Allergies

General: Allergy treatment depends on the type of allergy and severity of symptoms. Commonly used allergy medications include antihistamines, nasal sprays, decongestants, leukotriene inhibitors and immunotherapy (allergy shots).

Short-acting antihistamines: Short-acting antihistamines like diphenhydramine (Benadryl®) have been used to relieve mild to moderate allergy symptoms. Most short-acting antihistamines are available over-the-counter. These medications often cause drowsiness, and they have shown to blunt learning in children (even in the absence of drowsiness). However, loratadine (Claritin®), an over-the-counter medication, does not cause drowsiness or affect learning in children. Patients should consult their healthcare providers to determine whether these medications are safe for children.

Longer-acting antihistamines: Longer-acting antihistamines like fexofenadine (Allegra®) or cetirizine (Zyrtec®) are available by prescription for mild to moderate allergy symptoms. They cause less drowsiness than short-acting antihistamines, and they are equally effective. These medications do not usually interfere with learning. Patients should consult their healthcare providers to determine whether these medications are safe for children.

Nasal corticosteroid sprays: Nasal corticosteroid sprays can effectively relieve allergy symptoms in patients who are not responding to antihistamines. Commonly prescribed corticosteroid sprays include fluticasone (Flonase®), mometasone (Nasonex®) and triamcinolone (Nasacort AQ®).

Decongestants: Decongestants may help relieve symptoms such as nasal congestion (stuffy nose). These drugs shrink the tissues and blood vessels in the eyes and nose that swell in response to contact with an allergen. Nasal decongestant sprays like oxymetazoline (Afrin®) should not be used more than twice daily for three consecutive days because rebound nasal congestion may result. Decongestants in pill form do not cause this effect.

Cromolyn sodium: Cromolyn sodium is available as a nasal spray (Nasalcrom®) for treating hay fever. Eye drop versions of cromolyn sodium are also available for itchy, bloodshot eyes.

Leukotriene inhibitors: Leukotriene inhibitors like montelukast (Singulair®) have been used to control allergic asthma and to help relieve seasonal allergy symptoms.

Immunotherapy (allergy shots): Allergen immunotherapy, also known as allergy shots, is often used to treat patients who suffer from severe allergies, or for those who experience allergy symptoms more than three months a year. Allergen immunotherapy involves injecting increasing amounts of an allergen to a patient over several months.

Good scientific evidence :

Bromelain: Bromelain may be a useful addition to other therapies used for sinusitis (such as antibiotics) due to its ability to reduce inflammation/swelling. Studies report mixed results, although overall bromelain appears to be beneficial for reducing swelling and improving breathing. Better studies are needed before a firm conclusion can be made.

Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour or other members of the Bromeliaceaefamily. Use cautiously with history of bleeding disorders, stomach ulcers, heart disease, liver disease or kidney disease. Use cautiously before dental or surgical procedures or while driving or operating machinery. Avoid if pregnant or breastfeeding.

Butterbur: Good scientific evidence suggests that butterbur may effectively prevent allergic rhinitis in susceptible individuals. Comparisons of butterbur to prescription drugs, such as fexofenadine (Allegra®) and cetirizine (Zyrtec®), have reported similar efficacy. Additional studies are warranted before a firm conclusion can be made.

Avoid if allergic or hypersensitive to Petasites hybridus or other plants from the Asteraceae/Compositae family (like ragweed, marigolds, daisies and chrysanthemums). Raw, unprocessed butterbur plant should not be eaten due to the risk of liver or kidney, damage or cancer. Avoid if pregnant or breastfeeding.

Nasal irrigation: Good scientific evidence suggests that nasal irrigation can effectively treat allergic rhinitis. A well conducted, randomized controlled trial that fully reports the data would make the case for allergic rhinitis stronger.

There is also good scientific evidence that nasal irrigation may effectively treat chronic sinusitis. A large, randomized, double-blinded study would lend strong support to the usage of nasal irrigation for the treatment of chronic sinusitis.

Nasal irrigation is generally well tolerated. Use cautiously with history of frequent nosebleeds. If the irrigation liquid is hot, the nose may become irritated.

Probiotics: Use of probiotic Enterococcus faecalis bacteria in hypertrophic sinusitis (sinus inflammation) may reduce frequency of relapses and the need for antibiotic therapy.

Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.

