Therapy against an allergy depends on its strength and severity. The spectrum ranges from simple ointments to the administration of life-saving emergency medication such as adrenaline.
Specific immunotherapy - modes of action and implementation
Therapeutic vaccines are well advanced in the treatment of some allergies (mediated by the IgE antibody). The point is to suppress or modify immune responses to the allergen that have already expired. The theory behind the desensitization is to correct the further immune reaction mediated by the IgE, in which the further cells are likely to be converted into a state in which they e.g. can no longer be activated due to a lack of energy or regulation and thus cannot trigger any further IgE production.
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In the case of desensitization for the therapy of allergies, the tolerance should be increased by multiple administration of the relevant allergen. This therapy method is mainly used in the therapy of pollen and house dust mite allergies, as well as allergies to poisons from bees and wasps. Since immunotherapy is not only time-consuming (monthly for 3-5 years) but also expensive, the benefits and risks (anaphylactic reaction up to shock) of the treatment should be carefully considered and only used in patients with severe symptoms.
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1) antihistamines
The messenger substance histamine is primarily responsible for allergic reactions and can trigger effects on four different receptors (H receptors). The main target for the drugs is the H1 receptor, through which allergic reactions are mediated. These reactions include itching and pain, but also the constriction of the arteries and bronchi in the lungs, which causes breathing problems. Furthermore, the H1-mediated reaction increases the permeability of vessels. In this context, the nasal congestion, runny nose or swelling of the affected area occurs. The antihistamines bind to the receptor and thus prevent the messenger substance from accumulating and triggering the described reaction.
The drugs of the 1st generation this group, for example Diphenhydramine, clemastine or Dimetinden, in addition to the anti-allergic effect, also trigger severe tiredness, which severely restricts performance and ability to work. In addition, other severe side effects such as cardiac arrhythmias or seizures occur.
Antihistamines the second and third generation (Cetirizine, Desloratadine, fexofenadineIn contrast to the 1st generation, they cross the blood-brain barrier less well, which means that tiredness is less pronounced when taking these drugs.
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The effects of these drugs are mainly effective against allergic hives, rhinitis (rhinitis) and conjunctivitis (conjunctivitis), triggered by allergen exposure. For example, the antihistamines reduce the itching and the increased secretion production of the nose. In addition to taking in tablet form, the drugs are also available for use as eye drops or nasal sprays. These drugs are part of the basic therapy for certain allergies.
Learn more about the topic: Eye drops for an allergy
2) glucocorticoids
Glucocorticoids are used in the therapy of allergies to suppress inflammatory processes and their spread. This effect is mainly used for skin inflammation, allergic nasal infections and allergic asthma. Particular attention should be paid to side effects when used for a longer period of time.
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In addition to the glucocorticoids, there is the drug Montelukastwhich inhibits specific inflammatory cells (leukotrienes) and can thus be used in the treatment of (exercise-induced) asthma.
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3) mast cell stabilizers
Another starting point for drug therapy for allergies is to prevent the release of histamine from the so-called mast cells and is therefore only of a prophylactic nature. Because once the histamine is released, these drugs are not effective. The substances in this class of active ingredients are Disodium cromoglycate (DNCG) and that Nedocromil and are mainly used for mild allergic rhinitis, conjunctivitis and allergic asthma.
Other therapeutics
Also nasal sprays from the alpha sympathomimetic family, such as Xylometazoline or Oxymetazoline, can relieve symptoms. These drugs make the nose swell up and the patient can breathe more freely again. However, these substances are not suitable for long-term use (maximum 5-7 days) because they dry out the nasal mucous membranes and can cause rhinitis. The runny nose caused by the allergy can also be caused by the drug Ipratropium bromide (Anticholinergic).
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New therapies
The active ingredient creates new therapeutic options for severe allergic asthma Omalizumabwhich binds the IgE antibody and thus prevents an immune reaction.
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The nickel allergy is a so-called "contact allergy". Nickel itself is a vital metal that occurs naturally in the body. External contact with the skin can, however, lead to harmful reactions. Nickel is found in many everyday items such as jewelry, belts, paints, and batteries. In contrast to many other allergies, contact allergy manifests itself almost exclusively with symptoms of the skin.
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In the long term, it can lead to unpleasant eczema (skin rash with redness, flaking or blistering). The nickel allergy itself cannot be treated, but the symptoms can. The most important preventive measure consists in avoiding substances containing nickel. Furthermore, good skin care should be carried out in order to keep the skin flora and thus the barrier to foreign substances from the outside upright and intact. Creams that suppress the immune reaction are mainly used to treat allergic symptoms. The most common products in this category are creams containing cortisone. However, numerous modern substances can influence the immune system even without cortisone.
