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__NOTOC__
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{{Allergy}}
{{Allergy}}
{{CMG}}
{{CMG}}; {{AE}} {{MMT}}
 


==Overview==
==Overview==
Treatment for allergic response is primarily pharmacotherapeutic. Common methodologies include immunotherapy via [[desensitization]] or [[hyposensitization]], [[enzyme]] potentiated desensitization.
The mainstay of treatment for [[allergy]] is pharmacological [[medical therapy]].


==Medical Therapy==
==Medical Therapy==
There have been enormous improvements in the medical treatments used to treat allergic conditions. With respect to anaphylaxis and hypersensitivity reactions to [[food]]s, [[drug]]s, and insects and in allergic skin diseases, advances have included the identification of food proteins to which [[IgE]] binding is associated with severe reactions and development of low-allergen foods, improvements in skin prick test predictions; evaluation of the [[atopy]] patch test; in wasp sting outcomes predictions and a rapidly disintegrating [[epinephrine]] tablet, and anti-IL-5 for eosinophilic diseases.<ref>{{cite journal |author=Sicherer SH, Leung DY |title=Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects |journal=J. Allergy Clin. Immunol. |volume=119 |issue=6 |pages=1462-9 |year=2007 |pmid=17412401 |doi=10.1016/j.jaci.2007.02.013}}</ref>
*Medical therapies for [[allergy]] include  [[pharmacotherapy], [[immunotherapy]] and [[Unproven therapy]]. Immunotherapy via [[desensitization]] or [[hyposensitization]], as well as [[enzyme]] potentiated desensitization, are common methodologies. The medical treatments for allergic conditions have vastly improved in recent years.<ref>{{cite journal |author=Sicherer SH, Leung DY |title=Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects |journal=J. Allergy Clin. Immunol. |volume=119 |issue=6 |pages=1462-9 |year=2007 |pmid=17412401 |doi=10.1016/j.jaci.2007.02.013}}</ref>


Traditionally treatment and management of allergies involved simply avoiding the allergen in question or otherwise reducing exposure.  For instance, people with cat allergies were encouraged to avoid them.  While avoidance may help to reduce symptoms and avoid life-threatening [[anaphylaxis]], it is difficult to achieve for those with pollen or similar air-borne allergies.  Strict avoidance still has a role in management though, and is often used in managing food allergies.


===Pharmacotherapy===
===Pharmacotherapy===
Several [[antagonism|antagonistic]] drugs are used to block the action of allergic mediators, or to prevent activation of cells and degranulation processes. These include [[antihistamine]]s, [[cortisone]], [[dexamethasone]], [[hydrocortisone]], [[epinephrine]] (adrenaline), [[theophylline]] and [[cromolyn sodium]]. Anti-[[leukotriene]]s, such as [[Montelukast]] (Singulair) or [[Zafirlukast]] (Accolate), are FDA approved for treatment of allergic diseases. Anti-[[cholinergic]]s, [[decongestant]]s, mast cell stabilizers, and other compounds thought to impair eosinophil [[chemotaxis]], are also commonly used. These drugs help to alleviate the symptoms of allergy, and are imperative in the recovery of acute anaphylaxis, but play little role in chronic treatment of allergic disorders.
*''[[ANTIHISTAMINE]]S''
 
*''[[CORTICOSTEROID]]S''
''[[ANTIHISTAMINE]]S''
*[[epinephrine]] (adrenaline)
 
*[[theophylline]]
Antihistamines are available over-the-counter and by prescription. They are available in many forms, including:
*[[cromolyn sodium]]
 
*Anti-[[leukotriene]]s
*[[Capsule]]s and [[pill]]s
*Anti-[[cholinergic]]s
*Eye drops
*[[decongestant]]s
*[[Injection]]
*mast cell stabilizers
*Liquid
*[[Nasal spray]]
 
''[[CORTICOSTEROID]]S''
 
Anti-inflammatory medications (corticosteroids) are available in many forms, including:
 
*Creams and [[ointment]] for the skin
*[[Eye drop]]s
*[[Nasal spray]]
*Lung inhaler
Patients with severe allergic symptoms may be prescribed corticosteroid pills or injections for short periods of time.
 
''[[DECONGESTANT]]S''
 
Decongestants can help relieve a stuffy nose. Decongestant nasal spray should not be used for more than several days, because they can cause a "rebound" effect and make the congestion worse. Decongestants in pill form do not cause this problem.


