A beginner’s walkthrough + secrets from the doctor on dealing with allergies…
There are many reasons and benefits to get your allergies treated. One of these reasons is to prevent the progression of the “allergic march”.
What is this allergic march you may ask? If the allergy is not diagnosed or treated, it can progress from sensitive skin (eczema), sensitive nose (allergic rhinitis) to food allergies or even sensitive lung (asthma).
This means that if we treat allergies early enough, you can save yourself the trouble from developing a sensitive nose, lung sensitivities or asthma.
All in all, this represents cost savings to you and your family, saving on doctor’s fees, medications, downtime at work or even precious time with your loved ones. Furthermore, the improvement in one’s quality of life, especially being able to enjoy your day at work or play without the spectre of allergies looming is immeasurably priceless.
There are many permutations how a life where allergies are treated and under control can play out – from getting a good night’s sleep without sneezing, to starting your day at the park with your family without feeling lethargic and drained to even enjoying a cherished and quiet moment with your loved one at a cafe without having to reach for a packet of tissue papers to stop a runny nose dripping mucus down your face.
Many studies have shown that treatments for nasal allergies and asthma are cost-effective. Cost-effective because of the monies saved from seeing the doctor or taking medications during a flare-up, cost-effective also from an improved quality of life.
Doctor, so how then can I get my allergies treated? Is there a permanent solution for this?
Well my discerning reader, I am glad you asked. Because there is a very permanent solution to treating and curing nasal allergies. But before I jump to that I will discuss steps you can take at home and natural remedies to improve your condition. We can then discuss a little about medical treatments available and last but not least, the permanent solution for allergies we brought up earlier.
Natural non-pharmacological treatments
Without further ado, we start with some tips on, non-pharmacological in helping improve your allergies. I break them down into 2 major points. The first of which is things you can do at home and the second of which is a way to build your tolerance to allergies
Things you can do at home
- Dehumidify your house – low humidities have been shown to improve lung functions of patients with asthma
- Get rid of dust mites by Sunning and drying your pillowcases and bedsheets under the warmth
- Air purifiers that also have a HEPA filter (think Dyson, Xiaomi)
- Dust protectors
- Washing and vacuuming carpets and curtains regularly
- Smoking cessation
When it comes to pets, current studies done have been conflicting to whether having a child exposed to a pet cat or dog in the first year of life would improve or worsen allergy sensitivities later in life, BUT if you do have allergies yourself (another good reason to get tested), there is a higher chance of your child inheriting the same genes which cause sensitivities.
Building your tolerance to allergies
A well-described study 10 years ago listed the following tips which may help build a tolerance to allergies. There were some impractical suggestions such as taking unpasteurized milk or living on a farm but we will focus on the more practical solutions we can adopt in our daily lives
Consumption of probiotics
- Increase in outdoor physical activities and time in nature
- Taking more fresh fruit and vegetables
- Consumption of healthy diets – the Mediterranean diet has often been mooted as a healthy paradigm
PS: Of course, this list is not exhaustive and it serves as an adjunct to treatment.
Where possible, we always advocate medications when necessary.
What are The Causes of Allergy?
The first line of treatment comes in the form of tablets known as antihistamines. They are useful in providing relief for mild allergies, but most of the time, for those who have moderate to strong allergies, the relief is often short-lived and minimal.
Furthermore, there is an effect known as tachyphylaxis where over time, there is a diminishing response to the medications. Some antihistamines are also unfortunately drowsy, good for sleeping at night but not good for those who need relief in the day during their work.
Examples of antihistamines include – Loratidine, Zyrtec, Diphenhydramine, Chlorpheniramine, Telfast
The next set of medications that are useful for allergies are decongestants. They act by constricting the mucous membranes in the nasal passages, decreasing the symptoms of a blocked nose and are available either as nose sprays or tablets.
Examples of decongestants include Iliadin nose drops, Fedac, Clarinase, Zyrtec (D) and Telfast (D)
For nose drops such as iliadin, preparations for infants and babies are also available, but caution is advised as these cannot be used for more than 5 days as it causes a rebound blocked nose. However, for short term use, they are safe and effective.
Nasal rinses (Salt water nasal washes)
For many patients with allergies, a thick layer of mucus or even allergens can get trapped in the nasal mucosa surfaces.
If using nasal spray medications such as decongestants or intranasal steroids, these medications can fail to get to where it is needed for absorption if the nasal passages are clogged with mucus.
Furthermore, some allergens may remain trapped on these airway mucosal surfaces resulting in the recurrence and unremitting of symptoms.
There are many nasal rinses that are available over the counter from pharmacies – from Nettipot to Sinusrinses. BUT again caution is advised that these rinses have to be done with Saline (salt water) and not normal water otherwise it would not work! Also, the saline comes as sachets which you mix water with, and these come together with the sinus rinse / nettipots as a package.
