Everything can be important: what the patient eats, what they drink, where they live, how their home life is organised, whether they have pets, what cosmetics they use, etc. Doctors should routinely go through the basics of preventing allergy flare-ups with their patients. While unique preventative techniques for each disease have been developed, the following are general principles that apply to all allergic disorders.

Doctors should routinely go through the basics of preventing allergy flare-ups with their patients [Image: Freepik].

Avoidance of contact with causally significant allergens

Try to discover the primary provoking factors when diagnosing and assessing a patient with an allergic condition. There are a variety of diagnostic procedures for identifying allergens, including skin allergy tests, blood tests for specific IgE, and provocation tests. Before ordering one of these tests, review the patient’s medical history. After you’ve identified the allergens, give advice on how to prevent being exposed to them through lifestyle adjustments.

Control over environmental factors

The initial susceptibility to various manifestations of allergies is a physiological feature of patients suffering from any allergic condition. During an exacerbation, when the body is in a state of hyperreactivity, the situation becomes much more serious. Even a minor irritant can exacerbate the symptoms of the underlying condition at this time. That is why in allergology, there is the concept of a hypoallergenic life, which pertains to the complete avoidance of potential allergens.

Patients should protect their homes from risk factors. They should:

  • Not smoke in the house
  • Not use incense or other strong-smelling substances
  • Constantly wash blankets and rugs, soft chairs, extra pillows, and anything that can collect dust
  • Put special dust-proof covers on pillows and mattresses. Use hypoallergenic mattresses, pillows and blankets.
  • Wash bedding and blankets as often as possible.
  • Ventilate the room regularly.

Diet

Depending on the disease, different dietary recommendations are made. In many situations, adhering to a hypoallergenic diet can prevent an exacerbation from occurring. Adding certain foods to your diet, in addition to developing a sustainable, balanced diet, can assist allergy control even more. Vitamin C and bromelain, a substance that can help treat asthma, are abundant in tropical fruits.

Omega-3 fatty acids found in fatty fish have been shown to significantly reduce allergy symptoms. Onions contain quercetin, a natural substance that inhibits the body’s natural histamine response. Honey, taken in small doses throughout the year, can help people build immunity to the effects of seasonal allergies. Yogurt, meanwhile, is a natural source of probiotics, which can help people become less allergic to allergens, particularly in pollen-allergic youngsters.

Pharmacological treatment

Antihistamines

Antihistamines are the medications that are most often used to treat allergic reactions. They can help with the itching caused by histamine release. Antihistamines from the first generation, such as promethazine, produced sedation. With newer second generation antihistamines like loratadine and third generation antihistamines like desloratadine, this is less of a problem.

Antihistamines bind to histamine receptors located on cell surfaces. Histamine receptors (H1-H4) are found throughout the body, with H1 and H2 being the most commonly expressed. H1 histamine receptors can be found on airway and vascular smooth muscle cells, endothelial cells, epithelial cells, eosinophils, and neutrophils, among other cells.

Even though the receptors bind histamine, they can also signal constitutively without it adhering to the cell surface. The active and inactive versions of the receptor are in a state of equilibrium. Histamine stabilizes the receptor in its active state, whereas antihistamines stabilize the receptor in its inactive state. As a result, antihistamines with the H1 receptor operate as inverse agonists.

The sedating first-generation antihistamines are generally no longer used. The Global Allergy and Asthma European Network has recommended that these antihistamines be made prescription-only rather than over-the-counter medications due to their unfavourable adverse effect profile. Sedative qualities and impairment with rapid eye movement sleep are the key concerns. Children with allergic rhinitis who use sedating antihistamines perform worse in school than children who take non-sedating antihistamines or healthy children, according to studies.

Decongestants

A decongestant is a medication that relieves nasal and sinus congestion, which makes breathing difficult. Pills, liquids, nasal sprays, and drops are all examples of decongestants. Decongestants are not the same as antihistamines, although they are frequently confused. Most allergy symptoms are relieved by antihistamines, which stop the effect of histamine in your system rather than the congestion.

Corticosteroids

Corticosteroids are drugs that are used to treat asthma and allergic diseases such skin allergies. Inhaled corticosteroids are a type of asthma treatment. An inhaler is used to administer them. This drug should be taken on a regular basis to reduce inflammation in your lungs’ airways and avoid asthma flare-ups. Inhaled corticosteroids are thought to be the most effective long-term asthma control and management medicine. Depending on the severity of the asthma, doctors may prescribe a combination of an inhaled corticosteroid and a long-acting beta-2 agonist. For severe symptoms or acute asthma flare-ups, oral and intravenous corticosteroids may be required.

Many inflammatory rashes are treated with topical corticosteroids. They come as creams, ointments, lotions, eye treatments, and eardrops, among other forms. Topical steroids are frequently used in conjunction with antibacterial and antifungal medicines in combination formulations. These prescription and over-the-counter medications are used to treat a variety of inflammatory and sometimes infected skin, eye, and external ear diseases.

Mast cell stabilisers

Mast cell stabilisers work by stabilising the mast cell membrane, preventing the release of mast cell mediators like histamine. When taken prior to antigen exposure, these agents are most effective. These are frequently administered when patients are unable to take antihistamines or when antihistamines are ineffective in alleviating symptoms. Mast cell stabilisers do not provide rapid relief of symptoms and must be used for at least a few days.

Leukotriene inhibitors

Leukotrienes are potent inflammatory mediators that trigger an inflammatory response by interacting with particular receptors on target cell membranes. As a result, leukotrienes are thought to play a role in inflammatory disorders such as allergic rhinitis, inflammatory bowel disease, and asthma.

 

REFERENCES

Parisi, GF, et al, 2020. Antihistamines in children and adolescents: A practical update. Allergologia et Immunopathologia; Volume 48, Issue 6, November – December 2020, pages 753-762.