Drugs to Treat Allergy Symptoms: Prescription & OTC Medications

In general, there is no cure for allergies, but there are several types of medications available — both over-the-counter and prescription — to help ease and treat annoying symptoms like congestion and runny nose. These allergy drugs include antihistamines, decongestants, combination drugs, corticosteroids, and others.

Immunotherapy in the form of allergy shots or pills under the tongue, which gradually increase your ability to tolerate allergens, are also available.

Antihistamines

Antihistamines have been used for years to treat allergy symptoms. They can be taken as pills, liquid, nasal spray, or eye drops. Over-the-counter (OTC) antihistamine eye drops can relieve red itchy eyes, while nasal sprays can be used to treat the symptoms of seasonal or year-round allergies.

Examples of antihistamines include:

• Over-the-counter:Cetirizine (Zyrtec), fexofenadine (Allegra), levocetirizine (Xyzal), and loratadine (Alavert, Claritin) are taken by mouth. Brompheniramine (Dimetapp allergy, Nasahist B), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist), and diphenhydramine (Benadryl) can make you drowsy.  Ketotifen (Zaditor) and naphazoline and pheniramine combination ophthalmic (OcuHist) are eye drops.
• Prescription: Desloratadine (Clarinex) is a medication taken by mouth. Azelastine nasal (Astelin) is a nasal spray. Eye drops include azelastine ophthalmic (Optivar), epinastine ophthalmic (Elestat), and olopatadine ophthalmic (Patanol).

How Do Antihistamines Work?

When you are exposed to an allergen — for example, ragweed pollen — it triggers your immune system. People with allergies have an exaggerated immune response. Immune system cells known as “mast cells” release a substance called histamine, which attaches to receptors in blood vessels, causing them to enlarge. Histamine also binds to other receptors causing redness, swelling, itching, and changes in secretions. By blocking histamine and keeping it from binding to receptors, antihistamines prevent these symptoms.

What Are the Side Effects of Antihistamines?

Many older over-the-counter antihistamines may cause drowsiness. Newer antihistamines that don’t make you drowsy are available over-the-counter and by prescription.

Decongestants

Decongestants relieve congestion and are often prescribed along with antihistamines for allergies. They can come in nasal sprays, eye drops, liquids, and pills.

Nasal spray and eye drop decongestants should be used for only a few days at a time because long-term use can make symptoms worse. Pills and liquid decongestants can be taken longer safely.

Some examples of decongestants that are available over-the-counter include:

How Do Decongestants Work?

During an allergic reaction, tissues in your nose may swell in response to contact with the allergen. That swelling makes fluid and mucus. Blood vessels in the eyes can also swell, causing redness. Decongestants work by shrinking swollen nasal tissues and blood vessels, relieving the symptoms of nasal swelling, congestion, mucus secretion, and redness.

What Are the Side Effects of Decongestants?

Decongestants may raise blood pressure, so they typically are not recommended for people who have blood pressure problems or glaucoma. They may also cause insomnia or irritability and restrict urinary flow.

Combination Allergy Drugs

Some allergy drugs contain both an antihistamine and a decongestant to relieve multiple allergy symptoms. Other drugs have multiple effects aside from just blocking the effects of histamine, such as preventing mast cells from releasing other allergy-inducing chemicals.

Some examples of combination allergy medicines include:

Anticholinergic Nasal Sprays

The drug Ipratropium bromide (Atrovent) can reduce runny nose. When sprayed into each nostril, it lessens mucus from the glands lining the nasal passages.

What Are the Side Effects of Anticholinergic Nasal Sprays?

They may cause a very dry nose, leading to nosebleeds or irritation. Other side effects include headaches, stuffy nose, upset stomach, and sore throat.

Steroids

Steroids, known medically as corticosteroids, can reduce inflammation associated with allergies. They prevent and treat nasal stuffiness, sneezing, and itchy, runny nose due to seasonal or year-round allergies. They can also decrease inflammation and swelling from other types of allergic reactions.

Systemic steroids are available in various forms: as pills or liquids for serious allergies or asthma, locally acting inhalers for asthma, locally acting nasal sprays for seasonal or year-round allergies, topical creams for skin allergies, or topical eye drops for allergic conjunctivitis. In addition to steroid medications, your doctor may decide to prescribe additional types of medications to help combat your allergic symptoms.

Steroids are highly effective drugs for allergies, but they must be taken regularly, often daily, to be of benefit — even when you aren’t feeling allergy symptoms. In addition, it may take 1 to 2 weeks before the full effect of the medicine can be felt.

Some steroids include:

• Prescription nasal steroids: beclomethasone (Beconase, Qnasl, Qvar), ciclesonide (Alvesco, Omnaris, Zetonna), fluticasone furoate (Veramyst), and mometasone (Nasonex)
• Over-the-counter nasal steroids: budesonide (Rhinocort Allergy), fluticasone (Flonase Allergy Relief), and triamcinolone (Nasacort Allergy 24HR)
• Eye drops: dexamethasone ophthalmic (Maxidex), and loteprednol ophthalmic  (Alrex)
• Oral steroids:prednisone (Deltasone)

What Are the Side Effects of Steroids?

Steroids have many potential side effects, especially when taken for a long time.

Side effects of systemic steroids with short-term use include:

• Weight gain
• Fluid retention
• High blood pressure

Side effects with long-term use include:

• Growth suppression
• Diabetes
• Cataracts of the eyes
• Bone-thinning osteoporosis
• Muscle weakness

Side effects of inhaled steroids may include cough, hoarseness, or fungal infections of the mouth.

Mast Cell Stabilizers

Mast cell stabilizers treat mild to moderate inflammation.

Mast cell stabilizers are available as eye drops for allergic conjunctivitis, and nasal sprays for nasal allergy symptoms. Like with many drugs, it may take several weeks before the full effects are felt.

Some examples of mast cell stabilizers include:

How Do Mast Cell Stabilizers Work?

Mast cell stabilizers prevent the release of histamine from mast cells (cells that make and store histamine). Some of these drugs also have important anti-inflammatory effects, but typically they are not as effective as steroids.

What Are the Side Effects of Mast Cell Stabilizers?

Throat irritation, coughing, or skin rashes sometimes happen. Mast cell stabilizers in the form of eye drops may cause burning, stinging, or blurred vision.

Leukotriene Modifiers

Leukotriene modifiers treat asthma and nasal allergy symptoms. They can be prescribed along with other drugs.

These medications are available only with a doctor’s prescription and come as pills, chewable tablets, and oral granules.

The only leukotriene modifier that has FDA approval is montelukast  (Singulair).

How Do Leukotriene Modifiers Work?

Leukotriene modifiers block the effects of leukotrienes, chemicals produced in the body in response to an allergic reaction.

What Are the Side Effects of Leukotriene Modifiers?

Side effects of these drugs are rare but may include:

• Stomach pain or stomach upset
• Heartburn
• Fever
• Stuffy nose
• Cough
• Rash
• Headache
• Irritability

Other Over-the-Counter Products

Some simple over-the-counter products can help with allergy symptoms. They include:

• Saltwater solution, or saline, is available as a nasal spray to relieve mild congestion, loosen mucus, and prevent crusting. These sprays contain no medicine.
• Artificial tears, which also contain no medicine, are available to treat itchy, watery, and red eyes.

Immunotherapy

Immunotherapy may be one of the most effective forms of treatment if you suffer from allergies more than 3 months of the year. Allergy shots expose you to gradually increasing levels of the offending allergen to help your immune system build tolerance.

The FDA has approved several under-the-tongue immunotherapy tablets that can be taken at home. The prescription tablets, called Grastek, Oralair, and Ragwitek, treat hay fever and work the same way as shots. The goal is to boost a patient’s tolerance of allergy triggers. Odactra is an under-the-tongue medication that can relieve symptoms of allergies to dust mites. Palforzia treats peanut allergy.

Drug allergy – Diagnosis and treatment

Diagnosis

An accurate diagnosis is essential. Research has suggested that drug allergies may be overdiagnosed and that patients may report drug allergies that have never been confirmed. Misdiagnosed drug allergies may result in the use of less appropriate or more expensive drugs.

Your doctor will conduct a physical examination and ask you questions. Details about the onset of symptoms, the time you took medications, and improvement or worsening of symptoms are important clues for helping your doctor make a diagnosis.

Your doctor may order additional tests or refer you to an allergy specialist (allergist) for tests. These may include the following.

