Allergy medical therapy: Difference between revisions
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Treatment for allergic response is primarily pharmacotherapeutic. Common methodologies include immunotherapy via desensitization or hyposensitization, enzyme potentiated desensitization. | Treatment for allergic response is primarily pharmacotherapeutic. Common methodologies include immunotherapy via desensitization or hyposensitization, enzyme potentiated desensitization. | ||
==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. | 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. | ||
==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]] 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> | ||
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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. | 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== | |||
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" /> | 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" /> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Treatment for allergic response is primarily pharmacotherapeutic. Common methodologies include immunotherapy via desensitization or hyposensitization, enzyme potentiated desensitization.
Pharmacotherapy
Several antagonistic drugs are used to block the action of allergic mediators, or to prevent activation of cells and degranulation processes. These include antihistamines, cortisone, dexamethasone, hydrocortisone, epinephrine (adrenaline), theophylline and cromolyn sodium. Anti-leukotrienes, such as Montelukast (Singulair) or Zafirlukast (Accolate), are FDA approved for treatment of allergic diseases. Anti-cholinergics, decongestants, 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.
Immunotherapy
Desensitization or hyposensitization is a treatment in which the patient is gradually 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.[1] 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.[2] 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.[3]
A second form of immunotherapy involves the intravenous injection of 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 basophils 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.
A third type, Sublingual immunotherapy, is an orally-administered therapy which takes advantage of 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
An experimental treatment, enzyme potentiated desensitization (EPD), has been tried for decades but is not generally accepted as effective.[4] 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.[4]
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.[5]
References
- ↑ 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.
- ↑ Rank MA, Li JT (2007). "Allergen immunotherapy". Mayo Clin. Proc. 82 (9): 1119–23. PMID 17803880. Unknown parameter
|month=ignored (help) - ↑ Passalacqua G, Durham SR (2007). "Allergic rhinitis and its impact on asthma update: allergen immunotherapy". J. Allergy Clin. Immunol. 119 (4): 881–91. doi:10.1016/j.jaci.2007.01.045. PMID 17418661.
- ↑ 4.0 4.1 Terr AI (2004). "Unproven and controversial forms of immunotherapy". Clinical allergy and immunology. 18: 703–10. PMID 15042943.
- ↑ 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.