteroids, a popular means to reduce inflammation and stop itching. Oral OTC antihistamines also are used in treatment of minor allergic skin reactions, and the resulting sedating effects can help an itchy person catch some ZZZ's. When broken skin results in an infection, antibiotics may be prescribed.

Eyedrops

Red, itchy, watery eyes are common allergy symptoms -- symptoms that can drive sufferers to distraction. Over-the-counter eyedrops, most of which are decongestants that constrict the blood vessels, may temporarily relieve suffering, but they should not be used regularly. (Follow package directions carefully) Overuse of OTC eyedrops causes a rebound effect, much like that from nasal spray overuse. Allergists often prescribe an antihistamine or anti-inflammatory eyedrop for those suffering from prolonged eye irritation. Allergic eyes can be the only, or the main, allergy symptom. Rubbing irritated eyes can lead to an eye infection because bacteria can be introduced via the hands. You can tell if you have allergic conjunctivitis, rather than an infection, by the nature of the discharge. Allergic conjunctivitis is usually present in both eyes and the discharge is typically stringy rather than puslike.

Allergy Shots

Immunotherapy, also called allergy shots, desensitization therapy, and hyposensitization therapy, is the only allergy treatment that can decrease your long-term sensitivities to allergens. The concept is based on the same principle as immunizations, such as those for the flu or polio. Small, steady doses of an allergen or allergens are introduced into the body so that you can develop a tolerance to it. The injections lead to the development of a protective immune response both by increasing the suppressor T cells and by increasing the protective, or "blocking," antibodies. The more tolerant the body becomes, the fewer symptoms you will have. The good news is that immunotherapy ultimately provides meaningful improvement in up to 90 percent of patients with seasonal allergic rhinitis and in 70 to 80 percent with perennial allergic rhinitis.

How Allergy
Serums Are Made
In an oversimplification of the serum-extract process, allergy serums are collected and processed much like commercial food products. For example, pollen is gathered through a variety of means, then filtered, concentrated, and processed into a serum. A cat dander serum is extracted from cat dander. One of the more revolting processes involves those ugly cling-ons: dust mites. Mites are raised in large batches until they die. Dead mites -- fecal waste and all -- are gathered and processed to produce an extract. If that's an unappetizing thought, it is best not to think about how they concoct cockroach serum.

When to Consider Allergy Shots

Does your medicine cabinet resemble a drugstore? Does your drippy nose douse the flames of passion? Do you feel tired 24/7? If allergy medications aren't effective, or aren't effective enough, at controlling your symptoms, ask your doctor about immunotherapy, or allergy desensitization. Allergy shots have been shown to prevent development of new allergies and reduce the likelihood of developing asthma from 58 percent to less than 23 percent in children with allergic rhinitis. Allergy shots can make a tremendous difference in your life. Coupled with environmental control, allergy shots can both decrease your symptoms and help you get better control over allergies.

Allergy shots are suggested when:

There is an incomplete response to medications.

There are unacceptable side effects from medications.

Avoidance is impractical.

There is a desire to decrease long-term use of medications, such as in a child or in a woman who may wish to get pregnant a few years down the road.

They may prevent the development of additional allergies or related health problems. In children, allergy shots have been shown to decrease the likelihood of developing asthma.

Why There Are No
Home Allergy Shots
Allergists don't allow patients to self-administer allergy shots because of the risk of anaphylactic shock, a serious and potentially fatal reaction. Also, home-based patients prone to procrastination may not stick to the prescribed treatment schedule, resulting in complications. Even if your family member is a nurse or doctor, they may not have the equipment necessary to treat a life-threatening reaction at home.

The first step in immunotherapy is allergy testing, which will tell the doctor what you're allergic to and how sensitive you are to it. Using the test results and your history, the allergist will prepare your own personal extracts, made of one or many allergens. Since most allergic people react adversely to many allergens, several extracts (placed in individual vials) may be made. Some people will need only one shot each time, while others will need more than one extract mixture (and more than one shot), depending on how many allergens need to be covered.