Skin tests

With a skin test, the allergist or nurse administers a small amount of a suspect drug to your skin either with a tiny needle that scratches the skin, an injection or a patch. A positive reaction to a test will cause a red, itchy, raised bump.

A positive result suggests you may have a drug allergy.

A negative result isn’t as clear-cut. For some drugs, a negative test result usually means that you’re not allergic to the drug. For other drugs, a negative result may not completely rule out the possibility of a drug allergy.

Blood tests

Your doctor may order blood work to rule out other conditions that could be causing signs or symptoms.

While there are blood tests for detecting allergic reactions to a few drugs, these tests aren’t used often because of the relatively limited research on their accuracy. They may be used if there’s concern about a severe reaction to a skin test.

Results of diagnostic work-up

When your doctor analyzes your symptoms and test results, he or she can usually reach one of the following conclusions:

• You have a drug allergy
• You don’t have a drug allergy
• You may have a drug allergy — with varying degrees of certainty

These conclusions can help your doctor and you in making future treatment decisions.

Treatment

Interventions for a drug allergy can be divided into two general strategies:

• Treatment for present allergy symptoms
• Treatment that may enable you to take an allergy-causing drug if it’s medically necessary

Treating current symptoms

The following interventions may be used to treat an allergic reaction to a drug:

• Withdrawal of the drug. If your doctor determines that you have a drug allergy — or likely allergy — discontinuing the drug is the first step in treatment. In many cases, this may be the only intervention necessary.
• Antihistamines. Your doctor may prescribe an antihistamine or recommend an over-the-counter antihistamine such as diphenhydramine (Benadryl) that can block immune system chemicals activated during an allergic reaction.
• Corticosteroids. Either oral or injected corticosteroids may be used to treat inflammation associated with more-serious reactions.
• Treatment of anaphylaxis. Anaphylaxis requires an immediate epinephrine injection as well as hospital care to maintain blood pressure and support breathing.

Taking allergy-causing drugs

If you have a confirmed drug allergy, your doctor would not prescribe the drug unless it is necessary. In some cases — if the diagnosis of drug allergy is uncertain or there’s no alternative treatment — your doctor may use one of two strategies to use the suspect drug.

With either strategy, your doctor provides careful supervision, and supportive care services are available to treat an adverse reaction. These interventions are generally avoided if drugs have caused severe, life-threatening reactions in the past.

Graded challenge

If the diagnosis of a drug allergy is uncertain and your doctor judges that an allergy is unlikely, he or she may recommend a graded drug challenge. With this procedure, you receive two to five doses of the drug, starting with a small dose and increasing to the desired dose.

If you reach the therapeutic dose with no reaction, then your doctor will conclude that you aren’t allergic to the drug. You will be able to take the drug as prescribed.

Drug desensitization

If it’s necessary for you to take a drug that has caused an allergic reaction, your doctor may recommend a treatment called drug desensitization. With this treatment, you receive a very small dose and then progressively larger doses every 15 to 30 minutes over several hours or days. If you can reach the desired dosage with no reaction, then you can continue the treatment.

Preparing for your appointment

See your doctor if you experience signs or symptoms that may be related to a drug you recently started taking or take regularly. Be prepared to answer the following questions. These details will be important in helping your doctor determine the cause of your symptoms.

• What symptoms did you experience? Don’t leave out details even if they seem unrelated.
• When did the symptoms start? Be as specific as possible.
• How long did the symptoms last?
• What new drug have you taken?
• When did you take it?
• Have you stopped taking the new drug?
• What other over-the-counter or prescription drugs do you take?
• What herbal medications, vitamins or other dietary supplements do you take?
• At what time of day do you take your other medications or supplements?
• Have you increased the dosage of any regular drug or supplement?
• Have you stopped taking your regular medications or supplements?
• Did you take anything to treat your symptoms, and what was the effect?
• Have you had a reaction to a drug in the past? If so, what drug was it?
• Do you have hay fever, food allergy or other allergies?
• Is there a history of drug allergies in your family?

You may want to take pictures of any condition, such as a rash or swelling, to show your doctor. These may help your doctor if signs and symptoms have subsided by the time of your appointment.

Oct. 15, 2020

Allergies – Treatment – NHS

The treatment for an allergy depends on what you’re allergic to. In many cases, a GP will be able to offer advice and treatment.

They’ll advise you about taking steps to avoid exposure to the substance you’re allergic to, and can recommend medicines to control your symptoms.

Avoiding exposure to allergens

The best way to keep your symptoms under control is often to avoid the things you’re allergic to, although this is not always practical.

For example, you may be able to help manage:

• food allergies by being careful about what you eat
• animal allergies by keeping pets outside as much as possible and washing them regularly
• mould allergies by keeping your home dry and well-ventilated, and dealing with any damp and condensation
• hay fever by staying indoors and avoiding grassy areas when the pollen count is high
• dust mite allergies by using allergy-proof duvets and pillows, and fitting wooden floors rather than carpets

Allergy medicines

Medicines for mild allergies are available from pharmacies without a prescription.

But always ask a pharmacist or GP for advice before starting any new medicine, as they’re not suitable for everyone.

Antihistamines

Antihistamines are the main medicines for allergies.

They can be used:

• as and when you notice the symptoms of an allergic reaction
• to prevent allergic reactions – for example, you may take them in the morning if you have hay fever and you know the pollen count is high that day

Antihistamines can be taken as tablets, capsules, creams, liquids, eye drops or nasal sprays, depending on which part of your body is affected by your allergy.

Decongestants

Decongestants can be used as a short-term treatment for a blocked nose caused by an allergic reaction.

They can be taken as tablets, capsules, nasal sprays or liquids.

Do not use them for more than a week at a time, as using them for long periods can make your symptoms worse.

Lotions and creams

Red and itchy skin caused by an allergic reaction can sometimes be treated with over-the-counter creams and lotions, such as:

• moisturising creams (emollients) to keep the skin moist and protect it from allergens
• calamine lotion to reduce itchiness
• steroids to reduce inflammation

Steroids

Steroid medicines can help reduce inflammation caused by an allergic reaction.  

They’re available as:

Sprays, drops and weak steroid creams are available without a prescription.

Stronger creams, inhalers and tablets are available on prescription from a GP.

Immunotherapy (desensitisation) 

Immunotherapy may be an option for a small number of people with certain severe and persistent allergies who are unable to control their symptoms using the measures above.

The treatment involves being given occasional small doses of the allergen, either as an injection, or as drops or tablets under the tongue, over the course of several years.

The injection can only be performed in a specialist clinic under the supervision of a doctor, as there’s a small risk of a severe reaction.

The drops or tablets can usually be taken at home.

The aim of treatment is to help your body get used to the allergen so it does not react to it so severely. 

This will not necessarily cure your allergy, but it’ll make it milder and mean you can take less medicine.

Treating severe allergic reactions (anaphylaxis)

Some people with severe allergies may experience life-threatening reactions, known as anaphylaxis or anaphylactic shock.

If you’re at risk of this, you’ll be given special injectors containing a medicine called adrenaline to use in an emergency.

If you develop symptoms of anaphylaxis, such as difficulty breathing, you should inject yourself in the outer thigh before seeking emergency medical help.

Find out more about treating anaphylaxis

Treating specific allergic conditions

Use the links below to find information about how specific allergies and related conditions are treated:

Page last reviewed: 22 November 2018
Next review due: 22 November 2021

Medications and Drug Allergic Reactions

Everyone reacts to medications differently. One person may develop a rash while taking a certain medication, while another person on the same drug may have no adverse reaction. Does that mean the person with the rash has an allergy to that drug?

All medications have the potential to cause side effects, but only about 5 to 10% of adverse reactions to drugs are allergic.

Whether allergic or not, reactions to medications can range from mild to life-threatening.

It is important to take all medications exactly as your physician prescribes. Call your doctor if you have side effects that concern you, or you suspect a drug allergy has occurred. If your symptoms are severe, seek medical help immediately.

Allergic Reactions

Allergy symptoms are the result of a chain reaction that starts in the immune system. Your immune system controls how your body defends itself. For instance, if you have an allergy to a particular medication, your immune system identifies that drug as an invader or allergen. Your immune system may react to medications in several ways. One type of immune reaction is due to production of antibodies called Immunoglobulin E (IgE) specific to the drug. These antibodies travel to cells that release chemicals, triggering an immediate allergic reaction. This reaction causes symptoms in the nose, lungs, throat, sinuses, ears, lining of the stomach or on the skin and usually occurs within minutes to a few hours of taking the drug.