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An allergy to tattoos is rare, but can lead to pleasant symptoms with consequences. If not only ink is used as the dye in the tattoo, contact allergies to the additives can arise. The contact allergy causes only minor circulatory reactions, but is mainly focused on
Almost all tattooed people experience pain, redness and swelling for a short time. Allergic reactions are often noticed for the first time because these symptoms persist for an unusually long time. It can even lead to dizziness and fever. If the allergy is 100% confirmed with a medical test, the tattoo must be removed frequently, otherwise the symptoms will persist permanently. Creams, lotions and ointments often only provide relief for the duration of the application.
Also read: The right aftercare for a tattoo
In Germany, insect sting allergies are mostly stings from wasps, bees and mosquitoes. Without allergies, these are usually bothersome but harmless. However, around 20% of people in Germany have allergies to insect bites. These can be more or less pronounced and cause symptoms ranging from unpleasant itching to anaphylactic reactions with circulatory failure.
Read more on the topic: Anaphylactic shock
Therapy must also be geared towards the various symptoms and the danger they pose. The poisons and the allergens they contain differ greatly between bees, wasps and mosquitoes, which is why an allergy to one insect does not result in an allergy to other insects. If the extent of such an allergy is already known, medication should be kept ready in case of a sting.
In an emergency, this includes an adrenaline pen to prevent impending circulatory failure. Mild allergic symptoms should be observed first. The allergen must be avoided immediately and the person affected should not be outdoors if possible or only with insect repellent. If available, so-called antihistamines can be taken. They alleviate mild allergic symptoms and also help against all other types of allergies.
Severe allergies may need to be treated with cortisone. It is a drug that strongly suppresses the immune system. This can be given in tablet form or intravenously by a doctor. In the case of severe circulatory reactions, adrenaline therapy can also be used to prevent a drop in blood pressure and circulatory failure. This must be done especially in the case of the allergy form of the anaphylactic reaction.
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The therapy of an allergic emergency depends on the severity of the reaction and occurs particularly frequently in the case of allergies to food (nuts, etc.) and to insecticides. The affected patients therefore carry an emergency kit for self-help and self-medication with them, which contains a fast-acting antihistamine, a glucocorticoid and adrenaline (Epi-Pen: syringe with adrenaline). If the allergic reaction is not reversible after the measures taken independently, a doctor should be consulted immediately.
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If only a swelling and reddening of the exposed area occurs at first, some general measures should be taken: interruption of the allergen supply and the venous outflow (congestion), injecting adrenaline. In addition, the area should be cooled and an antihistamine should be taken.
If, in addition to the reddening of the skin, other symptoms such as rash and itching as well as mucosal reactions (swelling, discharge) and increased restlessness or headache occur, the measures should be extended to include the administration of a glucocorticoid and the vital signs (blood pressure, pulse) should be checked.
If the symptoms worsen (changes in vital signs, shortness of breath, urgency to stool / urge to urinate, feeling of fear), adrenaline and fluids are also administered and the allergic narrowing of the lungs is regulated by inhaling an expanding drug.
An allergic emergency can lead to respiratory and circulatory arrest and in this case reanimation (ventilation and chest compressions) is essential.
To prevent these allergic emergencies, it is important to avoid the allergens.
In addition to conventional medicine, numerous patients hope for improvement through alternative healing methods, which, however, are not entirely safe and can trigger allergic reactions. In addition to numerous therapy attempts using autologous blood therapy, autohomologous immunotherapy, aroma and color therapy, bioresonance, which have not been able to show any studies on effectiveness, there are some homeopathic methods (use of highly diluted active ingredients) whose effectiveness has been proven in hay fever. There are also indications of the effectiveness in the therapy of allergies when using traditional Chinese medicine (TCM), which is based on mixtures of different medicinal plants.
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The development of an allergy should be prevented in the same way as the development of an allergic reaction. The primary prevention serves to prevent sensitization by avoiding favorable situations. These favorable situations are to be understood as inflammatory processes such as those caused by cigarette smoke, exhaust gas particles or dust particles, for example in the lungs. These substances damage the skin and mucous membrane barriers and cause an inflammatory reaction.
Furthermore, contact with the allergens themselves can be prevented (parental leave). Measures for primary prevention can be implemented in the professional environment, for example by wearing protective clothing (gloves, respiratory protection). In the private sector, attempts should be made to have as little contact as possible with allergens and to keep allergen exposure low, especially in living rooms and bedrooms.
If sensitization, i.e. an allergy, already exists, secondary prevention should prevent the allergy from appearing with symptoms or prevent a further episode of disease by taking parental leave (tertiary prevention). In this context it is important to be informed about the allergies. General information such as a pollen calendar or precise details of ingredients on the packaging, but also individual information on allergen avoidance through consultations or allergy passes, help. These preventive measures are to be illustrated using the examples of house dust mite allergy and pollen allergy:
In the case of pollen allergies, it is especially important to keep pollen exposure in living rooms and bedrooms as low as possible. This is done by using pollen filters on the windows, ventilating bed linen and, if possible, avoiding open windows. In addition, you should shower in the evening and wash your hair in order to wash out the pollen and not to put the clothing you have worn in the bedroom.
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