''OTHER MEDICINES''


[[Leukotriene inhibitor]]s are medicines that specifically block the substances that trigger allergies. [[Zafirlukast]] (Accolate) and [[montelukast]] (Singulair) are approved for those with asthma and indoor and outdoor allergies.


===Immunotherapy===
===Immunotherapy===
Desensitization or [[hyposensitization]] is a treatment in which the patient is gradually [[vaccination|vaccinated]] with progressively larger doses of the allergen in question. This can either reduce the severity or eliminate hypersensitivity altogether. It relies on the progressive skewing of [[IgG]] antibody production, to block excessive IgE production seen in atopys. In a sense, the person builds up immunity to increasing amounts of the allergen in question. Studies have demonstrated the long-term efficacy and the preventive effect of immunotherapy in reducing the development of new allergy.<ref name="pmid10963288">{{cite journal |author=Ross RN, Nelson HS, Finegold I |title=Effectiveness of specific immunotherapy in the treatment of allergic rhinitis: an analysis of randomized, prospective, single- or double-blind, placebo-controlled studies |journal=Clinical therapeutics |volume=22 |issue=3 |pages=342–50 |year=2000 |pmid=10963288 |doi=10.1016/S0149-2918(00)80038-7}}</ref> Meta-analyses have also confirmed efficacy of the treatment in allergic rhinitis in children and in asthma. A review by the Mayo Clinic in Rochester confirmed the safety and efficacy of allergen immunotherapy for allergic rhinitis and conjunctivitis, allergic forms of asthma, and stinging insect based on numerous well-designed scientific studies.<ref name="pmid17803880">{{cite journal |author=Rank MA, Li JT |title=Allergen immunotherapy |journal=Mayo Clin. Proc. |volume=82 |issue=9 |pages=1119–23 |year=2007 |month= Sep |pmid=17803880 |doi=}}</ref>  Additionally, national and international guidelines confirm the clinical efficacy of injection immunotherapy in rhinitis and asthma, as well as the safety, provided that recommendations are followed.<ref name="pmid17418661">{{cite journal |author=Passalacqua G, Durham SR |title=Allergic rhinitis and its impact on asthma update: allergen immunotherapy |journal=J. Allergy Clin. Immunol. |volume=119 |issue=4 |pages=881–91 |year=2007 |pmid=17418661 |doi=10.1016/j.jaci.2007.01.045}}</ref>
*Desensitization, also known as [[hyposensitization]], is a therapy in which the patient is gradually [[vaccinated|vaccinated]] with increasing doses of the allergen in question. This will either lessen the severity of hypersensitivity or completely remove it. To block excessive IgE production seen in atopys, it depends on the progressive skewing of [[IgG]] antibody production. In a sense, the individual develops resistance to rising quantities of the allergen in question. Immunotherapy has been shown to have a long-term effectiveness and preventive effect in preventing the development of new allergies in studies.<ref name="pmid10963288">{{cite journal |author=Ross RN, Nelson HS, Finegold I |title=Effectiveness of specific immunotherapy in the treatment of allergic rhinitis: an analysis of randomized, prospective, single- or double-blind, placebo-controlled studies |journal=Clinical therapeutics |volume=22 |issue=3 |pages=342–50 |year=2000 |pmid=10963288 |doi=10.1016/S0149-2918(00)80038-7}}</ref>
 
*[[Intravenous]] injection of [[monoclonal antibody|monoclonal]] anti-IgE antibodies [[Omalizumab]]
A second form of immunotherapy involves the intravenous injection of [[monoclonal antibody|monoclonal]] anti-IgE antibodies. These bind to free and B-cell associated IgE; signalling their destruction. They do not bind to IgE already bound to the Fc receptor on [[basophil]]s and mast cells, as this would stimulate the allergic inflammatory response.  The first agent of this class is [[Omalizumab]]. While this form of immunotherapy is very effective in treating several types of atopy, it should ''not'' be used in treating the majority of people with food allergies. 
*[[Sublingual immunotherapy]]
 
A third type, [[Sublingual immunotherapy]], is an orally-administered therapy which takes advantage of [[immune tolerance|oral immune tolerance]] to non-pathogenic antigens such as foods and resident bacteria. This therapy currently accounts for 40 percent of allergy treatment in Europe. In the United States, sublingual immunotherapy is gaining support among traditional allergists and is endorsed by doctors who treat allergy.