The most common immune response to a drug is due to the expansion of T cells, a type of white blood cell that recognize the drug as foreign. These T cells orchestrate a delayed immune response that most often affects the skin, causing itchy rashes, and occurs days to weeks after exposure to the drug.

Most allergic reactions occur within hours to two weeks after taking the medication and most people react to medications to which they have been exposed in the past. This process is called “sensitization.” However, rashes may develop up to six weeks after starting certain types of medications.

The most severe form of immediate allergic reactions is anaphylaxis (an-a-fi-LAK-sis). Symptoms of anaphylaxis include hives, facial or throat swelling, wheezing, light-headedness, vomiting and shock.

Most anaphylactic reactions occur within one hour of taking a medication or receiving an injection of the medication, but sometimes the reaction may start several hours later. Anaphylaxis can result in death, so it is important to seek immediate medical attention if you experience these symptoms.

Antibiotics are the most common culprit of anaphylaxis, but more recently, chemotherapy drugs and monoclonal antibodies have also been shown to induce anaphylaxis.

The most severe form of delayed drug reactions not only cause rashes but may also involve other organs including the liver, kidneys, lungs, and heart. Blisters may be a sign of serious drug reactions called Stevens-Johnson Syndrome and Toxic epidermal necrolysis (TEN), where the surfaces of your eye, lips, mouth and genital region may be eroded.

You should seek medical help immediately if you experience any of these. Many medications can cause these severe delayed reactions including antibiotics, medications for epilepsy (seizures), depression and gout.

However, not all drug allergic reactions involve a specific immune reaction. Some people experience flushing, itching or a drop in blood pressure from intravenous dyes used in x-rays or CT scans. If you take angiotensin converting enzyme (ACE) inhibitors for high blood pressure, you may develop a cough or facial and tongue swelling.

In addition, some people are sensitive to aspirin, ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs). One type of aspirin or NSAID sensitivity may cause a stuffy nose, wheezing and difficulty breathing. This is most common in adults with asthma and in people with nasal polyps (benign growths). Other reactions to NSAIDs can result in hives or in rare instances, severe reactions can result in shock.

A number of factors influence your chances of having an adverse reaction to a medication. These include: genetics, body chemistry, frequent drug exposure or the presence of an underlying disease. Also, having an allergy to one drug predisposes an individual to have an allergy to another unrelated drug. Contrary to popular myth, a family history of a reaction to a specific drug typically does not increase your chance of reacting to the same drug.

Non-Allergic Reactions

Non-allergic reactions are much more common than drug allergic reactions. These reactions are usually predictable based on the properties of the drugs involved. Symptoms of non-allergic drug reactions vary, depending on the type of medication. People being treated with chemotherapy often suffer from vomiting and hair loss. Certain antibiotics irritate the intestines, which can cause stomach cramps and diarrhea.

Taking Precautions

It is important to tell your physician about any adverse reaction you experience while taking a medication. Be sure to keep a list of any drugs you are currently taking and make special note if you have had past reactions to specific medications. Share this list with your physician and discuss whether you should be avoiding any particular drugs or if you should be wearing a special bracelet that alerts people to your allergy.

When to See an Allergist / Immunologist

If you have a history of reactions to different medications, or if you have a serious reaction to a drug, an allergist / immunologist, often referred to as an allergist, has specialized training to diagnose the problem and help you develop a plan to protect you in the future.

Healthy Tips

• Allergic drug reactions account for 5 to 10% of all adverse drug reactions. Any drug has the potential to cause an allergic reaction.

• Symptoms of adverse drug reactions include cough, nausea, vomiting, diarrhea, and headaches.

• Skin reactions (i.e. rashes, itching) are the most common form of allergic drug reaction.

• Non-steroidal anti-inflammatory drugs, antibiotics, chemotherapy drugs, monoclonal antibodies, anti-seizure drugs and ACE inhibitors are frequent causes of allergic drug reactions.

• Contrary to popular myth, a family history of a reaction to a specific drug typically does not increase your chance of reacting to the same drug.

• If you have a serious adverse reaction, it is important to contact your physician immediately.

 

The AAAAI’s Find an Allergist / Immunologist service is a trusted resource to help you find a specialist close to home.

This article has been reviewed by Andrew Moore, MD, FAAAAI

Reviewed: 9/28/20

Allergy Treatments | AAFA.org

Allergy Treatment

Good allergy treatment is based on your medical history, the results of your allergy tests and how severe your symptoms are. It can include three treatment types: avoiding allergens, medicine options and/or immunotherapy (allergens given as a shot or placed under the tongue).

How Do I Avoid Allergens?

The best way to prevent allergy symptoms and limit your need for allergy medicine is to avoid your allergens as much as possible. This includes removing the source of allergens from your home and other places you spend time. You can also reduce your symptoms to airborne allergens by washing out your nose daily. You can do this by using a nasal saline rinse using a squeeze bottle or a Neti pot.

What Medicines Can I Take for Allergies?

Some people don’t take allergy medicines because they don’t think their symptoms are serious. They may say, “It’s only my allergies.” This can result in painful problems such as sinus or ear infections. Don’t take the risk. There are many safe prescription and over-the-counter medicines to relieve allergy symptoms. Here is a short list of allergy medicines:

• Nasal corticosteroids are nose sprays. They reduce swelling. Swelling causes a stuffy, runny and itchy nose. They are the most effective medicines for nasal allergies.

• Antihistamines block histamine, a trigger of allergic swelling. They can calm sneezing, itching, runny nose and hives. They come in pills, liquids, melting tablets or nose sprays. These treat seasonal and indoor allergies.
  
   
• Mast cell stabilizers keep your body from releasing histamine. This can help with itchy, watery eyes or an itchy, runny nose. They are available as eye drops or nose sprays.
  
   
• Decongestants reduce stuffiness by shrinking swollen membranes in the nose. But be careful. Using these sprays more than three days in a row may cause the swelling and stuffiness in your nose to get worse. This can happen even after you stop using the medicine. This reaction is a rebound reaction. 
  
   
• Corticosteroid creams or ointments relieve itchiness and stop the spread of rashes. See your doctor if your rash does not go away after using this cream for a week. Corticosteroids are not the same as anabolic steroids used illegally by some athletes to build muscles.

• Oral corticosteroids may be prescribed to reduce swelling and stop severe allergic reactions. These medicines can cause serious side effects. Expect your doctor to carefully monitor you while taking it. Oral corticosteroids are not the same as anabolic steroids used illegally by some athletes to build muscles.
  
   
• Epinephrine (ep-uh-NEF-rin) comes in a pre-measured and self-injectable device. It is the most important medicine to give during a life-threatening anaphylaxis (severe allergic reaction). To work, you must get an epinephrine shot within minutes of the first sign of serious allergic reaction. It treats life-threatening allergic reactions to food, stinging insects, latex and drugs/medicines.

ALLERGIC EMERGENCY

If you think you are having anaphylaxis, use your self-injectable epinephrine and call 911.

Do not delay. Do not take antihistamines in place of epinephrine. Epinephrine is the most effective treatment for anaphylaxis.

Some over-the-counter cold medicines are a blend of different medicines. Many include aspirin or other NSAID. Aspirin can cause asthma attacks in some people. If you have asthma, talk to your doctor before taking over-the-counter allergy or cold medicines.

New prescription and over-the-counter medicines are approved from time to time. Be sure to discuss all of your medicines with your doctor.

What Immunotherapy Treatments Are Available?

Immunotherapy is a treatment option for some allergy patients. There are two common types of immunotherapy. They are allergy shots and sublingual immunotherapy (SLIT).

Allergy shots involve giving injections of allergens in an increasing dose over time. The person becomes progressively less sensitive to that allergen. Allergy shots can work well for some people with allergies to pollen, pets, dust, bees or other stinging insects, as well as asthma. Allergy shots do not usually work well for allergies to food, medicines, feathers, or for hives or eczema.

SLIT is another way to treat certain allergies without injections. Allergists give patients small doses of an allergen under the tongue. This exposure improves tolerance to the substance and reduces symptoms. SLIT is fairly safe and effective for the treatment of nasal allergies and asthma. SLIT tablets are currently available for dust mites, grass and ragweed. Talk to your allergist if you want to learn more about SLIT. While allergy shots are fairly safe, there is a chance for a severe, life threatening allergic reaction to the injections, so they must always be given in an allergist’s office under observation from a medical professional.

