New Treatments for Allergies
Jun 17, 2014
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
School is winding down. The kids are excited. And I think back to summer as a kid. Im sure I had plenty of boring, do nothing days, but all I remember now is they exciting parts like losing a girlfriend over a water fall. The town I grew up in, Pinawa, really was Pinawa part 2. The original town site was about 20 km away. It was the site of the first hydro electric dam in the province. The original town is gone and it is now just called the Old Pinawa Dam. The military used it for demolition practice in the 1950s, but some of the structure is still there. We used to love to drive out to Old Pinawa and swim in the rapids. Looking back, the appeal was dubious because someone got hurt almost every trip. On the lower set of rapids, you could swim left hard and stand at the top of 4 foot waterfall. Then you jumped over the waterfall and could get underneath it, if you knew what you were doing. In fact there was just enough remove for say you and a girlfriend under there. I managed to convince a few girls to go under the waterfall with me over the years, but the important part was to swim left when I yelled, Swim left! Apparently some people dont listen as well as others.
As the weather has been warming up, people I talk to in the pharmacy are really starting to complain about their allergies. Some experts think that the long winter and late spring might be making all the plants around release their pollens at once. Whatever the cause, people are looking for relief. We usually talk about antihistamines over the counter and steroid nose sprays by prescription to treat allergies or allergic rhinitis. This year I can also talk about 3 new and different medications, Oralair, Grastek and Ragwitek.
What is allergic rhinitis? When a person with allergic rhinitis breathes in an allergen such as pollen,mold, animal dander,or dust the body overreacts as if these benign substances were attacking the body. The body releases chemicalslike histamine that cause inflammation and allergy symptoms. Symptoms may include: itchy, watery eyes, stuffy nose, cough, sore throat, and fatigue.
What can you do about allergic rhinitis? Well, if youve never had any of these symptoms before, get assessed by your doctor. They will want to rule out other illnesses, and possibly have you sent to a specialist to find out exactly what substances are your triggers. If you and your doctor are sure your problems are just allergies and the symptoms arent too severe, you can start with trigger avoidance.
To avoid your allergy triggers, you have to know what they are. Allergy testing can determine your triggers, and you can help yourself by keeping an allergy diary. In an allergy diary you list what you did and what you were exposed to and how your symptoms were in a given day. If it turns out you are allergic to pollen or outdoor molds try to remain inside during pollen season. Watch the pollen counts on the Weather Station and avoid outdoor activities on high pollen count days. Shower or bathe after outdoor activity to remove pollen from hair and skin and to prevent contamination of bedding. If you have indoor allergies like dust mites, then try to avoid carpeting. The less carpeting in the house, the better, especially the bedroom. A central vacuum system that exhausts outside is best, and the allergic person shouldnt even be in the home when the vacuuming is done, if possible. Encase all mattresses, box springs and pillows in zippered, allergen-proof casings. Keep indoor humidity under 50%.
After allergen avoidance we usually talk about antihistamines and nasal steroid sprays. There are newer treatments available.
They are completely different than the antihistamines. As a group they are called sublingual immunotherapy. The oldest is called Oralair, then came Grastek and the newest is Ragwitek. Immunotherapy has been around for a while. It usually involves injecting small amounts of the allergen under the skin in a specialists office. It is an attempt to retrain the immune system not to over react to the allergen. The idea is that if we expose the immune system to small amounts of the allergen, it will get used to it. We say immunotherapy desensitizes the immune system. The neat thing about these new medications is you dissolve a tablet under the tongue instead of getting an injection in a doctors office which is much more convenient. Oralair is has 5 different grass pollens in it, Grastek has one type of grass pollen and Ragwitek has ragweed pollen in it.
Now, to the downside of the new treatments. You have to go to a specialist and have allergy skin testing before these treatments are prescribed. The first treatment will be given in a doctors office and you will have to remain there for 30 minutes to make sure you dont have a severe allergic reaction. Minor side effects include mild allergy symptoms, minor mouth swelling or discomfort.
A patient should start the treatments about 4 months before their allergy season and continue to take them throughout their whole allergy season. Patients who use these treatments should have an EpiPen just in case. The improvements over placebo the companies report vary from 13% in Grastek, to 18% in Ragwitek to 23% in Oralair. They arent indicated for people with severe, uncontrolled asthma and shouldnt be used by people taking beta-blockers like metoprolol and propranolol. Finally they are expensive. They will cost about $140 per month.
Carmen didnt listen that well. I went first over the second set of rapids. I swam left, and was waiting to catch her at the top of the waterfall. Then Carmen started down. I yelled, Swim left! She didnt. She went over the 4 1 foot step falls on the right side. She kinda bounced on each step. I had to jump over the falls, swim down and retrieve her. She wasnt hurt, but needless to say had no interest in going under the falls with me that day.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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