Attack the Attack

Managing an allergy or allergies, as all the experts agree, is really quite simple. First, find out exactly what you’re allergic to. Second, avoid it. And, third, if you simply can’t avoid it, take an appropriate medication, of which there’s a wide selection in a variety of categories.

That’s the oft-used prescription of, among others, Dr. Norman Epstein, an allergist and director of the Allergy Clinic at St. Joseph’s Health Centre in Toronto. Once he’s arrived at a diagnosis, Epstein goes to work on his patient, because, he says, “it’s participaction. The patient has to take a role and a responsibility for their actions. They can’t go to a doctor and say, “Give me shots, and make me better.’ They’ve got to avoid tobacco smoking in the home. They can’t go on smoking. They’ve got to avoid the cat – cats are very allergenic. They’ve got to get rid of the feather pillow and the big carpet in their bedroom and so on. They’ve got to assume responsibility for themselves.They’ve got to participate.”

As Epstein suggests, avoidance isn’t purely passive. Part of avoidance is actively controlling your environment as best you can, which for most people is limited to their home, their c, perhaps part of their workplace. If they’re lucky, they might even convince friends or relatives to clean up their act, too (by getting rid of or not replacing a cat, for example), so they can visit without having an allergic attack.

When it comes to medications, most people can be their own self-managers, with a little help and advice from their doctor or pharmacist. Antihistamines, available in a wide variety of over-the-counter (OTC, or non-prescription) formulations, are the most common. They block the effects of histamine, which is released by mast cells in an allergic reaction, causing all the symptoms we associate with allergies. Antihistamines are neither anti-inflammatories nor decongestants, but they can dry out your stuffy nose and sinuses, relieve itching and put a lid on sneezing.

“Antihistamines are effective against many forms of allergy,” says Dr. Susan M. Tarlo, a respirologist with an interest in allergy. Tarlo is director of the Occupational Disease Clinic at The Toronto Hospital, Western Division. “They’re effective to a certain extent for allergic rhinitis – nasal and eye allergic symptoms – but not very effective for asthma, but then there are much better medications for asthma.”

Antihistamines are referred to as either H1 or H2 blockers, depending on the kind of receptor sites they bind to on cell surfaces. Most antihistamines used for allergies are H1 blockers, such asÊbrompheniramine (Dimetapp), diphenhydramine (Benadryl) and loratadine (Claritin). As June Engel, Ph.D., notes in The Complete Allergy Book, the H2 blockers, “such as cimetidine (Tagamet), ranitidine (Zantac) and famotidine (Pepcid), block mainly gastric symptoms.”

Antihistamines also come in two generations, older and newer. As Engel notes, “The older ones have more annoying side effects, such as drowsiness, urinary retention, mouth dryness and vision blurring. The second-generation forms tend to cause less (or no) drowsiness or mouth drying, but some have contraindications that prohibit their use in certain cases.”

The best-known examples of this are Hismanol and Seldane, both of which can cause potentially fatal heart arrhythmias in people with a particular predisposition, especially when taken with certain other medications. Thus, they should never be taken outside a doctor’s care; in fact, it’s wise to consult a healthcare professional before using either generation of antihistamines, as it is with any of the other classes of anti-allergy drugs.

These include anti-inflammatory drugs, especially corticosteroids taken as inhaled sprays, or puffers, such as beclomethasone (Beclovent); mast-cell stabilizers, such as cromolyn/cromoglycate (Rynacrom), which partially inhibit the release of histamine; and bronchodilators, such as salbutamol (Ventolin), which widen airways briefly and are especially useful for asthma sufferers.

“These medications now available, the nasal steroids in particular, are effective in about 90 per cent of people,” says Dr. Tarlo. For those in whom they’re not effective, or cause too many side effects, there’s another solution: immunization, or allergy shots. Dr. Epstein likens allergy shots to homeopathic medicine: “You give them little bits of what they’re allergic to – grasses, ragweed, dust mites – and they build up an immunity, protective antibodies.”

Indeed, allergy shots are extracts made from allergens. “You start with a small enough amount, so patients don’t have an allergic reaction,” Tarlo says. “You build up the dose gradually – over a period of three to five years – and it alters the immune response. People develop a different type of antibody, IgG instead of IgE, and the lymphocytes [immune cells] become less sensitive to the allergen.”

The potential advantage is that allergy shots sometimes alter the immune response permanently. “You could then stop them and perhaps your allergy symptoms will never come back,” Tarlo says, “whereas with medications like antihistamines, they’re effective while you take them, but you keep taking them year after year. Because they’re much more convenient to take for most people – safer, and you don’t run the risk of having a generalized allergic reaction, which can happen with the allergy shots – many doctors advise trying the medications first and reserve allergy shots for people who don’t do well with the medications.”

There are also a host of approaches to beating allergies from the field of complementary medicine, some of which may be effective for some people. For example, vitamin C’s a natural antihistamine that’s been shown to reduce allergy symptoms and asthma attacks.

Quercetin, an antioxidant in garlic and onions, is supposed to inhibit histamine production; you can chaw on the natural source or swallow it in coated tablets, 400mg twice a day between meals. Other potentially effective herbals include feverfew, the anti-migraine remedy, ginkgo, jewelweed, herbal teas and herbal baths. Japanese allergy sufferers reach for the wasabi, a potent horseradish they say clears sinuses and opens up lungs. Adherents recommend a spoonful a day, but be advised — this is no spoonful of sugar: Wasabi’s hot.

For a more comprehensive approach, you could try neutralization therapy, which includes avoidance strategies, elimination diets, and hearty supplements of vitamins and minerals, among other things. “It’s never been scientifically proven,” Epstein says, “but there’s probably some benefit involved, though I think the benefit largely is from the avoidance.”

In fact, there are treatments proposed by just about every discipline in complementary medicine, including acupressure, aromatherapy, ayurvedic medicine, homeopathy and Traditional Chinese Medicine (TCM). There are no clinical trials supporting their claims, but some practices do work for some people. If you’re not keen on conventional medications, and you can afford to take the plunge, go for it.

You have only your hives and sniffles to lose.