===Unproven or Ineffective Treatments===
===Unproven or Ineffective Treatments===
An experimental treatment, [[enzyme potentiated desensitization]] (EPD), has been tried for decades but is not generally accepted as effective.<ref name="pmid15042943">{{cite journal |author=Terr AI |title=Unproven and controversial forms of immunotherapy |journal=Clinical allergy and immunology |volume=18 |issue= |pages=703–10 |year=2004 |pmid=15042943 |doi=}}</ref> EPD uses dilutions of allergen and an enzyme, [[beta-glucuronidase]], to which T-regulatory lymphocytes are supposed to respond by favouring desensitization, or down-regulation, rather than sensitization. EPD has also been tried for the treatment of [[autoimmune diseases]] but again is not [[FDA]] approved or of proven effectiveness.<ref name="pmid15042943" />
*[[enzyme potentiated desensitization]]<ref name="pmid15042943">{{cite journal |author=Terr AI |title=Unproven and controversial forms of immunotherapy |journal=Clinical allergy and immunology |volume=18 |issue= |pages=703–10 |year=2004 |pmid=15042943 |doi=}}</ref>  
 
*Complementary medicine : [[naturopathy]], [[herbal medicine]], [[homeopathy]], [[traditional Chinese medicine]] and [[kinesiology]]<ref name="pmid17285788">{{cite journal |author=Altunç U, Pittler MH, Ernst E |title=Homeopathy for childhood and adolescence ailments: systematic review of randomized clinical trials |journal=Mayo Clin. Proc. |volume=82 |issue=1 |pages=69–75 |year=2007 |pmid=17285788 |doi=}}</ref>
In [[alternative medicine]], a number of allergy treatments are described by its practitioners, particularly [[naturopathic]], [[herbal medicine]], [[homeopathy]], [[traditional Chinese medicine]] and [[kinesiology]]. Systematic literature searches conducted by the Mayo Clinic through 2006, involving hundreds of articles studying multiple conditions, including asthma and upper respiratory tract infection showed no effectiveness of any alternative treatments, and no difference compared with placebo. The authors concluded that, based on rigorous clinical trials of all types of homeopathy for childhood and adolescence ailments, there is no convincing evidence that supports the use of alternative treatments.<ref name="pmid17285788">{{cite journal |author=Altunç U, Pittler MH, Ernst E |title=Homeopathy for childhood and adolescence ailments: systematic review of randomized clinical trials |journal=Mayo Clin. Proc. |volume=82 |issue=1 |pages=69–75 |year=2007 |pmid=17285788 |doi=}}</ref>


==References==
==References==

Revision as of 05:12, 25 March 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Marufa Marium, M.B.B.S[2]


Overview

The mainstay of treatment for allergy is pharmacological medical therapy.

Medical Therapy


Pharmacotherapy


Immunotherapy

  • Desensitization, also known as hyposensitization, is a therapy in which the patient is gradually vaccinated with increasing doses of the allergen in question. This will either lessen the severity of hypersensitivity or completely remove it. To block excessive IgE production seen in atopys, it depends on the progressive skewing of IgG antibody production. In a sense, the individual develops resistance to rising quantities of the allergen in question. Immunotherapy has been shown to have a long-term effectiveness and preventive effect in preventing the development of new allergies in studies.[2]
  • Intravenous injection of monoclonal anti-IgE antibodies Omalizumab
  • Sublingual immunotherapy

Unproven or Ineffective Treatments

References

  1. ↑ Sicherer SH, Leung DY (2007). "Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects". J. Allergy Clin. Immunol. 119 (6): 1462–9. doi:10.1016/j.jaci.2007.02.013. PMID 17412401.
  2. ↑ Ross RN, Nelson HS, Finegold I (2000). "Effectiveness of specific immunotherapy in the treatment of allergic rhinitis: an analysis of randomized, prospective, single- or double-blind, placebo-controlled studies". Clinical therapeutics. 22 (3): 342–50. doi:10.1016/S0149-2918(00)80038-7. PMID 10963288.
  3. ↑ Terr AI (2004). "Unproven and controversial forms of immunotherapy". Clinical allergy and immunology. 18: 703–10. PMID 15042943.
  4. ↑ Altunç U, Pittler MH, Ernst E (2007). "Homeopathy for childhood and adolescence ailments: systematic review of randomized clinical trials". Mayo Clin. Proc. 82 (1): 69–75. PMID 17285788.

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