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Sign up for a free Medical News Today account to customize your medical and health news experiences. According to the Centers for Disease Control CDC , more than 50 million Americans experience an allergic reaction each year, and the best treatment will depend on the cause and severity of the reaction. In this article, we take a close look at a range of treatments for allergic reactions, depending on a person's symptoms and their severity, including anaphylaxis.
An allergic reaction occurs when cells in the immune system interpret a foreign substance or allergen as harmful. The immune system overreacts to these allergens and produces histamine, which is a chemical that causes allergy symptoms, such as inflammation , sneezing, and coughing. Mild allergic reactions can usually be treated with home remedies and over-the-counter OTC medications. However, chronic allergies need treatment from a medical professional.
Severe allergic reactions always require emergency medical care. Many mild to moderate allergic reactions can be treated at home or with OTC medications. The following treatments are commonly used to reduce the symptoms of an allergic reaction:. Antihistamines can help to treat most minor allergic reactions regardless of the cause.
These drugs reduce the body's production of histamine, which reduces all symptoms, including sneezing, watering eyes , and skin reactions. Second-generation antihistamines, including Claritin loratadine and Zyrtec cetirizine , are less likely to cause drowsiness than first-generation antihistamines, such as Benadryl. Antihistamines come in several forms, usually to help deliver the medication closer to the source of the reaction or make it easier to consume, such as:.
How do you treat an allergic reaction?
Antihistamines in these forms are available from pharmacies, to buy online , or on prescription from a doctor. Antihistamines can also be taken to prevent allergies. Many people with seasonal or pet allergies will begin taking antihistamines when they know they are going to be exposed to an allergen.
A person who is pregnant or has a liver disorder should consult their doctor before taking antihistamines. Nasal decongestant pills, liquids, and sprays can also help reduce stuffy, swollen sinuses and related symptoms, such as a sore throat or coughing. Nasal decongestants are available over the counter and online. Non-steroidal anti-inflammatory medications NSAIDs may also be used to help temporarily reduce pain, swelling, and cramping caused by allergies.
The best way to treat and prevent allergic reactions is to know what triggers the reaction and stay away from it, especially food allergens. When this is not possible or realistic, using antihistamines or decongestants when in contact with allergens can help to treat the symptoms. This can remove allergens and clear the airways. Sinus rinsing devices can be purchased online or from a pharmacy. For airborne allergens, such as pollen, dust, and mold spores, additional treatment options include:. For allergic reactions that cause skin symptoms, including those associated with allergens found in animal saliva, poisonous plants, drugs, chemicals and metals, additional treatment options include:.
People should speak to a professional if they have or suspect that they have severe or chronic allergies. A doctor or allergy specialist can prescribe medications that contain much stronger doses of the compounds found in OTC products. Many traditional medicine systems use herbal supplements and extracts to both treat and prevent allergic reactions, especially seasonal allergies. Though there is little scientific evidence to support the use of most alternative or natural remedies, some people may find that some can provide relief from their symptoms.
The American Association of Naturopathic Physicians recommend the following natural treatments for allergies:. To achieve such results, pharmaceutical research should identify the possible biochemical steps that are common to the different triggering mechanisms of an allergic response. The existence of such common biochemical steps seems to be highly probable when considering the fact that different stimuli produce, for some aspects, the same final response. In addition to available medications, several new molecular entities are in an advanced phase of clinical study or are in development.
Most of them are anti-IL monoclonal antibodies [ 88 , 91 ] or enzymatic inhibitors, such as phosphodiesterase 4 PDE4 or phospholipaseA 2 PLA2 inhibitors [ 92 , 93 ], with clearly defined and limited targets. In addition, studies of calcium are continuing, with a particular interest in channel inhibitors [ 94 — 97 ] and FK binding proteins [ 98 ]. A number of genome-wide association studies GWAS have investigated asthma- and allergy-related phenotypes. Results suggest a need to increase pharmacogenetic studies for a better definition of the disease and identification of nonresponder patients [ 84 ].
