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==Overview==
==Overview==
Treatment for allergic response is primarily pharmacotherapeutic. Common methodologies include immunotherapy via desensitization or hyposensitization, enzyme potentiated desensitization.
The mainstay of treatment for [[allergy]] is pharmacological [[medical therapy]].Immunotherapy via [[desensitization]] or [[hyposensitization]], as well as [[enzyme]] potentiated desensitization, are common methodologies. The medical treatments for allergic conditions have vastly improved in recent years.
 
==Medical Therapy==
==Medical Therapy==
*Medical therapies for [[allergy]] include  [[pharmacotherapy]], [[immunotherapy]] and [[Unproven therapy]]. Immunotherapy via [[desensitization]] or [[hyposensitization]], as well as [[enzyme]] potentiated desensitization, are common methodologies. The medical treatments for allergic conditions have vastly improved in recent years.<ref>{{cite journal |author=Sicherer SH, Leung DY |title=Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects |journal=J. Allergy Clin. Immunol. |volume=119 |issue=6 |pages=1462-9 |year=2007 |pmid=17412401 |doi=10.1016/j.jaci.2007.02.013}}</ref>
===Pharmacotherapy===
===Pharmacotherapy===
Several [[antagonism|antagonistic]] drugs are used to block the action of allergic mediators, or to prevent activation of cells and degranulation processes. These include [[antihistamine]]s, [[cortisone]], [[dexamethasone]], [[hydrocortisone]], [[epinephrine]] (adrenaline), [[theophylline]] and [[cromolyn sodium]]. Anti-[[leukotriene]]s, such as [[Montelukast]] (Singulair) or [[Zafirlukast]] (Accolate), are FDA approved for treatment of allergic diseases. Anti-[[cholinergic]]s, [[decongestant]]s, mast cell stabilizers, and other compounds thought to impair eosinophil [[chemotaxis]], are also commonly used. These drugs help to alleviate the symptoms of allergy, and are imperative in the recovery of acute anaphylaxis, but play little role in chronic treatment of allergic disorders.
*[[Antihistamine]]
*[[Corticosteroid]]
*[[Epinephrine]]
*[[Theophylline]]
*[[Cromolyn sodium]]
*Anti-[[leukotriene]]s
*Anti-[[cholinergic]]s
*[[Decongestant]]s
*[[Mast cell stabilizers]]


===Immunotherapy===
===Immunotherapy===
Desensitization or [[hyposensitization]] is a treatment in which the patient is gradually [[vaccination|vaccinated]] with progressively larger doses of the allergen in question. This can either reduce the severity or eliminate hypersensitivity altogether. It relies on the progressive skewing of [[IgG]] antibody production, to block excessive IgE production seen in atopys.  In a sense, the person builds up immunity to increasing amounts of the allergen in question. Studies have demonstrated the long-term efficacy and the preventive effect of immunotherapy in reducing the development of new allergy.<ref name="pmid10963288">{{cite journal |author=Ross RN, Nelson HS, Finegold I |title=Effectiveness of specific immunotherapy in the treatment of allergic rhinitis: an analysis of randomized, prospective, single- or double-blind, placebo-controlled studies |journal=Clinical therapeutics |volume=22 |issue=3 |pages=342–50 |year=2000 |pmid=10963288 |doi=10.1016/S0149-2918(00)80038-7}}</ref> Meta-analyses have also confirmed efficacy of the treatment in allergic rhinitis in children and in asthma. A review by the Mayo Clinic in Rochester confirmed the safety and efficacy of allergen immunotherapy for allergic rhinitis and conjunctivitis, allergic forms of asthma, and stinging insect based on numerous well-designed scientific studies.<ref name="pmid17803880">{{cite journal |author=Rank MA, Li JT |title=Allergen immunotherapy |journal=Mayo Clin. Proc. |volume=82 |issue=9 |pages=1119–23 |year=2007 |month= Sep |pmid=17803880 |doi=}}</ref>  Additionally, national and international guidelines confirm the clinical efficacy of injection immunotherapy in rhinitis and asthma, as well as the safety, provided that recommendations are followed.<ref name="pmid17418661">{{cite journal |author=Passalacqua G, Durham SR |title=Allergic rhinitis and its impact on asthma update: allergen immunotherapy |journal=J. Allergy Clin. Immunol. |volume=119 |issue=4 |pages=881–91 |year=2007 |pmid=17418661 |doi=10.1016/j.jaci.2007.01.045}}</ref>
*Desensitization or [[hyposensitization]] with allergen <ref name="pmid10963288">{{cite journal |author=Ross RN, Nelson HS, Finegold I |title=Effectiveness of specific immunotherapy in the treatment of allergic rhinitis: an analysis of randomized, prospective, single- or double-blind, placebo-controlled studies |journal=Clinical therapeutics |volume=22 |issue=3 |pages=342–50 |year=2000 |pmid=10963288 |doi=10.1016/S0149-2918(00)80038-7}}</ref>
*[[Intravenous]] injection of [[monoclonal antibody|monoclonal]] anti-IgE antibodies [[Omalizumab]]
*[[Sublingual immunotherapy]]