This fancy sounding tablet medication blocks the chemical reactions that can lead to inflammation in the airways. This medication is relatively new, only introduced in the last 10 years and is used in both sensitive nose and sensitive lungs. It can be taken with antihistamines and it improves symptoms. It is also safe and well-tolerated for children (with a chewable form with a nice flavour)
Examples: Montelukast, Singulair
People are often worried about the negative connotations behind steroids as treatment. In fact, low doses of steroids especially targeted at the nose are found to be extremely effective for allergic nose symptoms.
These are very well tolerated but usually, need at least 1 week for a cumulative effect to build up and subsequently see the manifestation of its benefits.
Common examples of this include Nasonex and Avamys.
In treatment and prevention of asthma, inhaled steroids – often known as the brown, red or purple inhalers, help reduce and prevent airway inflammation and subsequent asthma symptoms.
Examples of this include Symbicort, Seratide and Beclomethasone.
In asthma, inhaled corticosteroids are used for moderate to severe asthma. Again, because of the life-threatening incidences of asthma, it is always advisable to keep asthma under control and prevent flare-ups.
Whether it is inhaled steroids or nasal steroids, at recommended doses which is targeted, they are very safe, even for children and have NO long term or negative effects on children and adults.
In adverse situations where asthma control is poor, tablet steroids are given as a short course over a few days to quickly reduce the inflammation in the airways. These have their own short term side effects such as risks of gastric ulcers or causing blood sugars to rise in those with diabetes, and your doctor will balance the pros and cons of this treatment, including the necessary precautions before prescribing this.
Examples of this medication include prednisolone, hydrocortisone.
For conditions such as eczema, topical steroids such as creams or lotions are effective in the short term reducing the inflammation and irritation on the skin. But long term usage causes the skin to thin and may resultantly interfere with the skin’s repair.
For the skin’s natural barrier repair and protection, we always advocate using moisturizers instead.
Common examples of topical steroidal preparations include hydrocortsone, elomet, clobetasol, desowen.
Doc, you’ve rattled on and on about different medications I can take for my allergies, but what about the long term, the permanent solution you were talking about?
Well, if you have read on this far, let me cut to the chase.
The definitive way of treating allergies is ultimately to target the root cause. And at Dr Tan & Partners (DTAP Clinic), we offer a2 step solution in identifying the root cause and treating it.
Step 1: Allergy Testing
This is either done with a Skin Prick Test – suitable for children and adults. And whilst skin prick does sound scary, rest assured that it is well tolerated by children where a plastic prong is used to introduce a small amount of allergen onto the skin, thereby eliciting a response.
More on that in our allergy testing video
This procedure is PAINLESS but ITCHY. The downside about skin prick testing is that the choices for testing are limited and not as vast as blood testing. Some patients do prefer a simple and quick blood test where others preferred to be spared the pain of a blood test. Whichever your choice, knowing your allergy is half the battle.
Step 2: Allergy Treatment
Allergy Treatment would then involve “priming” the body on a daily basis to recognize and eventually stop reacting to the exact cause of the allergy. This treatment is also known as Sublingual Immunotherapy or SLIT.
A mix of low dose allergens are created in a spray, this spray is taken once a day under the tongue for 3-5 years. Another preparation specifically for dust mite allergies also come as an under the tongue tablet for adult patients. For those with dust mite allergies and frequently on the go, this might be a better option of SLIT rather than the spray.
This 2 step approach has brought lots of success for allergy sufferers and usually, patients start to see an improvement of their symptoms at 6 months
Improvements such as lesser frequency and or severity of symptoms, lesser usage of medications, effects of cure lasting long even after treatment has been completed.
In fact, 2 large medical bodies have further supported the benefits of SLIT. The World allergy organization describes the benefits of SLIT as follows: besides controlling symptoms, SLIT has the potential to completely cure such allergies for good and or even prevent them from developing at all (allergic march).
Singapore’s Ministry of Health has also released recommendations that SLIT should be considered for children over 5 that have poor control of their sensitive nose (repeated attacks and symptoms) even with maximum oral therapy and also for those children who are unable or will not take medications. In simple terms, SLIT is good for children who do not like taking medications or when medications are no longer effective.
And if you are a parent, worried about your child’s allergies, you would be pleased to know that across numerous studies, SLIT significantly reduces their nasal symptoms and has a nearly 4x likelihood of NOT developing asthma. For those children who already have asthma, SLIT also shows a reduction in asthma and the associated lung allergies.
Safety and side effects
To sum everything up, it is also important to know that SLIT has an extremely good safety profile. In more than 60 studies done in the year 2006, more than 1 million doses of SLIT were administered across more than 4000 patients with ZERO life-threatening reactions.
However, just like all medical treatment, there were still some side effects which occurred in 14 out of the million doses. These included itchiness and swelling over the mouth, lips or throat. Stomach pain, discomfort, nausea, asthmatic symptoms.
If you wish to speak to our doctors about the above allergy testing and allergy treatment, please email us at firstname.lastname@example.org. You can also walk-in or call our Holland Village or Raffles Place branches for Skin Prick Testing or Sublingual immunotherapy (SLIT) Allergy Treatment.