What are the strategies for allergy management?

From the Guidelines

Effective allergy management involves identifying triggers and implementing a multi-faceted approach to reduce symptoms, with avoidance of known allergens being the most effective way to manage animal sensitivity, as stated in the study by 1. To manage allergies, it is essential to identify the triggers and implement a comprehensive approach to reduce symptoms.

• Avoid known allergens when possible by keeping windows closed during high pollen seasons, using air purifiers with HEPA filters, regularly washing bedding in hot water, and maintaining a clean living environment.
• For animal sensitivity, consider removing the animal or confining it to an uncarpeted room with a HEPA or electrostatic air purifier to reduce airborne allergen in the remainder of the home by 90%, as suggested by 1.
• For medication management, start with non-sedating antihistamines like cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily) for immediate symptom relief, as guided by the principles outlined in 1.
• Nasal corticosteroids such as fluticasone (1-2 sprays per nostril daily) or mometasone (2 sprays per nostril daily) are effective for nasal congestion and should be used consistently for optimal results.
• For eye symptoms, ketotifen (1 drop twice daily) or olopatadine eye drops can provide relief.
• In severe cases, consider immunotherapy (allergy shots) for long-term desensitization to specific allergens, which can be administered through subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT), as discussed in 1 and 1.
• During acute flare-ups, short-term use of oral corticosteroids like prednisone may be necessary. These medications work by blocking histamine receptors or reducing inflammation, addressing the underlying immune response that causes allergy symptoms. Always consult with a healthcare provider before starting new medications, especially if you have other health conditions or are taking other medications, as emphasized in 1.

From the FDA Drug Label

1 INDICATIONS & USAGE Adrenalin® is available as a single-use 1 mL vial and a multiple-use 30 mL vial for intramuscular and subcutaneous use. Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis.

The strategies for allergy management include:

• Emergency treatment of allergic reactions (Type I), including anaphylaxis 2
• Administration of epinephrine (IM) for the treatment of anaphylaxis 2, 2 Note that the provided drug labels do not offer a comprehensive guide to allergy management, but rather focus on the treatment of anaphylaxis using epinephrine (IM).

From the Research

Strategies for Allergy Management

The following strategies are used for allergy management:

• Allergen avoidance: This is often the first and most significant measure in managing allergies 3, 4, 5
• Pharmacotherapy: This includes the use of medications such as antihistamines, corticosteroids, and bronchodilators to reduce symptoms and inflammation 4, 6
• Immunotherapy: This involves the use of standardized allergens to improve the efficacy of immunotherapy, and is an effective treatment for stinging insect allergy, allergic rhinitis, and asthma 4, 7
• Sublingual immunotherapy: This is an emerging trend in allergen treatment 7
• Primary prevention: This includes methods such as breastfeeding and ceasing smoking to prevent allergic disease in children 7
• Oral immunotherapy: This involves the ingestion of small amounts of the allergen to build up tolerance, and may be considered for patients with a high threshold of reactivity 5

Approaches for Patients Who Are Not Highly Allergic

For patients who are not highly allergic, the following approaches may be considered:

• Ingestion of products with precautionary allergen labels 5
• Allowing dietary indiscretions with small amounts of the allergen 5
• Encouraging ingestion of subthreshold amounts with therapeutic intent 5
• Shared decision making with patients and families to discuss the risks and benefits of these approaches 5

Pharmacological Management of Acute Allergic Reactions

The pharmacological management of acute allergic reactions includes:

• Oral anti-histamines for mild to moderate symptoms 6
• Adrenaline as the first-line therapy for anaphylaxis 6
• Adjunctive therapies such as anti-histamines, beta-agonists, and glucocorticoids for the subsequent management of anaphylaxis 6