Researchers are studying possible treatments for certain food allergies. These include oral immunotherapy (OIT), SLIT and other methods. These studies are still experiments. They are not proven treatments. The studies are testing the safety and effectiveness of these treatments. Before you enroll in these types of studies, talk to your allergist about the risks and benefits.

Medical Review March 2018.

Drug Allergy: Symptoms, Diagnosis & Treatments

Overview

What is a drug allergy?

A drug allergy is a form of bad physical reaction to a medication. There are different forms of allergic reactions to drugs, including immediate and delayed hypersensitivity reactions.

Immediate reactions (anaphylaxis) occur when the drug enters the body. The medication triggers a response by the immune system, and creates specific IgE antibodies (proteins made by the immune system to fight the drug). This is called “sensitization.”

When the medication is taken again, the IgE antibodies release large amounts of the chemical histamine, which try to rid the drug from the body. During a delayed reaction, immune cells help to fight the drug.

Symptoms and Causes

Which drugs most often cause an allergic reaction?

The most common cause of drug allergies is penicillin and other antibiotics similar to penicillin. Other drugs that can cause reactions (that do not involve IgE antibodies) include:

• Sulfa drugs
• Anticonvulsants
• Non-steroidal agents (like aspirin and ibuprofen)
• Contrast dye
• Chemotherapy drugs

What are the symptoms of drug allergy?

Symptoms of allergic reactions can range from mild itching to life-threatening conditions. Many drugs can also cause side effects or intolerances such as an upset stomach. These symptoms do not always indicate a true allergy to a drug.

During an allergic reaction, histamine and other chemicals can cause symptoms that include:

Symptoms of more serious reactions include:

Diagnosis and Tests

How are drug allergies diagnosed?

Drug allergies are diagnosed by a careful review of the patient’s medical history and symptoms by a physician. If an allergy to an antibiotic such as penicillin is suspected, your allergist may do a skin test to confirm the allergy.

However, skin testing is not available for all drugs and in some cases could be dangerous. In special cases, your allergist may recommend a “challenge” (taking the medication again under medical supervision).

Because of the potential risk associated with a reaction — if you have had a severe, life-threatening, allergic-type reaction to a particular drug — your doctor may recommend the use of an alternative, equally effective medication.

Management and Treatment

How are drug allergies treated?

The primary concern when treating drug allergies is relieving the symptoms:

• Common symptoms such as rash, hives, and itching can often be controlled with antihistamines and occasionally corticosteroids.
• For coughing and lung congestion, bronchodilators (inhalers) may be prescribed.
• For more serious, anaphylactic symptoms (life-threatening reactions, including difficulty breathing or loss of consciousness) epinephrine (adrenaline) is usually injected.

Desensitization is occasionally used for treatment of drug allergy, particularly when no testing is available or feasible. This technique is designed to allow your body to temporarily tolerate allergy-causing agents as long as you continue to use the medication.

For example, during penicillin desensitization, small amounts of penicillin are injected periodically at increasingly larger levels until your immune system learns to tolerate the drug. Desensitization procedures are not a cure for drug allergy.

Living With

Living with drug allergies

If you have a drug allergy, always inform your healthcare provider before undergoing any type of treatment, including dental care or surgical procedures.

It is also a good idea to either wear jewelry (bracelet or necklace) or carry a card that identifies your drug allergy. In cases of emergency, this type of identification could save your life.

How to Determine Which Works Best for You

• The three main types of allergy medicine are antihistamines, corticosteroid nasal sprays, and decongestants. 
• Sometimes, a combination of these medications will work to treat your seasonal allergies — though each have varying side effects and should be used in different situations. 
• If these types of allergy medicine don’t reduce allergy symptoms, you may want to consider immunotherapy, or allergy shots. 
• This article was medically reviewed by Omid Mehdizadeh, MD, otolaryngologist and laryngologist at the Pacific Neuroscience Institute’s Pacific Eye, Ear & Skull Base Center at Providence Saint John’s Health Center in Santa Monica, CA.
• This story is part of Insider’s guide to Seasonal Allergies.

Hay fever, also known as allergic rhinitis or

seasonal allergies

, affects up to 30% of people worldwide. It’s caused by an allergic reaction to substances like pollen, mold, or dust, which can lead to symptoms such as nasal congestion, sneezing, runny nose, and irritated eyes. 

There are many ways to treat seasonal allergies. For example, if pollen triggers your allergies, then you can stay indoors when pollen counts are high, and make sure to wash your clothes and body after being exposed to pollen outside. 

Additionally, air purifiers may be helpful for clearing allergens from your home. Nasal salt water rinses, such as a neti pot, can also flush your sinuses and remove allergy-causing particles. 

But if you can’t manage your allergies with these natural remedies, and the symptoms are still severe, you may want to try medication. Here’s how each kind of allergy medicine works. 

Types of allergy medicine 

There are three main types of allergy medicine:

• Antihistamines are the first line of defense for relieving a runny nose, sneezing, post-nasal drip, itchy eyes, and itchy skin.
• Nasal sprays can help reduce congestion and sneezing.
• Decongestants can help relieve a stuffy nose and sinus congestion.

While these medications will not cure your allergies, they can help manage symptoms and improve your quality of life, says Atul N. Shah, MD, an allergist and founder of the Center for

Asthma

& Allergy. 

You may even find a combination of these medications helpful, as they each treat individual aspects of your allergy symptoms and can be taken for different reasons. 

However, because over the counter (OTC) medications may contain multiple ingredients, you should ask your doctor or pharmacist about which are safe to combine before you do so. 

Antihistamines

Antihistamines block your immune system from creating histamines, which are chemicals your body releases during an allergic reaction that cause allergy symptoms.

While histamines are a helpful part of your immune response, taking an antihistamine can help manage nasal congestion, runny nose, sneezing, irritated eyes, or itchy skin.

Some common antihistamines that are available without a prescription, and are considered non-drowsy, include: 

• Allegra (fexofenadine)
• Claritin (loratadine)
• Zyrtec (cetirizine)
• Xyzal (levocetirizine)

Over-the-counter antihistamines that contain diphenhydramine — like Benadryl — or chlorpheniramine — like Chlor-Trimeton — may cause drowsiness, so you shouldn’t take them before driving or doing other activities that require you to be alert. 

Drowsy allergy medicine is best taken before bed, to get better sleep if you’re exposed to allergies. You should talk to your doctor before taking medication that causes drowsiness, as it can worsen symptoms of some conditions like dementia. 

For more severe allergy symptoms, or if you’re experiencing side effects from OTC products, your doctor may prescribe an antihistamine with a stronger dosage and fewer side effects. 

Some antihistamines that are available with a prescription include Atarax (hydroxyzine) and Clarinex (desloratadine). 

Along with drowsiness, the side effects of antihistamines may include:

• Constipation
• Dry mouth
• Nervousness
• Lack of appetite

If you’re experiencing these side effects, you should ask your doctor about changing the dosage or using a different product. 

However, you shouldn’t take antihistamines if you have any of the following conditions:

• Enlarged prostate
• Epilepsy
• Glaucoma
• Overactive thyroid

Ask your health care provider about what antihistamines are safe for your child. If you are pregnant or breastfeeding, consult with your doctor before taking an antihistamine. 

A Centers for Disease Control (CDC) review on the association between antihistamines and birth defects found that most antihistamines — including Benadryl, Claritin, and Zyrtec — are safe to take during your pregnancy.

Nasal sprays 

The corticosteroids in nasal sprays relieve congestion by reducing the swelling in your nasal passages. This medicine can help prevent the onset of symptoms, and Shah says it should be taken two to four weeks before pollen season to be fully effective.   

“Start using a corticosteroid nose spray before the season starts, and add it if antihistamines do not control all the allergy symptoms,” Shah says. “Using the corticosteroid nose sprays regularly can reduce the need for decongestants.”

The following corticosteroid nasal sprays are available over the counter:

• ClariSpray (fluticasone)
• Flonase (fluticasone)
• Nasacort (triamcinolone)

Some corticosteroid nasal sprays, such as Nasonex (mometasone) and Zetonna (ciclesonide), are available only with a prescription. 