Unclear or conflicting scientific evidence :

Acupuncture: More well-designed studies are needed to determine whether or not acupuncture offers benefit in chronic sinusitis patients.

Preliminary research suggests that acupuncture may effectively treat hives. However, further research is needed to confirm these results.

Applied kinesiology: Applied kinesiology is commonly used to diagnose food allergies. However, there is conflicting scientific evidence as to whether applied kinesiology is an effective diagnostic tool. Further research is warranted before a firm conclusion can be drawn.

Aromatherapy: Despite widespread use in over-the-counter agents and vapors, there is not enough scientific evidence to recommend use of eucalyptus oil as a decongestant-expectorant (by mouth or inhaled form). The available studies are of poor quality, and have used combination therapies or 1,8-cineole (eucalyptol), which is a component of eucalyptus. Further studies are needed before a firm conclusion can be made.

Cat's claw: It has been suggested that cat's claw may help treat allergic respiratory diseases. However, there is limited scientific evidence to support this claim. More well-designed trials are needed to determine whether cat's claw is a beneficial treatment.

Choline: Oral tricholine citrate (TRI) effectively relieved allergic rhinitis symptoms in one study. However, further research is needed before a firm conclusion can be made.

Ephedra: A preliminary study suggests that ephedrine nasal spray, a chemical in ephedra, may help treat symptoms of nasal allergies. Additional research is needed before a firm conclusion can be made.

Honey: Currently there is insufficient human evidence to recommend honey for the treatment of rhinoconjunctivitis. One poor quality trial reported no benefit of the use of honey for the treatment of rhinoconjunctivitis. Further research is necessary before a firm conclusion can be made.

Hypnotherapy, hypnosis: It has been suggested that hypnotherapy may help treat hay fever. However, further research is necessary to determine whether it is an effective treatment.

Lactobacillus acidophilus: A small study was conducted to evaluate the effects of Lactobacillus acidophilus strain L-92 (L-92) on the symptoms of Japanese cedar-pollen allergy with positive results. Further research is needed before a decision can be made.

Perilla: Preliminary evidence suggests some benefit of perilla extract for seasonal allergies. Further clinical trials are required before a firm conclusion can be made.

Probiotics: Only a few types and combinations of probiotics have been studied as a possible treatment for allergies. They have been studied mostly in children, teenagers and young adults. Further research is necessary before a firm conclusion can be made.

Sorrel: There is no reliable human evidence evaluating sorrel monotherapy as a treatment for bronchitis. However, it is an ingredient in the combination herbal product Sinupret®, which also contains cowslip flower, European elderflower, gentian root and verbena. This proprietary formula has been used historically in Europe for the treatment of acute bronchitis and sinusitis. Although no studies have been conducted comparing the combination product to placebo, there is initial evidence from a comparison trial of various expectorants vs. Sinupret® in the treatment of acute bronchitis. Additional evidence is necessary before a firm conclusion can be drawn regarding the use of sorrel or Sinupret® in the management of bronchitis.

Stinging nettle: For many years, a freeze-dried preparation of Urtica dioica has been prescribed by physicians and sold over-the-counter to treat allergic rhinitis. Clinical trials demonstrating statistical significance over placebo, and/or equivalence with other available treatments, are needed before a firm conclusion can be made.

Vitamin E: Although thought to aid in reducing the nasal symptoms of allergies, vitamin E intake may not be effective. However, current evidence is limited, and more studies are needed before a firm conclusion can be drawn.

Avoid substances that trigger allergic reactions. Patients who are allergic to pollen should remain indoors in the morning and evening when outdoor pollen levels are highest.

Keep windows closed, and use the air conditioner, if possible, in the house and car.

Do not dry clothes outside.

Avoid unnecessary exposure to other environmental irritants such as insect sprays, tobacco smoke, air pollution and fresh tar or paint.

Regularly wash the hands and face to remove pollen.

A humidifier may help remove some of the allergens out of the air.

Children who have been breastfed are less likely to develop allergies. In addition, a mother who avoids cow's milk, eggs, nuts and peanuts while breastfeeding may help prevent allergy-related conditions, such as eczema, in some children.

There is evidence that infants who are exposed to airborne allergens like dust mites and animal dander may be less likely to develop related allergies.

Individuals with a history of anaphylaxis should carry an autoinjectable epinephrine device (known as an EpiPen®) with them at all times.