A closer interaction between industry, academia, and health workers is advisable for identifying novel biomarkers linked to well-characterized phenotypes [ 99 ]. It is evident that modern molecules are increasingly specific. This narrow approach of pharmacologists presupposes deep and complete knowledge of the complex onset pathway of respiratory allergic diseases in order to achieve the exact identification of the best target for a good pharmacological response. Since this knowledge is unfortunately still incomplete, research is now moving in several different directions in an attempt to identify the best pharmacological target, thus risking a waste of resources.
Accordingly, a further article will be prepared to provide new hypothetical explanations of some of these unclear events, as well as the possible biochemical steps that are common to the different triggering mechanisms of the allergic response. These unpublished observations will allow pharmacological research to concentrate its efforts in a well-defined, fundamental direction. The drugs come in different pharmaceutical forms such as: Delivery systems include nebulizers, propellant-based oral and nasal metered-dose inhalers, dry powder inhalers, soft mist inhalers, devices for premetered and device-metered nasal sprays, insufflators, devices for ocular drop instillation, syringes, and accessories such as spacers, facemasks, and needles.
This wide variety of dosage forms and devices represents an ambitious challenge for pharmaceutical scientists. Inhalers and sprays in particular have undergone a process of chaotic development in recent years and are continuously evolving. Delivery systems have been reviewed recently [ — ], so only the most commonly used devices will be briefly described here Table 2.
Their major advantages and disadvantages have been clearly tabulated in Lavorini's recent review article [ ]. Nebulizers are the oldest inhalation devices. They can be utilized by all patients, including those with weak or slow inhalation capacities or coordination problems like the elderly and children. Nebulizers deliver a cloud of droplets of a drug solution or watery drug suspension.
The cloud can be produced in three different ways: In conventional systems, the cloud is delivered constantly. Nevertheless, the three different principles yield different aerosols with different densities and size distributions at different output rates.
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Mesh nebulizers have been shown to be more efficient than ultrasound and jet types. In recent years, to reduce environmental aerosol dispersion and increase delivery to patients, jet nebulizers have evolved towards four different subcategories: The breath-enhanced type has two one-way valves to reduce dispersion, while the breath-actuated version only generates aerosol during inspiration. The four subcategories can have consistent differences in delivery, with the reservoir tube type generally being the least efficient and the breath-actuated version the most efficient.
In addition, mesh nebulizers are changing; the last generation models are battery-powered, very light, and silent and give a minimal residual volume.
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The breath-controlled aerosol delivery Akita system, which is an evolution of the adaptive aerosol delivery AAD system, is a portable, electronic, vibrating mesh nebulizer that monitors breathing and delivers aerosol only during inhalation. It can be operated in two different breathing modes: A consistent reduction in treatment times is achievable with good deposition by selecting the second operation mode that guides the patient toward deep and slow breathing.
For example, suspensions should not be used with ultrasound devices. Nebulizers can be coupled with a facemask or a mouthpiece, with a consequent possible increase in the delivered dose.
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Mouthpieces are preferable to facemasks because they eliminate losses in the nose and increase deposition in the lungs. Facemasks for nebulizers should have vent holes to reduce deposition on the face and in the eyes. In conclusion, nebulizers are suitable for all patients, delivering variable doses of a broad range of drugs and not releasing any propellant.
Nevertheless, given the high variability in the performance of the different systems, particular attention should be paid to the manufacturer's instructions and the drug label, particularly, when delivering drugs with narrow therapeutic indices. Inhalers are typically single-patient-use, portable devices that are available in combination with a specific formulation and dose of drug. They have a shelf life of at least 12—24 months and are disposed of when depleted.