Some of the possible side effects of using a corticosteroid nasal spray are:

• Nasal dryness, burning, or itching
• Nosebleeds

If you’re experiencing these side effects, you should stop using the nasal spray and ask your doctor about changing the dosage or using a different product. 

You shouldn’t use a corticosteroid nasal spray if you have any of the following conditions:

• An infection in your nose
• Recent surgery on your nose
• Pulmonary tuberculosis (PB)
• Acute angle glaucoma

If you are pregnant or breastfeeding, consult with your doctor before using a nasal spray. Ask your health care provider about corticosteroid nasal sprays that are safe for your child.

Decongestants 

Decongestants shrink the blood vessels and tissue inside your nose, allowing more air to pass through and making it easier to breathe. 

Shah says that decongestants are better to use in combination with antihistamines, because taken together, the medications are more effective at reducing nasal congestion and other seasonal allergy symptoms. 

The following are some of the decongestants available over the counter:

• Afrin nasal spray 
• Sudafed (pseudoephedrine)
• Sudafed PE (phenylephrine)
• Zyrtec-D (cetirizine with pseudoephedrine)

Some of the side effects of decongestants may include:

• Increased blood pressure or heart rate
• Nervousness
• Sleeplessness

If you’re experiencing an unpleasant reaction to the decongestant you’re using, you should ask your doctor or pharmacist to recommend a different product.

The American Academy of Allergy, Asthma, and Immunology (AAAAI) warns that you should avoid using a decongestant nasal spray for more than four consecutive days since it may worsen your stuffy nose and lead you to become dependent on the spray.

You shouldn’t take a decongestant if you have any of these conditions:

• Enlarged prostate
• Heart disease
• High blood pressure

If you have any heart conditions, check with your doctor before using a decongestant.

You shouldn’t give a decongestant to children younger than 6 years old, according to the American Academy of Family Physicians. If you are pregnant or breastfeeding, consult with your doctor before taking a decongestant.

The bottom line 

If your allergies are severe, talk with your doctor about trying these medications before allergy season. Together, you’ll be able to determine which allergy medicine works best for you. 

If you’d like to purchase one of these allergy medications, or another remedy such as an air purifier, Insider Reviews has complied a list of the best allergy medicine remedies. 

And, if these main types of allergy medicine don’t help reduce symptoms, there may be other options you can ask your doctor about. Leukotriene inhibitors, such as Singular, target pathways in the body that cause allergies, and this type of medication may work better for you. 

Lastly, immunotherapy — or allergy shots — can also regulate your allergies in the long term and help prevent flare-ups in your symptoms each allergy season. 

Related articles from our Health Reference library:

How to choose antihistamines for adults and children

Recently, doctors began to say that during colds and acute respiratory viral infections, antihistamines can be taken to reduce the severity of symptoms (nasal congestion and runny nose, swelling of the mucous membranes, redness of the eyes and watery eyes, redness skin and sneezing).

All these reactions by the mechanism of occurrence are similar to the mechanisms of occurrence of an allergic reaction. Despite the fact that the common cold is not fatal, because of all these symptoms, it becomes the cause of temporary disability.

Therefore, it was suggested that in order to relieve inflammation and reduce the symptoms of colds and SARS, antiallergic drugs can be taken.

In order to test whether allergy pills will help with colds, a study was conducted that showed whether the condition of patients with a cold who take allergy medication is different from those who take placebo.

As can be seen from the table, the effect of antihistamines is less pronounced than placebo.This suggests that it makes no sense to take drugs for allergies during a cold, since this practically does not affect the manifestation of the disease and does not in any way affect its duration and severity.

However, antihistamines are included in almost all combination drugs for eliminating cold symptoms, as one of the components that help reduce nasal congestion, cough, and so on. However, “pure” antiallergic drugs are not used, but they can be included in combination drugs, the purpose of which reduce symptoms and alleviate viral upper respiratory tract disease.

Do you know how global summer heat affects the body? Literally all organs and systems are affected. And if you do not know how to properly cool in the heat and regulate body temperature, then the occurrence of painful conditions is possible. But this can be avoided. Read our article on how heat and dehydration affect the body. From it you will learn what happens to organs and systems in high temperature conditions, and get valuable life hacks on how to avoid overheating in the heat when there is no air conditioning.

By the way, it is believed that in summer sunscreen with SPF becomes a real salvation for the skin. Cosmetologists unanimously recommend using face creams with an SPF filter. But we, the apteka24.ua team, wondered if sunscreens are really that useful and provide such effective protection? And we found out that everything is not quite the way it is presented to us in advertising. To find out more, read our article on what SPF is and how to choose the right sunscreen to really benefit.

apteka24.ua is the first online pharmacy you can trust.

This editorial has been verified for accuracy by the family doctor of the Medical Plaza – Ekaterina Yurievna Krasnova.

Sources

“Power up the doctor about allergies”: for the most recent power supply, fahivets Yuriy Bisyuk / MOZ

WHO Model List of Essential Medicines / WHO

Allergy / Health.gov.il

Allergy during pregnancy: treatment / Doc.ua

Antihistamines for colds / Ukrainian Medical Journal

The choice of antihistamines in the treatment of allergic and pseudo-allergic reactions / Asthma and allergies

Disclaimer

apteka24.ua provides comprehensive and reliable information on medicine, health and well-being, however, only your doctor can make a diagnosis and choose a treatment method! Self-medication can be unsafe for your health.apteka24.ua is not responsible for possible negative consequences arising from the use of information posted on the site by users of apteka24.ua.

90,000 Antihistamines: first and second generation

Get ready for allergies!

First, let’s find out what contributes to the development of an allergic reaction. What can cause sudden itching of the skin, swelling of the respiratory tract mucosa, abdominal pain and other manifestations of acute allergies? This is due to the release of histamine, a neurotransmitter released in response to an allergen.

Therefore, in the fight against the manifestations of allergies, an important place is occupied by the intake of drugs that block histamine receptors, which reduce its effect on the body. They are called antihistamines. There are two generations of antihistamines. ^{1, 2} Let’s consider them in more detail.

1st generation antihistamines

Each of their generations is a kind of evolutionary round in the development of medicines. The newer they are, the more favorable their safety profile, the lower the risk of drug resistance, and the longer the duration of action. ²

The first generation appeared at the beginning of the 20th century, and their effects are associated with a blocking effect on histamine receptors. However, unfortunately for allergy sufferers, the connection with these receptors is very fragile and easily reversible, and it is for this reason that the clinical effect of these drugs is rapidly decreasing, and frequent use of these drugs is required. On average, it appears 30 minutes after ingestion, and the duration of its action is limited to 4-12 hours. This is due to the fact that these drugs are rapidly metabolized and excreted in the urine. ¹

Unfortunately, 1st generation antihistamines have a number of serious side effects that significantly limit their use. The fact is that the active substances penetrate the blood-brain barrier (a kind of physiological filter between the circulatory system and the central nervous system, through which nutrients, bioactive substances and some drugs enter the brain), where they bind to brain receptors, blockade develops central serotonin and m-cholinergic receptors.This can cause the development of sedative effects of varying degrees of severity, from mild to strong.

There are other side effects – dry mouth, increased obstruction (obstruction) of the airways, increased viscosity of sputum, tachycardia, blurred vision. Of the negative properties, it is worth noting the development of tachyphylaxis, that is, a decrease in the effect after a certain period of admission, usually after 15-20 days. ^{1, 2}

The most famous 1st generation antihistamines:

• Diphenhydramine.

• Mebhydrolin.
  May cause dizziness, inhibition of mental activity. Due to the irritating effect on the gastric mucosa, it is recommended to take it after meals.

• Chloropyramine.
  May be used for conjunctivitis and skin allergies. For a quick effect, it is prescribed by injection. ^{1, 2}

2nd generation antihistamines

Preparations of the 2nd generation are distinguished by a minimal effect on serotonin and so-called m-cholinergic receptors, as well as by the fact that histamine receptors are very sensitive to them.These drugs last up to 48 hours, so they can be taken less frequently, which can reduce the risk of side effects. ¹

They practically do not cause a sedative effect, they also do not have the effect of tachyphylaxis, so they can be prescribed for a long time (on the recommendation of a doctor). However, it is worth remembering that 2nd generation drugs can have an undesirable effect on the heart, therefore, when they are taken for a long time, it is necessary to control the work of the heart muscle. ¹

Second generation antihistamines:

• Loratadin
  Long-term effect, up to 24 hours.Relieves itching, swelling, normalizes capillary permeability.

