The treatment of an allergy should correspond to the severity of the symptoms. On the one hand, it would be an exaggeration to treat occasional episodes of itchy eyes and a runny nose with a long-term therapy or even a vaccine therapy, on the other hand, one should also not make the mistake to not treat an allergy enough or to disregard treatment altogether. Unfortunately, this often happens – mostly because of an exaggerated aversion to taking medication. Inadequate treatment, however, can lead to a deterioration of the overall allergy situation. The goal of any therapy should be to prevent the spread of allergic inflammation. As already mentioned several times, an inadequately treated allergic rhinitis can spread into the lower respiratory tract and cause bronchitis and even bronchial asthma (progression). The simplest form of treatment is the avoidance of the allergy trigger. This is sometimes possible (diets for food allergies, avoidance of certain medications, etc.). In some cases, this is possible to a limited extent (e.g., implementing dust mite control). Mostly, however, a treatment with medication is recommended. There are many effective symptomatic therapy forms available today:
Local therapy of the mucous membranes and respiratory tract
In the case of mild allergies, especially with mild forms of hay fever, it is sufficient to apply anti-allergy medications directly to the inflamed area. These drugs are often combined with tablets (antihistamines - see below). There are nasal sprays and eye drops of different strengths and compositions:
- Locally effective antihistamines: block the inflammatory effect of histamine, which is released in allergic reactions. These drugs work well for inflammation of the nose and eyes and can be used as needed. Antihistamine drops or sprays are the ideal treatment when only mild discomfort occurs predominantly at one site, e.g., if only conjunctivitis is present. The therapy is tolerated exceptionally well.
- Locally effective cortisone drugs: Cortisone drugs are the strongest anti-allergy medication. In the form of drops or sprays, they have an excellent effect on blocked noses and more severe allergic rhinitis. The therapy should be carried out regularly, as no immediate effect can be expected. The substances that are used on the mucous membranes are practically not absorbed into the organism, thus the problematic side effects of systemic cortisone therapy (tablets, injection) do not occur. An unpleasant dryness of the mucous membranes is sometimes reported as a side effect.
- Decongestant nose or eye drops: caution is advised. Although these drugs work fast and are highly effective, but one can easily form a dependency on the medication. In addition, the mucous membranes are damaged during prolonged use.
There are different variants of bronchial asthma and not every form of asthma is triggered by allergy. The goal of all asthma therapy is, on the one hand, to combat the inflammation of the bronchial mucosa and, on the other hand, to open up the cramped muscles that surround the bronchial tubes. Cortisone-containing dry powder or sprays are available as anti-inflammatory inhalants. The cortisone drugs, which are used today as a remedy for asthma, are characterized by the fact that they only have a local effect. They are not absorbed into the bloodstream and therefore do not trigger any of the dreaded side effects of a long-term cortisone therapy. To relax the bronchial muscles and dilate the bronchi drugs are used which reduce the muscle tension on the bronchi (by influencing the local nerves). According to the autonomic nervous supply of the bronchial musculature, sympathic nervous system stimulating substances or vagus nerve blocking agents are used here. Side effects of this treatment are an acceleration of the heartbeat, tremor of the hands, and possibly a feeling of inner restlessness. The new combination medications in which both treatment components are combined in an inhalation device are a considerable simplification of the inhalation therapy. In addition to inhaled treatments, the allergic component of asthma may be treated with anti-allergic agents. Special inflammatory mediators (leukotrienes) in asthma can also be blocked medically by way of leukotriene inhibitors. This therapy often helps to reduce the number of necessary inhalations. For the treatment of severe asthma there are also various medications available that cannot be listed in detail here. The treatment should be reviewed during regular check-ups by the specialist or pulmonologist.
The drugs that are on the market today are excellent for mild to moderate allergies and allergic skin conditions such as hives or itching. Depending on the severity of the symptoms, localised therapies are usually prescribed in addition (see above). There are several products from different manufacturers that are recommended. The latest generation of anti-allergic medications are excellently compatible. The tablets should be taken once a day and are designed to have a 24-hour effect. In the case of the older allergy medicines, a typical side effect is fatigue –some older antihistamines are even marketed as sleeping pills. These drugs are only used when sleep is disturbed by allergic symptoms or when a calming component is expressly desired, e.g., in infants with severe itching.
In allergic emergencies, it is necessary to quickly administer large amounts of anti-allergic drugs. This can only be done by injection or infusion into the bloodstream. The most effective remedy in an emergency is adrenaline. In addition, antihistamines, cortisone, and – if necessary – asthma medications are administered. Blood pressure is maintained by infusing a liquid solution.
It is possible to suppress allergy symptoms for several weeks with an injection of cortisone. It is a sustained-release drug, which means the solution is slowly absorbed after injection into the muscle and provides the patient with cortisone for a prolonged period of time. This treatment option should only be used as an emergency solution and not on a regular basis, as otherwise the dreaded side effects of prolonged cortisone therapy may occur.
Vaccination therapy is a treatment for patients suffering from allergic rhinitis, conjunctivitis, or bronchial asthma caused by pollen or house dust mites. In addition, it is utilised with excellent success in insect venom allergy. The great advantage of this form of treatment is that – not only are the symptoms of the allergy treated – the immunological processes that are responsible for the development of allergies are causally inhibited. The principle of the vaccine treatment is to make the body tolerant to increasing amounts of the allergen again. For example, a pollen allergy sufferer is given pollen extract in large quantities over several years. As a result, his/her immune system becomes tolerant of the allergy trigger. Another important aspect of vaccine treatment is the preventive effect of this form of allergy. New studies show that a vaccine treatment prevents the upper and lower respiratory system from progressing in terms of disease and prevents the development of new allergies. The vaccination therapy can be carried out in two forms:
Treatment by injections
The allergy trigger is injected in increasing doses under the skin on the back of the upper arm. First the dose is increased weekly until the maintenance dose is reached. This is then continued monthly for three to five years. As a side effect itchy swellings can usually be observed at the injection site. Less common are redness, runny nose, or hives. For safety reasons, the patient must be observed for half an hour after the injection in the outpatient clinic. In addition to the vaccine treatment, of course, other anti-allergic drugs can be taken if necessary. Annual check-ups including skin tests and IgE findings as well as the observation and documentation of the complaints keep track of the success of the vaccination therapy.
Sublingual immunotherapy (drops or tablets – administered under the tongue)
In this treatment, the vaccine (an extract of allergy inducer, e.g., pollen) in the form of a soluble tablet or in the form of drops is taken regularly. The vaccine should be