Allergy medications are dispensed in many forms, namely tablets, liquids, inhalers, drops, topical creams and even as injections. Now, lets take a brief look at some of them.
1) Antihistamines (AH) - this forms the front line of an allergy. They are classified into many groups acceding to its sedating properties. They work mainly by nullifying the effects of the main allergy chemical in our body i.e. histamine. Some of the more common antihistamines prescribed by doctors are cetrizine (levocetrizine), chlorpeniramine, benadryl, and loratidine (desloratidine). Antihistamines reduces the symptoms of allergy such as itch, runny nose, sneezing and allergic rashes (not eczema). Aside tablet forms, AH is also available as eye/nose/ear drops. Intranasal antihistamine are also gaining popularity.
2) Corticosteroids (CS) - While Steroids may send shivers down the spine of some patients, we have to bear in mind that they are naturally occurring in the human body. Steroids are absolutely essential for the normal functioning of the body. While I will not go in detail on its role, suffice to say that a large part of our hormone are steroids in nature. It is interesting to note that from the diagram above, we can see that Cholesterol is the starting point in chemical pathway for the steroid formation. This is why I always tell my patients that having some cholesterol is essential for the body. Anyway, not to digress, steroids here are used to suppress our hyperactive and confused immune system form overreacting; thus causing allergic symptoms. Having said that, it is also important to note that steroid are not usually the first line treatment by the doctors except in severe cases.
3) Monteleucast (Singulare) - mast cell stabilizers that reduces the release of allergy chemicals forms mast cells. This makes this drug ideal for chronic allergies and asthmatics. It is not used in an acute allergic episode. The drawback of this drug is its cost.
4) Allergy shots - these are actually a form of immunotherapy. Once the offending allergen is known, the allergist will inject carefully titrated doses of allergens every fortnight. The rationale behind this treatment is by allowing the body to accept the allergen and not to fight it. These injections are very costly, and are not given as a routine.
5) Immunotherapy - is the cutting edge of allergy treatment. It can be said allergy treatment is leading the way in possible future treatment of all illness. For the first time, we can actually modify our immune system not to overreact to allergens. So far there are immunotherapy to treat allergies to house dust mite, bee/wasp stings and tree pollen allergens. Immunotherapy can be injected as a fortnightly injections for 2-3 years (Ouch!) to make our immune tolerate to pollen or bee sting. Currently Immunotherapy for house dust mite and tree pollens can be administered as drops below the tongue daily. This method has gained more acceptance and is proving to be a success in North America & Europe. Its use is limited in Asia due to its cost (about Rm 400-500/months x 2 years).
6) Epipen - This is a life saving device prescribed to patients with history of a serious Anaphylatic reaction. An anaphylactic reaction is the most serious form (life threatening) of allergy. Symptoms of an anaphylactic reactions include chocking, coughing, vomiting and shortness of breath on exposure of allergy. It usually occurs to food allergy such as seafood, nuts and even some fruits. Epipen is an automatic injection that is pre filled with epinephrine. The patient is thought to recognize symptoms of anaphylaxis and how to use the epipen device. In Malaysia, its availability is scarce and many doctors are not trained in its use.
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