Most extracts are for airborne allergens, such as pollens, mold spores, dust mites, and animal dander, and for insect-sting allergies. (Desensitization therapy targeting insect-sting allergies is called venom immunotherapy.) There are no FDA-approved extracts for food allergies or latex allergies and few for chemical allergies.

The Pros and Cons

As with any medical treatment, immunotherapy has advantages and disadvantages. It's best to examine both before, shall we say, taking a shot at it.

Use of BenadrylBug bites, cat scratches, and allergy injection sites often swell and itch. Treatment for minor allergic reactions involves applying a cold compress and using an OTC oral antihistamine, such as Benadryl. When stocking the medicine cabinet and first-aid kits, be sure to include an antihistamine. But remember, Benadryl, as well as many other over-the-counter antihistamines, is sedating.

Immunotherapy advantages:

Immunotherapy is the only allergy treatment that alters immune system reactions and can have lasting benefits.

Allergy shots, taken on a regular schedule, help relieve symptoms, especially for those suffering from airborne and perennial allergies.

Immunotherapy is a well-established and effective treatment that has been used since the early 1900s. It is constantly advancing and improving. For example, 20 years ago extracts contained little or no dust-mite allergens. Now they do.

Allergy extracts are not physiologically addictive.

Many patients find relief after three to six months of treatment.

Shots are safe. They may be given to children and pregnant women, although shots should not be started during pregnancy. Following an injection, patients are monitored at the doctor's office for any reactions.

Allergy Shots
and Pregnancy
Any woman who is pregnant or considering becoming pregnant should always consult the doctor before starting or continuing an allergy-treatment program. With that said, many pregnant women will be happy to know that pregnancy and immunotherapy are usually compatible if the expectant mother has already started the desensitization program. The injections contain the same allergenic materials the mother breathes in. Doctors may decrease a pregnant woman's dose to minimize the risk of reaction, but expectant moms are usually encouraged to follow through with shots during the entire nine months. Remember, shots are a means to decrease the use of medication.

Most shots are administered with a fine needle and into fatty tissue and therefore are not painful.

A 3- to 5-year immunotherapy program may provide allergy relief for 10 to 30 years.

Immunotherapy disadvantages:

Inconvenience. Inconvenience. Inconvenience. Allergy shots are usually given every week for several months or more, then every other week, and finally every three or four weeks. Having to make so many trips to the doctor's office can be a major disadvantage for those with hectic work schedules and busy lives. Individuals living in rural locations might find it difficult to make a long trip to the doctor's office so frequently.

A heavy-duty commitment. Depending on your sensitivity, you could be receiving shots for three to five years.

Allergy shots aren't a cure-all. (Then again, nothing is.) The battle against allergies is multidimensional. You can't rely on shots alone to relieve symptoms. If no avoidance measures are taken, such as allergy-proofing the home, shots may prove ineffective.

Many children and some adults dread shots.

The injection site may be sore and red for several hours or days. Shots should be rotated from arm to arm with each dose.

Risk of anaphylaxis (symptoms include swollen lips, tongue, or ears; uneasiness or agitation; red face; hives; prickling and itching sensations in the throat and skin; throbbing or ringing in the ears; sneezing, coughing, or breathing difficulty; nausea or vomiting; dizziness; loss of bladder or bowel control; convulsions; weak, rapid pulse; cold, clammy, pale skin; and unresponsiveness) is the most serious side effect. However, most allergists require a patient to remain in the office for 15-30 minutes after receiving a shot -- a necessary, but inconvenient requirement. The risk is higher in patients with uncontrolled asthma.

Shots don't control food allergies and may aggravate skin allergy symptoms. But they can actually help eczema.

Once you've identified your allergy problem, the next step is choosing a treatment. While there are a number of effective treatments, it is important you select the right one for you. This can range from a simple over-the-counter drug to a prescription medication. Your doctor, once you've found the right one, should be able to help.

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