Unlike nebulizers, inhalers must be developed and approved as drug and device combinations. PMDIs were the first handheld inhalation devices and were developed in the s. Under the vapor pressure of the propellant contained in the device, they deliver a cloud of droplets of a drug solution or watery drug suspension.
To ensure reliable dosing, the vapor pressure must be constant all the way through the product's life. With coming into force of the Montreal Protocol, the old chlorofluorocarbon CFC propellants have been substituted with hydrofluoroalkane HFA propellants, which partly reduce ozone-depleting problems. The physical characteristics of the sprays delivered by pMDIs favor oropharyngeal deposition and sometimes the consequent development of local irritation or candidiasis.
Accordingly, the use of spacers is generally recommended to reduce undesirable oral effects and possibly increase pulmonary deposition. Spacers can be a fixed extension of the device or a separate accessory, and in every case reduce portability, and constitute a problem of adherence for patients. Nonelectrostatic valved holding chambers VHCs , facemasks, and mouthpieces are other useful accessories, particularly for children [ ]. As with nebulizers, it is important to realize that, as well as reducing oropharyngeal loss, all of these accessories and particularly VHCs can increase deposition in the lungs and the delivered dose, with consequent possible therapeutic benefits.
On the other hand, there is a risk of delivering the above the upper threshold of the therapeutic window. In conclusion, pMDIs are portable, robust, cheap, and easy-to-use and are therefore indispensable for disabled patients. However, they are often inefficient and a nonnegligible source of environmental pollution. DPIs received great consideration after the banning of CFCs and, in a few years, have attained an important position in the market. They do not need propellant, since the drug's release is due to the flow generated within the device by the patient's inspiration effort.
Powders are built by aggregating the active principle with a carrier usually lactose, sometimes mannitol, or others [ ] and are particularly studied in terms of form and cohesion force. Their purpose is to release the active principle under the force of the flow [ ]. In addition, deaggregation depends on the internal design of the inhaler, because deaggregation increases when resistance to airflow rises.
Considerable differences of resistance are measurable in different inhalers. Two categories of DPI exist: In the first of these, the dose is premeasured by the manufacturer as capsules or blisters. In the latter, the device has a reservoir of drug and a control to premeasure the dose. The different preparatory operations of the various devices are a frequent source of patient error. DPIs do not have propellant and are small, portable, cheap, and breath-actuated.
However, the variability of the effective dose with the required medium-high force of inspiration limits their use to patients over five years of age [ 35 ]. Mist inhalers, also known as soft mist inhalers, smart mist inhalers, solution-metering inhalers, or aqueous droplet inhalers, have been introduced in the last ten years. At present, only one model has been approved, although others are being developed. They have different methods of aerosol generation: This type of inhaler has two main advantages: A mist of droplets of the drug solution is delivered in a slightly longer time than usual, which should help to overcome the problem of synchronization between device actuation and inhalation.
Their disadvantages are their size and the fact that they are not inexpensive. Spacers, valved holding chambers, facemasks, and mouthpieces are common accessories for nebulizers and inhalers. Often, they are dedicated to a particular device. Since spacer devices or facemasks differ in how they deliver a drug, they may not be interchangeable. Moreover, for effective asthma therapy, different age groups require different inhalers [ 26 ]. Therefore, the GINA guidelines considered three age groups and suggested six different, alternative devices for children with asthma.
There are relatively few nebulizers specifically designed for intranasal delivery. They work like pulmonary nebulizers but have a nosepiece as an add-on instead of a facemask. A description of them has recently been provided [ ]. Traditional droppers and squeeze bottles are unsuitable for proper dose delivery and are progressively being replaced by multidose metered spray pumps. They must contain preservatives to prevent microbial contamination. Nevertheless, the use of preservatives is avoided in more complex systems, which have aseptic air filters or collapsible bag systems included.