• Cetirizine
  Used to prevent and reduce allergy symptoms. Acts quickly, the effect is noted after about 20 minutes and lasts for more than a day. ³

• Ebastin.
  Prescribed for allergies to the skin and mucous membranes of the eyes. It does not penetrate into the brain, therefore, the effect of Ebastine on the nervous system and mental reactions is minimal.

Active metabolites of 2nd generation drugs

There are absolutely modern developments that are practically devoid of the disadvantages of previous generations of allergy drugs. They do not affect the heart and central nervous system, do not suppress mental reactions, do not lead to addiction.

These drugs include fexofenadine and desloratadine. The first is indicated for seasonal allergic rhinitis and chronic urticaria, prevents the release of histamine and the development of reactions to the allergen.In this case, the action begins approximately 1 hour after taking the dose, and lasts up to a day. The second drug is prescribed for allergic rhinitis, urticaria. It blocks the release of biologically active factors of allergy and prevents the symptoms of the disease. Relieves spasm, reduces swelling and itching, normalizes capillary permeability. The effect appears relatively quickly, within about 30 minutes after dosing, and lasts up to 24 hours.

Antiallergic drops and sprays in the nose: remedies and medicines for allergic rhinitis

28.10.2021

142 495

4 minutes

Contents:

Classification of antihistamines
Combination therapy for allergies

Medicines for allergies – an integral component of the treatment of symptoms as an integral part of the immune system -or substance. The action of such drugs is aimed at eliminating nasal congestion and abundant discharge from it, itching, burning and lacrimation.

Modern sprays from allergic rhinitis are distinguished by their complex action, which allows blocking the production of histamines ¹ (substances responsible for the manifestations of allergies), arresting the inflammatory process in the nasal mucosa, regulating the degree of blood filling of the capillaries in it and eliminating one of the most unpleasant manifestations – a runny nose, itching and nasal congestion.

Up to the table of contents

Classification of antihistamines

• The first generation of antihistamines are sedatives ² and lasting no more than 6 hours, after which the next dose of the drug is required.The main disadvantage of the first generation of antihistamines is their ability to become addictive after 2-3 weeks from the start of use and the side effect in the form of drowsiness. This does not allow them to be used for the treatment of allergic reactions (including rhinitis) in children. These antihistamines are also contraindicated in people whose occupation does not allow for impaired concentration.
• The second generation – antihistamines that can effectively block the production of histamines for 14 hours after administration and do not reduce concentration.Like any other antihistamines, they can be addictive, but the completion of the course of treatment (no longer than 10 days) is without withdrawal syndrome. The cardiotoxic effect of these drugs (including nasal drops and nasal sprays), which is enhanced when taken together with antidepressants and antimycotics, significantly limits the indications for their use. Any violation of the cardiovascular system is a strict contraindication to the treatment of allergies with the help of second generation antihistamines.These drugs are available in various forms, including in the form of a nasal spray for allergies.
• Third generation – drugs in which there are no shortcomings of the previous generations, but high efficacy remains in relation to blocking the production of histamines. These are active metabolites that do not pose a threat to the heart and blood vessels and are available in various forms – from tablets for oral administration to sprays for allergic rhinitis.

Up to content

Combination therapy for allergies

Treatment of allergies, including allergic rhinitis, involves an integrated approach, which uses sprays for allergic rhinitis in combination with anti-inflammatory nasal drugs (sprays or drops for allergies or allergic rhinitis in nose), as well as eye drops and glucocorticoids – depending on the doctor’s prescription.

The decision on the form of release of the antihistamine and the combination of drugs remains with the doctor and is based on individual characteristics – the severity of the reactions, the age of the patient, etc. You should be especially careful when choosing the drug complex and allergy spray for the treatment of rhinitis in children.

The information in this article is for reference only and does not replace the professional advice of a physician. Consult a qualified professional for diagnosis and treatment.

REFERENCES:

1. Nenasheva N.M. Allergic rhinitis therapy: which antihistamine to choose? FGBOU DPO RMANPO of the Ministry of Health of Russia, Moscow. Russian medical journal from 20.05.2015 (9): 514.
2. Hideyuki Kawauchi, Kazuhiko Yanai, De-Yun Wang et al. Antihistamines for allergic rhinitis treatment from the viewpoint of nonsedative properties. International Journal of Molecular Sciences. 2019 Jan; 20 (1): 213. Hideyuki Kawauchi, Kazuhiko Yanai, De-Yun Wang, etc.Antihistamines for the treatment of allergic rhinitis in terms of non-sedating properties.

Comprehensive testing for the diagnosis of drug allergies at the Central Clinical Hospital of the Russian Academy of Sciences

Inhibition test of natural emigration of leukocytes – drug test

Skin examination of reaction to drug allergens

Sublingual provocative test with drug allergens

Provocative dosing test with drug allergens

We will introduce you to research methods for the identification and confirmation of drug allergies.Drug allergy is an increased sensitivity of the body to drugs, which is based on immune mechanisms. Complications of drug therapy of allergic genesis have the following features: in some cases, manifestations in the form of classic symptoms of an allergic disease are possible; they arise from the minimum amount of the drug; after the first contact with the drug, the sensitization stage must be completed for at least 5-7 days, except in cases of latent sensitization.The manifestations of drug allergy do not resemble the pharmacological action of drugs; they occur with subsequent administrations of drugs – allergens. Reactions can result from exposure to several drugs with similar chemical structures and cross-allergenic properties. If the postponed reaction was severe (anaphylactic shock, toxic epidermal necrolysis, Stevens-Johnson syndrome) and developed against the background of the use of two or more groups of drugs, and the patient needs uncontested use of any of these drugs, then the risk and need for testing determined by a council of specialists.The council should consist of an allergist-immunologist and other specialists, the choice of which depends on the disease. Given the lack of a single immune mechanism for the development of allergic reactions to drugs, there is no single test that allows you to completely exclude allergic hypersensitivity to a drug, but the proposed tests allow you to prevent the development of acute life-threatening reactions, such as angioedema of the larynx (Quincke’s edema), a severe attack of bronchial asthma with the development of status asthmaticus, anaphylactic shock.During testing, it is possible to develop local and systemic reactions, which are described below. The information content of the provocative drug testing method is quite high – 86%.

Survey technique

Tests conducted by an allergist-immunologist in an allergy office (or hospital): Test of inhibition of natural emigration of leukocytes (TTEEL) according to A.D. Ado for the diagnosis of allergies to antibiotics, sulfonamides, local anesthetics, NSAIDs.Before setting TTEEL, the patient is examined by an allergist-immunologist, who measures blood pressure, heart rate, respiratory rate and establishes the absence of contraindications for research. The study is not carried out on an empty stomach, the patient thoroughly rinses the oral cavity with boiled water to mechanically clean it for 2 minutes, then sequentially rinse all the offered cups for 2 minutes with an interval of 15 minutes. After the test, blood pressure, pulse, respiratory rate are measured, and the oral cavity is examined.

Skin examination of reactions to drug allergens. The sensitivity and diagnostic value of skin testing depend on the causative drug and the clinical manifestations of the reaction. In case of drug allergy developing according to the immediate type, a sufficiently high sensitivity and diagnostic value of skin testing with β-lactam antibiotics, muscle relaxants, platinum salts and heparins is shown. Skin testing is done 4-6 weeks after the reaction. The types of skin testing are selected depending on the expected pathogenesis of the transferred reaction.To diagnose immediate allergic reactions, testing is done in a specific order. First, the prick test is performed, if the result is negative, the next step is an intradermal test. The period for evaluating the result is from 20 to 60 minutes. To diagnose an allergic reaction proceeding in a delayed manner, testing is carried out in the following order: first, an application test, in case of a negative result, an intradermal test is performed. The period for evaluating the result is up to 72 hours.

Sublingual provocative test for drug allergens. Allergen is applied to the mucous membrane of the sublingual region. In case of drug allergy, the test begins with 1% of the dose of the drug, then 1/8 -1/4 of a single dose of the solute is given.

Provocative dosing tests with drug allergens with the introduction of the drug at the full therapeutic dose is the gold standard for identifying a causal drug.The test technique involves the introduction of sufficiently small doses that are not capable of causing serious reactions, followed by a careful increase in the amount of the drug administered, until a therapeutic dose is reached. A provocative dosed test is carried out no earlier than 1 month after the reaction.

