Rhinitis and allergic asthma are diseases that are characterized by the presence of very annoying symptoms such as nasal obstruction, frequent sneezing, runny nose, cough and shortness of breath. All these symptoms affect the quality of life of patients who suffer from them.
What treatments exist to treat allergy symptoms?
Specialists in Allergology can offer 2 lines of treatment. On the one hand, we have symptomatic treatment and on the other, specific treatment. The first, as its name indicates, seeks to relive the symptoms caused by respiratory allergies. These include oral antihistamines, nasal sprays, bronchial inhalers, and eye drops.
The second line, the specific treatment, acts on the cause of the problem, the response of the immune system to allergens (mites, pollens, fungi, epithelium, etc.) to which we are “allergic”. This treatment is Specific Immunotherapy, also known as “allergy shots”.
Depending on the intensity and frequency of the symptoms and the impact on quality of life, specialists in Allergology can recommend one or the other line of treatment, even indicate both, since they are compatible with each other and their combination increases their potency.
What is the difference between oral antihistamines and nasal spray?
Oral antihistamine is the most well-known treatment for treating the symptoms of rhinitis. It is the first step of treatment and in many cases it is enough to control the symptoms. The benefit of taking them is because oral antihistamines reduce the itchy nose, sneezing, and runny nose.
The vast majority of nasal sprays contain corticosteroids which make them a more potent medication than oral antihistamines. Due to this greater potency they are considered the second step of treatment. In addition to reducing symptoms such as antihistamines, the nasal spray has greater ability to control nasal congestion. Unlike oral antihistamines, which achieve their maximum benefit within a few hours, the nasal spray requires a longer time to obtain 100% of its effect. For this reason it is advised to use it for days or weeks.
If I am already taking oral antihistamines, can I also use the nasal spray?
Oral antihistamines and nasal spray are compatible with each other. Depending on the intensity and frequency of the symptoms, specialists in Allergology can recommend one or the other and even, in cases with very annoying symptoms, use both at the same time. Currently there are nasal sprays that in addition to corticosteroids include antihistamines in their formulation which enhances their effect.
Is it bad to use nasal spray with corticosteroids for long periods of time?
There is a certain generalized fear in the population, not very well founded, about the use of corticosteroids. Although continuous use of corticosteroids, especially oral or intramuscular corticosteroids, for long periods of time at high doses can trigger side effects, nasal corticosteroids, such as those found in most nasal sprays, rarely produce these side effects.
The advantage of nasal sprays containing corticosteroids is that they are applied directly to the site to be treated, the nasal mucosa. This way of application turns them into topical corticosteroids, similar to creams or ointments. The nasal topical administration route allows to significantly reduce the dose, as well as the effect on other organs. Despite this, some patients report nasal dryness and in a few cases bleeding. Both mild symptoms that can be controlled by reducing the frequency of the spray or moisturizing the nasal mucosa.
What about the use of Utabon ®, Respibien ® and Respir ®?
Utabon ®, Respibien ® and Respir ® are nasal decongestants and their use is not indicated in the treatment of allergic rhinitis. These nasal sprays work by decreasing blood flow to the nasal mucosa. They have little effect on itchy nose, mucus discharge, and sneezing. Their continuous administration for more than 2-3 days can reduce their potency and produce dependence on them due to a rebound effect after their withdrawal. In addition, they can atrophy and deform the nasal mucosa.
What treatments are available for allergic asthma?
Like rhinitis, allergic asthma is an inflammatory process of the airways, only in this case it is the lower airway (lungs). In general terms, the treatment of allergic asthma is similar to that of allergic rhinitis, controlling the inflammation with topical treatments (bronchial inhalers).
In the case of allergic asthma, the use of bronchodilators such as Salbutamol (Ventolin ®) is frequent (and even excessive). This type of inhaler, as its name already indicates, dilates the bronchus, but does not act on inflammation. Every day its use is more limited and it is only recommended in cases of crisis, as rescue medication, or in asthma induced by physical exercise. For the rest of the cases, inhalers containing inhaled corticosteroids are preferred. In the same way that corticosteroid nasal sprays act only on the nasal mucosa, bronchial inhalers have an effect exclusively on the bronchial mucosa, so their side effects are very limited.
What are “allergy shots”?
“Allergy shots”, whose correct name is Specific Immunotherapy, is currently the only treatment capable of reducing the intensity and frequency of symptoms, reducing the consumption of medication (oral antihistamines, nasal sprays, bronchial inhalers, etc.), improve the response to these and in many cases allow the coexistence between the patient and the allergens (mites, pollens, dander) responsible for their symptoms.
“Allergy shots” is the specific treatment of respiratory allergy. Unlike symptomatic treatment (oral antihistamines, nasal sprays, bronchial inhalers and eye drops) which only reduces symptoms, Specific Immunotherapy modifies the immune system of the patient who receives it. Its administration seeks to control and reduce the response (hyperresponse/hypersensitivity) of the immune system that is generated when the patient is exposed to what he is allergic to.
The main objective of Specific Immunotherapy is to create a state of “tolerance” in which the patient does not develop symptoms despite being in contact with the allergens (mites, pollens, fungi, dander, etc.) responsible for their allergy. To achieve this goal, Specific Immunotherapy requires doses at frequent intervals over several years. In the case of subcutaneous Specific Immunotherapy, better known as “allergy vaccine”, it involves small doses of the allergens to which one is allergic, which are administered by injecting the lateral face of the arm, into the fat under the skin (subcutaneous cellular tissue), monthly for 3 to 5 years.
There are other forms of administration of Specific Immunotherapy, such as the sublingual route (drops or tablets) or intradermal (injections into the most superficial layers of the skin). All of them require frequent time intervals and at least 3 years of treatment.
Are “allergy shots” compatible with oral antihistamines and nasal spray?
Both symptomatic treatment (oral antihistamines, nasal spray, bronchial inhalers, etc.) and specific treatment (Specific Immunotherapy) are mutually compatible. In fact, in the first months of Specific Immunotherapy it is advisable to continue with the usual symptomatic medication. The state of “tolerance” sought with Specific Immunotherapy takes time to be reached and until such this state is achieved it is advisable to keep symptoms under control with symptomatic medication. In addition, it has been shown that as more and more doses of Specific Immunotherapy are accumulated, this reduces the need, both in dose and frequency, for symptomatic medication. That is, both treatments used together allow better and faster control of symptoms.
Does the allergy have a cure?
No, there is no cure for respiratory allergy. Despite advances in Allergology, allergic patients will always remain allergic despite the treatment (symptomatic or specific) they carry out. But being allergic doesn’t mean having symptoms.
Currently specialists in Allergology can offer treatments that create “tolerance” in allergic patients. That is, we can ensure that the allergic patient can live with those allergens (mites, pollens, fungi, dander, etc.) responsible for their allergy without developing symptoms. This “tolerance” is independent of the result of the skin tests (prick test) or determination of specific antibodies, remember, the patient is still allergic, but no longer has significant symptoms.
From ClinicAL we hope to have provided information on the treatment of rhinitis and allergic asthma, treatment with different lines whose ultimate goal is to improve the quality of life of allergic patients.
Recuerda solicitar la valoración de tu alergólogo si presentas síntomas al inicio de la primavera, desde CliniCAL esperamos haber aportado información sobre la alergia a polen de platanero.
Dr. Federico de la Roca Pinzón
Médico Especialista en Alergología
ClinicAL