Propellant-based nasal sprayers are similar to pMDIs. The powder form is ideal for active principles that are unstable in liquid formulations, do not need preservatives, and can produce longer nasal retention times than liquids. Another type of powder device, known as an insufflator, is in development. This device establishes an external, tubular connection between the nostrils according to the principles of Breath-powered Bi-DirectionalTM technology, so that exhalation from one nostril blows the drug into the other and vice versa [ ].
In addition to improving the efficacy of active principles, formulations, and devices, another important objective of pharmaceutical research is improving the relationship between in vitro test data and in vivo behavior. In this direction, the constructive dialogue between industry, regulators, and academic researchers, which started with workshops concerning bioequivalence, is continuing.
Some recent, important documents have been published in the last two years. These reflect the official positions of those involved in orally inhaled and nasal drug product OINDPs development, with particular attention being paid to their design and analytical control. Clearly, the role of the physician is fundamental in motivating and addressing patients towards the choice of the better device that is compatible with possible individual limitations [ , ]. Therefore, the FDA has distributed a couple of draft guidance to device design [ , ], with the aim of reducing the most common human usage errors.
With reference to the acceptance criteria for materials, in a quality by design approach QbD , the IPAC-RS last year promoted a series of webinars, the most important [ ] of which took place on 11 October, With respect to AIM-EDA, there is a proposal by manufacturers to include in pharmacopoeias abbreviated impactor measurement AIM and efficient data analysis EDA as an alternative approach to the current cascade impaction CI for the measurement of aerodynamic particle size distribution APSD in product quality assessments [ , ].
On the other hand, the same presentation confirmed the authorities' position on delivered dose uniformity DDU , which is also a matter of debate. This draft concerns several interesting chapters: The deadline for receiving comments was March 31, This general, concise overview of the pharmacotherapy of respiratory allergies has highlighted that, in spite of the availability of new drugs and several specialized devices, in some cases AR, AA, and related comorbidities continue to be uncontrolled diseases that can evolve towards chronicity. Moreover, the levels of these diseases are increasing worldwide.
For this reason, many publications, initiatives, and reports continue to be produced and are a clear expression of the general need to make progress. A recent review [ ] emphasizes the importance of diagnostic tests for the better characterization of patients and the personalization of treatments in childhood AR and AA. The better characterization and identification of responders and nonresponders to targeted asthma treatments have also been suggested for adults, especially with biologics that are costly [ 84 , 99 ].
Therefore, particular requirements are.
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Regulation improvement by rationalizing and harmonizing regulatory documents and guidelines includes. Research improvement, particularly in diagnostics, device design, analytical control, and basic mechanisms includes. This is especially true for device design improvements, device analytical controls, new biomarkers, and new diagnostic tests.
Physicians and health authorities can provide other fruitful answers. Great, foreseeable benefits could be achieved: Nevertheless, it is unlikely that recovery from illness will only be achieved in these ways. Indeed, only two of the available treatments have been shown to have the capability to both prevent new allergic sensitization and arrest the progression of these diseases: Anti-IgE is, however, also the more expensive treatment, and its prescription is therefore limited. This therapeutic offer, which is not yet completely adequate, and the increase in the spread of respiratory allergies fully justify the alarm of the scientific community.
We should undoubtedly enhance our knowledge of these diseases, and especially their first steps, to counteract their spread and to increase the availability and efficacy of specific therapeutic offers. In fact, although the exceptional progress of molecular biology in the last decade has allowed us to discover many important effectors of the complex pathway of the allergic response, unfortunately, there is lack of information about the biochemical characterization of these effectors, their way of interaction, and particularly their chemical connections and reactions.
This deeper insight into the molecular mechanisms of respiratory allergy onset would lead to better knowledge and considerable improvement in the classification, diagnosis, and therapy of these diseases and could help to identify new, more effective remedies. In addition, it will lead to greater knowledge of the causes of the widespread increase in these allergies in industrialized areas and will enable consequent social benefits to be realized.