Contraindications

Absolute contraindications

• Acute allergic disease.
• A history of a verified drug allergic reaction in the form of Stevens-Johnson syndrome, Lyell’s syndrome, exfoliative dermatitis, or immune cytopenia.
• Mental illness in which contact with the patient is impossible. Pregnancy and lactation.
• The presence of epilepsy without basic antiepileptic therapy.

Relative contraindications

• Exacerbation of chronic infectious diseases (tuberculosis, syphilis, brucellosis, etc.).
• Acute intercurrent infectious diseases (respiratory diseases, tonsillitis, pneumonia, etc.)).
• Autoimmune diseases (systemic lupus erythematosus, scleroderma, rheumatoid arthritis, dermatomyositis) in the acute stage.
• Decompensation of diseases of internal organs (liver, kidneys, organs of the circulatory and endocrine systems, blood).
• Severe decompensated bronchial asthma (FEV1 less than 70%).
• Mental illness in which contact with the patient is impossible.
• Pregnancy and lactation.
• The presence of a malignant formation with the presence of functional moderate and severe limitation, during the period of specific antitumor treatment.
• The presence of a verified allergic disease in the stage of mild exacerbation.

Additional contraindications for TTEEL according to Ado and sublingual tests are: Acute stage of inflammatory diseases of the oral cavity Complete absence of teeth in the oral cavity.For skin tests, urticarial dermographism is an additional contraindication.

Possible complications

No doctor can guarantee you the absolute absence of the risk of complications. By the nature of the reaction to the allergen, it is impossible to predict the risk of developing a systemic reaction. Systemic reactions are extremely rare.

Preparing for a planned study

No special training is required. The test is carried out some time after eating (from one to three hours, but strictly not on an empty stomach!).3-5 days before the reaction, or at another time specified by the allergist-immunologist, the patient should stop taking antihistamines and systemic glucocorticosteroids. If the information provided to you about the behavior before, during and after the study was not entirely clear, please ask us. Our recommendations will help ensure that the research is informative and successful.

90,000 First peanut allergy drug approved in the US

February 1, 2020

Photo Credit, Getty Images

Photo Caption,

Peanut allergy is the most common type of food allergy in the United States

First ever approved in the United States a medicine for peanut allergy in children.

This preparation, under the designation AR101 and with the trade name Palforzia, is available as a powder sprinkled on food.

The course of treatment lasts six months – during this time, patients are taking an increasing amount of the drug, which contains peanut protein. As a result, the body gradually develops a certain tolerance for peanuts.

This medicine does not relieve patients of allergies, and its manufacturers warn that there is a risk of life-threatening anaphylactic shock.

In addition, even after six months of treatment, patients should continue to take the medication daily to avoid an allergic reaction if peanuts are accidentally eaten. And, of course, they shouldn’t eat peanuts.

Nuts are the most common food allergen in the United States, with an increasing number of people suffering from food allergies in Western countries in recent decades.

High Price

Various drugs have been tested in the United States and other countries to reduce susceptibility to peanuts and other nuts.However, Palforzia is the first drug to receive FDA approval.

Palforzia has been found suitable for the treatment of patients aged 4 to 17 years.

Its cost is extremely high – the manufacturing company reported that the monthly course of the drug will cost patients $ 890.

In addition, according to the Washington Post, a recent study by the American Institute for Clinical and Economic Research (ICER), which assesses the effectiveness of drugs with their price, found that there is insufficient evidence that Palforzia is more effective than completely eliminating peanuts – or already existing immunotherapy using peanut flour.

Last year, researchers at King’s College London reported that oral immunotherapy can provide protection, but not complete relief from nut allergies, and patients will have to constantly take drugs with a small dose of the allergen to maintain immunity.

medicines – Science – Kommersant

According to the official version, the well-known journalist Yuri Shchekochikhin died from a deadly allergic reaction to drugs – Lyell’s syndrome.Some people still suspect that the death was not accidental: Shchekochikhin never suffered from allergies. But the horror of drug allergy is that it is unpredictable and can strike like a bolt from the blue. There never was – and suddenly death.

Everyone probably knows about the side effects of medications. Allergy to drugs is also one of them, only it is not associated with an overdose or unwanted drug interaction. This is an erroneous “actuation” of the immune system, which perceives the drug as a foreign agent that can harm the body.And if side effects of drugs cause about 5% of hospitalizations and occur in 10-15% of patients in hospitals, then drug allergy is “to blame” in 6-10% of all these cases.

Most middle-aged people are susceptible to drug allergy, women are more. Another risk factor is viral infection (HIV, herpes). The way the drug is delivered to the body also matters: intramuscular and intravenous injections are more likely to cause allergies than taking pills, and intravenous injections lead to more severe reactions.But people suffering from any other allergies are not included in the risk group.

Rare but scary

Skin rashes become symptoms of drug allergy in about 95% of cases. This reaction is provoked by antiepileptic drugs (anticonvulsants), sulfa and non-steroidal anti-inflammatory drugs (most often aspirin), allopurinol for gout, X-ray contrast agents, chemotherapy drugs and monoclonal antibodies (used to treat cancer and severe allergic diseases).

The worst skin manifestations of drug allergy are Stevens-Johnson syndrome and Lyell’s syndrome. Some doctors consider these to be two phases of the same condition. First, huge blisters appear on the body (bullous rash), which burst, leaving painful wounds. In this case, all mucous membranes are damaged – mouth, throat, eyes, bronchi, lungs. Due to a violation of the ocular epithelium, scars appear on the eyes, vision decreases, and blindness occurs. And then the epidermis (the top layer of the skin) simply leaves the body, leaving the deeper layers unprotected.If a person is not placed in a sterile box, sepsis will immediately begin – and a fatal outcome. Fortunately, these diseases with a mortality rate of 10% to 60% are extremely rare: Stevens-Johnson syndrome – 0.4-1.2 cases per million people per year, Lyell’s syndrome – 1.2-6 cases per million people in year.

Hurricane Strike

Anaphylactic reaction to drugs is also not uncommon: it occurs in 11% of all allergic drug reactions and in 6–35% of all-cause anaphylaxis.It is the most common cause of death in the UK, New Zealand and Australia. In a British study from 1992-1998, 164 people died from anaphylactic shock, 39% of them due to drug reactions. Anaphylaxis is most often caused by penicillin and other beta-lactam antibiotics (cephalosporins, carbapenems, monobactams), muscle relaxants, local and general anesthetics, allergens for allergen-specific immunotherapy (ASIT).

“In my memory there was a case when just one injection of lidocaine provoked anaphylactic shock,” recalls the medical director of the Allergotop project, allergist-immunologist, candidate of medical sciences Elena Shuvatova.- Resuscitators pulled the patient out literally from the other world. Anaphylaxis to drugs usually develops hurricane and, in the absence of full resuscitation, most often ends in death. ”

What diagnostics is needed

Studies show that an allergy to penicillin increases the risk of postoperative infections by one and a half times, because other antibiotics are much worse at dealing with germs. At the same time, about 95% of patients who believe that they are allergic to penicillin, in fact, easily tolerate the antibiotic.This also applies to other drugs. How can you prove to people that they are not sick, because diagnostic methods suitable for other types of allergies (blood tests, skin tests, etc.) do not work here?

In the West, provocative tests are used – small doses of a substance are administered to the patient and the reaction is monitored. But this diagnostic method for true allergies is very dangerous. In Russia, the only reliable and reliable test is the inhibition of the natural emigration of leukocytes (TTEL) according to A. D. Ado, or the rinsing drug test.(Andrei Dmitrievich Ado is an outstanding Soviet doctor, the founder of Russian immunology.)

The test is carried out in two stages. “At the first stage, the patient rinses his mouth with liquid from different cups, one of which contains a very weak solution of the drug,” says Elena Shuvatova. “After that, the doctor counts the number of leukocytes in the washings obtained. If there are no leukocytes in certain washes, that is, there is no “emigration”, then the patient will respond to the drug with a significant allergic reaction with a probability of 99%.

The second stage takes place in the hospital, where the patient receives the drug in a larger dose. If there are no complications, the conclusion is given: there is no allergy to the drug. The study is expensive, but safe, because the drug is diluted in microscopic doses, moreover, it practically does not enter the body. This is the only way to choose the right drug or eliminate allergies.

Elena Tueva

90,000 Invitro. Allergological studies, find out the prices for tests and pass in Moscow

Celery, IgE (Celery, IgE, F85)

During the study, specific IgE to celery allergens is determined in the blood serum.