A second form of immunotherapy involves the intravenous injection of [[monoclonal antibody|monoclonal]] anti-IgE antibodies. These bind to free and B-cell associated IgE; signalling their destruction. They do not bind to IgE already bound to the Fc receptor on [[basophil]]s and mast cells, as this would stimulate the allergic inflammatory response.  The first agent of this class is [[Omalizumab]]. While this form of immunotherapy is very effective in treating several types of atopy, it should ''not'' be used in treating the majority of people with food allergies.
===Unproven or Ineffective Treatments===
*[[Enzyme potentiated desensitization]]<ref name="pmid15042943">{{cite journal |author=Terr AI |title=Unproven and controversial forms of immunotherapy |journal=Clinical allergy and immunology |volume=18 |issue= |pages=703–10 |year=2004 |pmid=15042943 |doi=}}</ref>
*Complementary medicine : [[naturopathy]], [[herbal medicine]], [[homeopathy]], [[traditional Chinese medicine]] and [[kinesiology]]<ref name="pmid17285788">{{cite journal |author=Altunç U, Pittler MH, Ernst E |title=Homeopathy for childhood and adolescence ailments: systematic review of randomized clinical trials |journal=Mayo Clin. Proc. |volume=82 |issue=1 |pages=69–75 |year=2007 |pmid=17285788 |doi=}}</ref>


A third type, [[Sublingual immunotherapy]], is an orally-administered therapy which takes advantage of [[immune tolerance|oral immune tolerance]] to non-pathogenic antigens such as foods and resident bacteria. This therapy currently accounts for 40 percent of allergy treatment in Europe. In the United States, sublingual immunotherapy is gaining support among traditional allergists and is endorsed by doctors who treat allergy.


===Unproven or Ineffective Treatments===
===Contraindicated Medications===
An experimental treatment, [[enzyme potentiated desensitization]] (EPD), has been tried for decades but is not generally accepted as effective.<ref name="pmid15042943">{{cite journal |author=Terr AI |title=Unproven and controversial forms of immunotherapy |journal=Clinical allergy and immunology |volume=18 |issue= |pages=703–10 |year=2004 |pmid=15042943 |doi=}}</ref> EPD uses dilutions of allergen and an enzyme, [[beta-glucuronidase]], to which T-regulatory lymphocytes are supposed to respond by favouring desensitization, or down-regulation, rather than sensitization. EPD has also been tried for the treatment of [[autoimmune diseases]] but again is not [[FDA]] approved or of proven effectiveness.<ref name="pmid15042943" />
{{MedCondContrAbs
 
|MedCond = AbobotulinumtoxinA|AbobotulinumtoxinA}}
In [[alternative medicine]], a number of allergy treatments are described by its practitioners, particularly [[naturopathic]], [[herbal medicine]], [[homeopathy]], [[traditional Chinese medicine]] and [[kinesiology]]. Systematic literature searches conducted by the Mayo Clinic through 2006, involving hundreds of articles studying multiple conditions, including asthma and upper respiratory tract infection showed no effectiveness of any alternative treatments, and no difference compared with placebo. The authors concluded that, based on rigorous clinical trials of all types of homeopathy for childhood and adolescence ailments, there is no convincing evidence that supports the use of alternative treatments.<ref name="pmid17285788">{{cite journal |author=Altunç U, Pittler MH, Ernst E |title=Homeopathy for childhood and adolescence ailments: systematic review of randomized clinical trials |journal=Mayo Clin. Proc. |volume=82 |issue=1 |pages=69–75 |year=2007 |pmid=17285788 |doi=}}</ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 15:20, 22 January 2024

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Marufa Marium, M.B.B.S[2]


Overview

The mainstay of treatment for allergy is pharmacological medical therapy.Immunotherapy via desensitization or hyposensitization, as well as enzyme potentiated desensitization, are common methodologies. The medical treatments for allergic conditions have vastly improved in recent years.

Medical Therapy


Pharmacotherapy

Immunotherapy

Unproven or Ineffective Treatments


Contraindicated Medications

AbobotulinumtoxinA is considered an absolute contraindication to the use of the following medications:

References

  1. ↑ Sicherer SH, Leung DY (2007). "Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects". J. Allergy Clin. Immunol. 119 (6): 1462–9. doi:10.1016/j.jaci.2007.02.013. PMID 17412401.
  2. ↑ Ross RN, Nelson HS, Finegold I (2000). "Effectiveness of specific immunotherapy in the treatment of allergic rhinitis: an analysis of randomized, prospective, single- or double-blind, placebo-controlled studies". Clinical therapeutics. 22 (3): 342–50. doi:10.1016/S0149-2918(00)80038-7. PMID 10963288.
  3. ↑ Terr AI (2004). "Unproven and controversial forms of immunotherapy". Clinical allergy and immunology. 18: 703–10. PMID 15042943.
  4. ↑ Altunç U, Pittler MH, Ernst E (2007). "Homeopathy for childhood and adolescence ailments: systematic review of randomized clinical trials". Mayo Clin. Proc. 82 (1): 69–75. PMID 17285788.

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