There are many different types of medications used to treat allergies and atopic conditions. Below are some of the main ones.
Food, Drug or Venom Allergy Treatments
There are two main treatments to treat allergic reactions which are triggered by foods, drugs or venom.
Antihistamines are designed to block histamine binding to their receptors and as such, they can block the actions of histamine. Antihistamines should be taken if someone has been exposed to a food they are allergic to and develop signs of a mild to moderate allergic reaction which would include:
- abdominal pain
- runny nose
- itchy eyes
Antihistamines DO NOT treat anaphylaxis or stop it from occurring.
Antihistamines are also very useful for treating environmental allergies. They are useful to stop sneezing, a runny nose and runny, itchy eyes.
First generation antihistamines cause sedation and are generally not recommended other than chlorpheniramine in under 2’s. They are short acting and tend to be less effective at treating reactions.
Second generation antihistamines include cetirizine, levocetirizine, loratadine and fexofenadine. For most people they are well tolerated and are extremely safe medications.
All antihistamines except high dose fexofenadine (180mg) are available without prescription. Chlorpheniramine will need to be prescribed if it is for a child under one.
If someone is having anaphylaxis, adrenaline should always be given. Two adrenaline auto-injectors should be carried at all times by those at risk of anaphylaxis.
There are 2 brands of adrenaline auto-injectors in the UK:
- Epipen – comes in 0.15mg and 0.3mg dose
- Jext – comes in 0.15mg and 0.3mg dose
Adrenaline auto-injectors are only available on prescription and it is vital you receive training on how to use each specific brand.
Environmental Allergy Treatments
Besides avoidance, the main treatments for environmental allergies are nasal rinses, antihistamines and nasal sprays.
Washing the nose out from allergens can be all that some people with environmental allergies need to do to control their symptoms. They are particularly useful when used in combination with nasal steroid sprays. Remember to use the nasal spray after rinsing the nose out.
The two main rinses that can be used are Sterimar or Neilmed Sinus rinse. These can both be bought over the counter.
Antihistamines are very useful for treating environmental allergies. They are useful to stop sneezing, a runny nose, and runny, itchy eyes. They do not tend to work well for nasal congestion.
The nasal sprays which are recommended for treating allergy symptoms are steroid nasal sprays, antihistamine nasal sprays or combination steroid and anti-histamine nasal sprays. Many individuals find benefit from pseudofed (which contains pseudoephedrine) but this is not recommended. Psuedofed is useful for short term use of 3-4 days for cold symptoms but if used long term, it causes a worsening of congestion symptoms and should be stopped as soon as possible.
Nasal steroid sprays are very safe long term. Fluticasone or mometasone based nasal sprays can be bought over the counter and are extremely helpful for congestion. However, one should remember that it can take 3-4 weeks for them to work, and they need to administered properly.
Please read the following leaflet to ensure this is achieved:
Combination nasal sprays which contain antihistamines and steroid often work well. These sprays are only available on prescription, likewise, antihistamine only nasal sprays are also only available on prescription.
One of the most challenging aspects of eczema is that nearly all treatments are applied to the skin – ie. a cream or ointment. This can be very time consuming, and compliance is often a big issue which Dr Helen completely understands. Trying to settle into a routine, can really help with the control of this challenging condition.
There are many, many different types of creams, lotions and ointments available to help eczema. Many patients with eczema think that their creams don’t help, but it’s important to remember that moisturisation forms the basis of all eczema treatment and their only purpose is to help keep the skin hydrated. They will not cure eczema and it is this expectation that sometimes leads people to stop using creams. Without regular usage, the skin will deteriorate and flare more frequently.
Moisturisers can be bought over the counter but when used in adequate quantities, this can become expensive and therefore having these creams prescribed may be more appropriate.
Steroid creams have been used for many years and they are often used to successfully treat eczema flare ups. Rightly, there is much concern about the long term use of steroids, but when used in the correct manner, their safety profile is very good.
Hydrocortisone 1% and Eumovate are available to buy over the counter but stronger steroids need a prescription. Dr Helen would encourage guidance when any steroids are used, even if bought over the counter.
For individuals with eczema which is not controlled by regular steroid use or if the eczema is on the face and not manageable, calcineurin inhibitors such as Protopic or Tacrolimus are a fantastic alternative. These need to be prescribed and appropriate advice needs to be given to ensure they are safe for the individual.
When all of the above options have been exhausted and someone still has uncontrolled eczema, oral immunosuppressants may be the only other choice. The use of these medications are assessed by a dermatologist and the pros and cons need to be carefully weighed up.
The majority of asthmatics will have their symptoms controlled with the use of regular inhalers. It is also sensible for asthmatics to identify any triggers for their symptoms and avoid these where possible. There are oral medications available for asthmatics if inhalers do not help.
There are many different inhalers which are prescribed to prevent asthma symptoms from occurring and to control symptoms during an attack. A clinician will assess what medication is correct for you.
Leukotriene Receptor Antagonists
These are oral medications which come in the form of granules, chewable tablets, or normal tablets for adults. They are not steroid based and can be very useful either as an asthma medication alone or in combination with inhalers when symptoms are not controlled. Many asthmatics who have environmental allergies, find this medication useful. It is a prescribed medication.