The authors wish to thank Prof. Ferdinando Giordano, Torre d'Isola, Italy, for his assistance in preparing and completing this work. The authors declare that there is no conflict of interests regarding the publication of this paper. National Center for Biotechnology Information , U. Published online Mar Author information Article notes Copyright and License information Disclaimer. Received Nov 6; Accepted Dec This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract The spread of respiratory allergies is increasing in parallel with the alarm of the scientific community. Introduction It is known that allergic rhinitis AR is mainly induced by an IgE-mediated response and shares many features with allergic asthma AA.
Respiratory Allergies: A General Overview of Remedies, Delivery Systems, and the Need to Progress
Existing therapeutic preparations can essentially be divided into the following three groups, in which drugs for inflammation reduction belong to the second, while drugs for the recovery of the immune balance belong to the other two: Allergen Specific Immunotherapy A patient's hypersensitivity can be reduced by a desensitization or hyposensitization treatment known as allergen specific immunotherapy SIT , which consists of gradual vaccination with progressively larger doses of an allergen. Traditional Drugs Currently available medication options for the treatment of symptoms of respiratory allergies are summarized in Table 1 and then briefly described.
Table 1 Treatment of respiratory allergies: Open in a separate window. Drugs for Allergic Rhinitis It is known that, generally, six classes of drug and nasal saline are used to treat AR [ 57 ]: Anti-IgE Biological Agents Anti-IgE therapy, which is a recent and very promising form of biological therapy, involves the subcutaneous or intravenous injection of monoclonal anti-IgE antibodies. Current Pharmacological Research In addition to available medications, several new molecular entities are in an advanced phase of clinical study or are in development. Table 2 Delivery systems for respiratory antiallergic drugs.
Pulmonary Devices Pulmonary devices fall into two main categories: Inhalers Inhalers are typically single-patient-use, portable devices that are available in combination with a specific formulation and dose of drug. Accessories for Pulmonary Devices Spacers, valved holding chambers, facemasks, and mouthpieces are common accessories for nebulizers and inhalers. Nasal Devices Nasal devices fall into three main categories: The season typically begins in early spring, when trees, including oak, cedar, elm, birch, ash, maple, and walnut, start to pollinate. Grasses, such as timothy, Bermuda, orchard, and some bluegrasses, germinate in late spring and early summer.
Goldenrod, often confused with ragweed, is sometimes blamed for allergy symptoms, but it actually produces sticky, nonairborne pollen. Unfortunately for some, moldy leaves, an often overlooked allergen, can extend symptoms almost until winter. A seasonal allergy can feel like a cold, with symptoms such as chronic congestion, a runny nose, and itchy, watery eyes. Luckily, that part is simple. The skin-prick test is the most common. Alternatively, or if that test is inconclusive, a doctor might try a more sensitive intradermal shot, which injects allergens deeper below the skin.
What are the most effective treatments available? Allergic reactions can spread deep into the lungs, putting you at an increased risk for asthma.
In fact, up to 40 percent of long-term allergy sufferers also have asthma. Another 40 percent will develop sinusitis, an infection of the sinuses. All work similarly, by trying to stop a reaction in its tracks. You might want to take something before going outside, or consistently treat yourself before the start of the season.
Antihistamines They prevent cells in the body from releasing histamines, which trigger the coldlike symptoms. Oral over-the-counter options are often combined with a decongestant generally tagged with a D for more relief. Treat throat and nasal itching, watery eyes, a runny nose, and sneezing. Newer brands, like Claritin and Allegra, claim not to cause drowsiness. Some brands can cause drowsiness. Nasal Corticosteroids Stronger than antihistamines, these prescription sprays, like Flonase, block inflammation and have been shown in some clinical studies to be the most effective remedy for allergy symptoms.
An oral version is available for extreme cases. Very effective at treating congestion. May take a week or so to bring noticeable improvement. Decongestants Nonprescription and fast acting, decongestants are available orally or as a nasal spray.