The Daily Dose- 2/5/09

If you have a medical problem, or something is bothering you or a member of your family, The Jackson County Times now has a local physician, Dr. John Spence, of the Panhandle Family Care Associates available to respond to your questions via e-mail.

As suggested previously, allergy season is nearly upon us. My last article touched on methods of allergen avoidance what to look for, or avoid, in over the counter remedies. Along that same vein, I will now focus on physician driven treatments, i.e. drug and injection therapy, and finish with some comments about allergies in general, hopefully dispelling some popular misconceptions about management.

If OTC medications fail, what next?
Despite your best intentions, mere avoidance coupled with OTC medication may fall flat. At this point, your primary physician may be necessary to assist in controlling your symptoms. Most of the time, allergies should be controlled within one to two weeks from initiation of therapy. There are several options available. First, standard prescription strength antihistamines remain the most commonly used agent. Antihistamines like allegra or xyzal block the release of histamine, a chemical responsible for the itching, sneezing, etc. Second, nasal steroid sprays such as nasonex or flonase can be used to decrease inflammation and symptoms of nasal stuffiness or runny nose. Finally, leukotriene inhibitors like singulair block the chemical effects of leukotrienes which are released in response to an allergen contact.

Do I need allergy shots?
The same applies – if medications do not control symptoms over time, then you may need to consider stepping up to allergy injections. Generally, these are administered once or twice per week and therapy may last for several years. Patients will require antihistamines in addition to the shots, at least in the beginning.

Will steam cleaning carpet reduce allergies?
Only one study has formally evaluated this issue. No benefit was seen. To remove dust mites and pet allergens, it is suggested that all carpeting be removed. The coolness of the concrete floor beneath combined with indoor humidity increase the allergen load substantially. Certainly, removing carpets is an extreme measure, not to mention a potentially expensive one.

What about washing your pets? Using a HEPA filter?
As it turns out, neither has any proven efficacy. It takes 12-16 weeks to reduce cat allergens down to the level of a house without a cat! Outside of getting rid of the animal, keep it out of bedrooms and remove upholstered furniture and carpets from the house. HEPA filters have been studied extensively and were found to be ineffective. Despite removing cats from the bedroom, applying an impermeable mattress cover and running the cleaners 90% of the time, one study showed no difference in allergy symptoms over six months.

What’s new in allergy treatment?
A new type of treatment known as sublingual immunotherapy may replace allergy shots completely. Treatments are given 1-2 times per week, but drops are given under the tongue. No needles necessary! The drops are slow release formulations which allow patients to build up resistance over time with less potential for side effects, such as anaphylaxis (severe allergy reaction).
Sublingual immunotherapy is currently under investigation in trials and may take some time to reach the mainstream, but the wait may well be worth it.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.