Allergy management has a number of different aspects. Typically, these are allergen avoidance and in the case of certain allergies, particularly respiratory allergies, there are medications that can prove very helpful for managing ongoing symptoms and provide allergy relief.
How are allergies treated?
Sometimes it is impossible to avoid the allergen that you are sensitive to, particularly in the case of environmental allergies such as hay fever, dust mite allergy or pet allergies. In this case, there are very broadly two types of allergy treatment that can be helpful.
The first is medications that reduce the symptoms caused by exposure to the allergen and the second is medications and treatments that reduce the underlying allergy (also known as immunotherapy or desensitisation and are considered further below). With the regards to the medication that can reduce symptoms, there are a range of different options available which will be considered separately in the sections below. However, all of these simply reduce or suppress symptoms rather than change the underlying allergic problem. That said, many are safe even for long-term use and can be very effective and thus have an important place in the management of allergies.
Many of the symptoms caused by exposure to allergens are the result of your body releasing a chemical called histamine. This chemical is found naturally in cells in your body and when released can cause itchiness, swelling and heat. Antihistamines can be very effective at reducing the symptoms caused by this by acting on the cells that are sensitive to histamine. Antihistamines do not reduce or prevent the release of histamine in the first instance but reduce the effect of the histamine that is released. Older antihistamines tended to be quite sedating which limited the value of their use, particularly for relieving hay fever or dust mite allergy symptoms. However, second and third generation antihistamines much less commonly cause these symptoms and so can be taken safely in doses that are very effective for long periods of time. As a result of their excellent safety track record, many of them are available over the counter. Third generation antihistamines are used less commonly because of the general effectiveness of the second-generation antihistamines, but if there are troublesome side effects with these, they can prove useful.
Steroids have a central role in the management of a range of allergic conditions including asthma, eczema and hay fever. They can be extremely effective at reducing symptoms such as inflammation. However, steroid medication can have side effects although this is mostly an issue with steroids by mouth which are thankfully rarely required except in more severe allergies. Steroids used as nasal sprays, inhalers or topically as creams, are generally safe as long as they are used appropriately. Steroid eye drops are also very effective but require specialist monitoring as they can increase the pressure on the eye. Expertise is required to ensure that the maximal benefit can be gained from these types of medications but without there being a risk of any short term or longer term side effects.
The mainstay of managing eczema has traditionally been a combination of emollients to help manage the dryness associated with the skin condition as well as steroid-based creams and ointments to help manage inflammation. Appropriate assessment is also required to fully understand the role of allergies contributing towards eczema in order to manage it optimally. In some cases, steroid creams are not the best option, for example in areas where the skin is particularly thin such as around the eyes or mouth where there is an increased risk of skin atrophy from prolonged use particularly with more potent steroids. In these cases, there is a potential role for calcineurin inhibitors such as Tacrolimus and Pimecrolimus which are more recently developed medication. They are also anti-inflammatory creams but work in a slightly different way to steroids and as a consequence there is no risk of skin thinning from their use. However, they can be significantly more expensive than steroid creams and also have different side effects which will require careful consideration as to where their uses are appropriate.
Leukotriene receptor antagonists
These are medications such as Montelukast that are used in the treatment of chronic asthma and sometimes in rhinitis. They are not steroid-based which has the benefit of knowing that there is no risk of steroid-related side effects, but they have been demonstrated to cause behavioural side effects in some people and hence careful consideration needs to be given as to where they might fit in the management of any particular patient’s symptoms, and expertise and experience is required.
What are the side effects of allergy medication?
All medications have potential side effects and it is therefore critical that a careful risk-benefit analysis is made in order to tailor the best treatment programme for an individual’s allergies. Whilst allergy medication generally does not change the underlying natural course of the condition, they still have an important role to play in managing them.
Do I need a prescription for allergy medication?
Some uncommon and effective allergy medications such as second generation antihistamines including Cetirizine and Loratadine do not require a prescription. Some nasal sprays and topical steroids can also be bought without a prescription for adults. There are also some very helpful non-medication based options such as saline nasal sprays that can also be bought without prescription. This reflects a longstanding and positive safety track record although medications still must only be taken as directed. More potent topical steroids, some antihistamines as well as steroid-based nasal sprays and inhalers do require a prescription.
How often does allergy medication need to be taken?
Allergy is a chronic condition and therefore allergy medication to treat them usually needs to be taken on a regular basis in order to be effective. In some cases, for example using nasal sprays for hay fever, they will only work well if taken on a regular basis and will work best if treatment is started before the beginning of the pollen season. For other medication, this is less important and they can be taken on an ‘as required’ basis, for example antihistamines for hay fever, especially if you are already on a regular nasal spray. With asthma, similarly some medications such as steroid preventer inhalers need to be taken regularly whereas bronchodilators that are used as reliever inhalers (for example Salbutamol) should only be taken as required. After your consultation, you should have a very clear plan as to what your regular medication would be and which medications you can take additionally as required.
What medicine and treatments can cure allergies?
The medications detailed above are usually for the management of allergy symptoms. There are an additional group of treatments that are focussed at reducing the underlying allergy so as to reduce the need to take other regular medication. These treatments are known as immunotherapy or desensitisation and usually involve regular exposure to large quantities of the allergen that causes the problem. This can either be using regular injections or more commonly as tablets that are put under the tongue, for example for tree pollen, grass pollen and dust mite or pet allergies. Immunotherapy is also available for certain foods although it needs to be made very clear that these are not curative treatments, just reducing sensitivity to minimise the risk of accidental reactions. In respiratory allergies such as severe hay fever, desensitisation treatments can markedly reduce the requirement for regular medication and the severity of symptoms. Importantly, this effect can last for many years beyond the course of treatment itself, and there is some evidence that desensitisation treatments can reduce the development of further allergies and the development of other allergic conditions such as asthma. Please see more on our Immunotherapy page.
Professor Adam Fox
Date reviewed: March 2022
Adam Fox is a Professor of Paediatric Allergy with over 20 years experience in both the NHS and private sector. Professor Fox is Commercial Medical Director at Guy’s & St Thomas’ Hospitals NHS Foundation Trust and Professor of Paediatric Allergy at King’s College London and the founding Director of the KCL Allergy Academy, a postgraduate educational programme, which was a finalist at the BMJ Awards in 2018.
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