I recommend you do nothing…
…if you don’t have symptoms.
That means about 70% of you can stop reading this post and do something more useful. (That’s 70% give or take 10% depending on the country you live in, and I haven’t allowed for self-selection bias because most people reading this will be allergic. That’s all the stats for today, folks).
Many countries, including Australia, are in the grip of an allergy epidemic which is the only way to describe a medical condition that has doubled in prevalence over the past generation in certain countries.
So, what can you do for blocked, runny nose, sneezing, sinus congestion and pain, and itch, swollen eyes? The first suggestion always listed for long-term management is the most difficult! AVOIDANCE!
Well, you shouldn’t waste time avoiding allergy triggers that don’t affect you. So you need to be tested. In many countries (such as Australia) your first approach should be to a general medical practitioner (GP) who will usually sort things out with some simple tests or refer you to an allergist/clinical immunologist. In some countries (such as USA) you may elect to go directly to the specialist. Allergy skin tests or allergy blood tests are very good at identifying airborne allergies. Some alternative tests such as a pulse test (measuring your pulse rate while passing foods in front of you), applied kinesiology (ditto but substituting a measurement of muscle power) and electrode tests (ditto but using a machine with hand-held probes) cannot detect airborne allergies. You can read more about these bizarre tests at Australia’s ASCIA website.
In my practice (what follows is now anecdotal evidence but most scientific studies support these facts), the commonest airborne allergies are:
House dust mite. Pollen. Cat. Dog. Mold. Horse. There are some rarities. I have one case on the books from 20 years ago of airborne allergy to kangaroo. That’s another story.
Avoiding dust mite is hard. Evidence shows hot washing of sheets/pillow cases and mite-allergen-proof encasing for pillows/doonas (duvets)/mattresses WILL reduce mite allergen levels. Will they reduce symptoms? Often yes. Sometimes no. Completely? Very rarely. Will they work for asthma? Some studies say they help, but an assessment of all studies suggests no. Yes, removing wall-to-wall carpet reduces levels, not easy, impossible if you’re renting.
Avoiding pollens in spring and summer (and in ragweed areas in autumn)? If the climate and geography of your district promote prevailing winds, and there are large areas of grass pastures/weeds/trees, often tens or hundreds of kilometers/miles away, then you cannot avoid pollens. I’m sorry, in those circumstances, planting a “low-allergy garden” will not help. This is the case in southern temperate Australia.
Avoiding a pet that you already own is impossible, unless it never comes into the house. If it is a family pet and does come inside, the best you can do is banish it from the bedroom. Even that is hard for many people who are used to their cat or dog sleeping on (occasionally in) the bed. My advice is “PETS OUT OF THE BEDROOM” and if you do that I call it a win. But the allergen remains in the rest of the house.
Horses? This is a drama when a young teen owns the horse. Avoidance is not possible. But if a nonallergic member of the family rides horses, and another member of the family is allergic to these animals, then a lot can be done. NO horsey paraphenalia indoors (bridles, horseblankets, boots, you know). Back from riding? Don’t go into the house before stripping off outerwear, and go straight to the bathroom for a shower.
What about mold? If you see it or smell it, you have problems. Indeed, some people can react to mold chemicals in the air even if not technically allergic to mold protein allergens. Yes, clean up the mold, but if the house is damp, prevention can be expensive.
PHEW! Next step! MEDICATION. In most countries, the majority of medication for airborne allergies is available over the counter at the pharmacy. This is certainly the case in Australia. The first step for me is a saline spray without preservatives used 4 times a day (every meal and bedtime). This can be surprisingly useful, it’s cheap, there are no side-effects.
No relief? I would move on to intranasal corticosteroids, especially if there is significant nasal/sinus block or congestion. Oral antihistamines are very useful, although many studies, including ours published in the BMJ, show the sprays generally work better. But some people can’t stand squirting a spray up their nose, and a small percentage of people get a dry nose/crusty nose/bleeding nose from them. There are antihistamine sprays and antihistamine eyedrops, good for brief periods of time (a few days). If you have mainly eye symptoms, I suggest lubricating or saline eyedrops without preservatives with an oral antihistamine. It’s surprising how many people use medicated eyedrops containing antihistamines or decongestants (and preservatives) in them and they continue to use them for weeks or months with little relief, often because those very drops are causing an irritant reaction in the eyes.
There are medicines (montelukast/oral corticosteroids) used occasionally for resistant symptoms for brief periods of time. This should be discussed with your doctor.
Still no good? We move on to ALLERGEN IMMUNOTHERAPY (allergy shots or drops), also called desensitization. This year is the 100th anniversary of when this form of treatment was published by Noon. Proper randomized controlled trials over the past 60 years show they work, they last for years, they are cost-effective in the long-term, and there is evidence that they prevent allergic asthma. You can read about this treatment on another post on this site. For this treatment, a visit to a doctor trained in the procedure is advisable. In most parts of Europe, in Australia, and increasingly in other countries, the method of choice is sublingual (oral) immunotherapy because of safety, rapid onset, and convenience. This usually outweighs the slightly better response of the injections. A brief paper I wrote in 2006 on the use of allergy injections in Australia may be of interest. In my own practice, sublingual immunotherapy (drops) is now preferred. There is continuing academic debate on the injections vs the drops.
Is there anything else you can do? Well, you could move to a low allergy part of the world. How about a beach in the north-west of Australia, facing the Indian Ocean? Tempted?