Tomatoes, IgE (Tomato, IgE, F25)

During the study, specific IgE to tomato allergens is determined in the blood serum.

Cod, IgE (Codfish, IgE, F3)

During the study, specific IgE to cod proteins is determined in blood serum.

Chocolate, IgE (Chocolate, IgE, F105)

During the study, specific IgE to chocolate allergens is determined in blood serum.

House dust (h2), allergen-specific IgE

During the study, specific IgE to house dust allergens (allergen produced by Greer Labs., Inc), especially for mite allergens.

Dermatophagoides farinae mite (D2), IgE

During the study, specific IgE to the allergens of the house dust mite Dermatophagoides farinae is determined in the blood serum.

Dermatophagoides pteronyssinus mite (D1), IgE

During the study, specific IgE to the allergens of the house dust mite Dermatophagoides pteronyssinus is determined in the blood serum.

Cat, IgE (Cat Dander-Epithelium, E1, IgE)

During the study, specific IgE to cat epithelium allergens is determined in the blood serum.

Chicken, feather (E 85), allergen-specific IgE

During the study, specific IgE to chicken feather allergens is determined in the blood serum, mainly to the residues of saliva proteins and skin secretions that fall on the feathers during the life of the bird.

Aspergillus fumigatus mold (M3), IgE

During the study, specific IgE to Aspergillus fumigatus mold allergens is determined in the blood serum.

Mold Candida albicans (M5), IgE

During the study, specific IgE to the allergens of the fungus Candida albicans is determined in the blood serum.

Cladosporium herbarum mold (M2), IgE

In the course of the study, specific IgE to the allergens of the Cladosporium herbarum mold is determined in the blood serum.

Mold Penicillum notatum (M1), IgE

During the study, specific IgE to allergens of the mold Penicillum notatum is determined in the blood serum.

Dog, IgE (Dog Epithelium, IgE, E2)

During the study, specific IgE to epidermal allergens of the dog is determined in the blood serum.

Cockroach, IgE (Cockroach, IgE, FI 6)

During the study, specific IgE to cockroach allergens is determined in the blood serum.

Mold Alternaria tenuis (M6), IgE

During the study, specific IgE to the allergens of the mold Alternaria tenuis is determined in the blood serum.

Poplar, IgE (Poplar, IgE, T14)

During the study, specific IgE to poplar allergens is determined in blood serum.

Latex, IgE (Latex, IgE, K82)

During the study, specific IgE to latex-containing medical, household and technical products is determined in blood serum.

IgG antibodies to the panel of food allergens

Determination of IgG subclasses to food allergens in blood serum.Testing for IgG antibodies to the panel of food allergens is advisable to be carried out in conjunction with other studies in the diagnosis of food allergies and food intolerances.

Alternaria alternata, rAlt a 1 (m229) IgE, ImmunoCAP

An IgE test for the main allergenic component of mold Alternaria alternate helps to distinguish true sensitization to this allergen from cross-reactivity.

Shrimp tropomyosin, rPen a1 (f351) IgE, ImmunoCAP

The test is used in the diagnosis of allergy to seafood (crustaceans and molluscs), as well as to assess the likely cross-reactivity to tropomyosins of other invertebrates.

Omega-5 Wheat Gliadin, rTri a 19 (f416) IgE, ImmunoCAP

The test evaluates sensitization to one of the important allergic components of wheat associated with the risk of developing an IgE-mediated reaction to wheat in food, including anaphylaxis to wheat induced by exercise …

Ovalbumin, egg albumin, nGal d 2 (f232) IgE, ImmunoCAP (Egg, Ovalbumin, nGal d 2 (f232), IgE, ImmunoCAP) component testing to assess the sensitization profile and predict the likelihood of clinically significant reactions in patients with egg allergy.

Ovomucoid, nGal d 1 (f233) IgE, ImmunoCAP (egg white mucoprotein, Egg Ovomucoid, nGal d 1 (f233) IgE, ImmunoCAP)

The study is carried out to measure the concentration of specific IgE to ovomucoid – the main (major) allergic component of egg white complex component testing to assess the level of sensitization and predict the likelihood of clinically significant reactions, to determine recommendations for patients with egg allergy.

Egg lysozyme, nGal d 4 (k208), IgE, ImmunoCAP (Egg Lysozyme, nGal d 4 (k208) IgE, ImmunoCAP)

A study designed to detect sensitization to egg lysozyme is carried out in case of suspected egg allergy, lysozyme allergy associated with production factors, as well as in the framework of comprehensive testing for sensitization to individual egg allergen components to predict possible reactions and determine practical recommendations.

Tryptase

The test is used to confirm the activation of mast cells as a consequence of anaphylaxis, as well as in the diagnosis of systemic mastocytosis, mast cell activation syndrome and some hematological disorders.

Mixture of food allergens (fx15) (composition of the mixture: orange, apple, banana, peach), IgE, ImmunoCAP (Food Allergen Mix: f33, f49, f92, f95, Orange, Apple, Banana, Peach)

mixtures of food allergens of the most common fruits. A general answer is given for the mixture.

Infant Food Allergen IgE, mix fx5: Egg white, Milk, Fish, Wheat, Peanut, Soybean – f1, f2, f3, f4, f13, f14)

Determination of specific IgE to six food allergens that most often cause allergies in children. Use for laboratory confirmation of IgE sensitization for skin / food allergy symptoms. A general answer is given for the mixture.

Mix of meat allergens (fx73), IgE: pork, chicken, beef, IgE, ImmunoCAP (Food Allergy Mix: Fx73 – Meat (Pork, Beef and Chiken), IgE)

The test is used to detect sensitization to pork, chicken, beef , related to allergens of medium degree of allergenic activity.

Baker’s yeast (Saccharomyces cerevisiae) (f45) IgE, ImmunoCAP

The study is aimed at determining in the blood specific immunoglobulins of class E to the yeast Saccharomyces cerevisiae, which are used in baking and brewing.

Food Allergen Mix (fx21) (mix composition: Kiwi, Melon, Banana, Peach, Pineapple), IgE, ImmunoCAP (Food Allergen Mix: f84, f87, f92, f95, f210 Kiwifruit, Melon, Banana, Peach, Pineapple)

Study is aimed at detecting sensitization to a mixture of tropical fruit allergens. A general answer is given for the mixture.

Alternaria alternata (m6) IgE, ImmunoCAP

The study reveals sensitization to the mildew allergens Alternaria alternata / Alternaria tenuis, one of the most significant respiratory allergens.

A mixture of mold allergens (mx2), IgE, ImmunoCAP (Mold allergens mix: m1, m2, m3, m5, m6, m8 – Penicillium chrysogenum, Cladosporium herbarum, Aspergillus fumigatus, Candida albicans, Alternaria alternata, Setomelanomma rostrata) 9 to detect sensitization to mold allergens. A general answer is given for the mixture.

Staphylococcal enterotoxin TSST (m226) IgE, ImmunoCAP

The test is aimed at detecting sensitization to staphylococcal enterotoxin TSST, it is more often used in examining patients with atopic dermatitis to assess the effect of this factor on the course of the disease.

Staphylococcal enterotoxin B (m81) IgE, ImmunoCAP

The test is aimed at detecting sensitization to staphylococcal enterotoxin B, it is more often used in examining patients with atopic dermatitis to assess the effect of this factor on the course of the disease.

Staphylococcal enterotoxin A (m80) IgE, ImmunoCAP

The test is aimed at detecting sensitization to staphylococcal enterotoxin A, it is more often used in examining patients with atopic dermatitis to assess the effect of this factor on the course of the disease.

Cladosporium herbarum (m2) IgE, ImmunoCAP

The test is aimed at detecting sensitization to Cladosporium herbarum, one of the most common respiratory mold allergens.

Aspergillus fumigatus (m3) IgE, ImmunoCAP

Investigation of specific IgE to Aspergillus fumigatus is aimed at detecting sensitization to this allergen.

Penicillium notatum (P. chrysogenum) (m1) IgE, ImmunoCAP

The study is aimed at detecting sensitization to allergens of the mold fungus Penicillium notatum (not associated with increased sensitivity to penicillin antibiotics!).

Birch (t3), IgE, ImmunoCAP (Birch, Common Silver Birch, Betula verrucosa (t3), IgE)

The test is aimed at detecting sensitization to birch pollen allergens.