Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Avoidance of identified allergens is the most helpful factor in controlling allergy symptoms. Attempts to control the environment and avoidance measures often significantly aid in resolving symptoms. However, allergy avoidance is often not easy. A thorough discussion with your physician is needed, and control measures may be required daily.
If avoidance is not possible or does not relieve symptoms, additional treatment is needed. Many patients respond to medications that combat the effects of histamine, known as antihistamines. Antihistamines do not stop the formation of histamine, nor do they stop the conflict between the IgE and antigen. Therefore, antihistamines do not stop the allergic reaction but rather protect tissues from the effects of the allergic response.
The first-generation antihistamines, such as diphenhydramine (Benadryl), chlorpheniramine (Chlortrimaton), dimenhydrinate (Dramamine), brompheniramine (Dimetapp and others), clemastine fumarate (Tavist, Allerhist), and dexbrompheniramine (Drixoral) frequently cause mouth dryness and sleepiness
as side effects. Newer, so-called "non-sedating" or second-generation antihistamines are also available. These include loratadine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec), fexofenidine (Allegra), and azelastine (Astelin Nasal Spray). In general, this group of antihistamines is
slightly more expensive, has a slower onset of action, is longer acting, and induces less sleepiness. Discuss with your physician other antihistamine side effects that very occasionally occur (for
example, urine retention in males, fast heart rate, and others). You should always discuss the potential side effects of any medication with your physician and/or pharmacist. A thorough review of specific antihistamines can be found under the Medications Center and more in the Nasal Allergy Medications article.
Decongestants help control allergy symptoms but not their causes. Decongestants shrink the swollen membranes in the nose and make it easier to breathe. Decongestants can be taken orally or by nasal spray. Decongestant nasal sprays should not be used for more than five days without a doctor's advice, and if so, usually only when accompanied by a nasal steroid. Decongestant nasal sprays often cause a so-called "rebound effect" if taken for too long. A rebound effect is the worsening of symptoms when a drug is discontinued. This is a result of a tissue dependence on the medication.
Some people with allergies need specialized prescription medications such as corticosteroids, cromolyn, and ipratropium (Atropine-like) nasal sprays. These nasal sprays do not cause the rebound effect noticed with decongestant nasal sprays. Cortisone nasal sprays are very effective in reducing the inflammation which causes swelling, sneezing, and
a runny nose. Cortisone can also stop the allergy "war" by halting the formation of the many allergy chemicals described above. Many cortisone nasal sprays are on the market through prescription only. Fluticasone (Flonase) is one example, but many preparations are available.
Cromolyn is also an antiinflammatory medication. Although cromolyn is not as potent as cortisone, it has a very safe profile. Cromolyn must be used well in advance of anticipated allergy symptoms to be useful. Ipratropium nasal spray is available for drying a wet runny nose. It will not prevent allergic reactions. This is an atropine derivative and although usually very safe, a person sensitive to atropine should be cautious when taking this drug.
Montelukast (Singulair) is an inhibitor of leukotriene action, another chemical involved in the allergic reaction. This medication is used for therapy of asthma and has also been approved for treatment of allergic rhinitis. It has been shown to be most effective in those for whom significant congestion is a primary complaint. It may also be used in some cases together with second-generation antihistamines.
If antihistamines and nasal sprays are not effective or not tolerated by the patient, other modalities of therapy are available. Allergy desensitization or immunotherapy may be needed. Allergy immunotherapy stimulates the immune system with gradually increasing doses of the substances to which a person is allergic. Since the patient is being exposed to the allergy-inducing substance, an allergic reaction can occur, and this treatment should be supervised by an allergy specialist. Although the exact way allergy desensitization works is not completely known, allergy injections appear to modify or stop the allergy "war" by reducing the strength of the IgE and its effect on the mast cells. This form of treatment is very effective for allergies to pollen, mites, cats, and especially stinging insects (for example, bees). Allergy immunotherapy usually requires a series of injections and takes three months to one year to become effective. The required length of treatment may vary, but three years is a typical course. Frequent office visits are necessary.
The success rate of an allergy desensitization program in significantly reducing symptoms can be up to about 80%. The duration of the effect of allergy immunotherapy should last many years, if not a lifetime. Although rare (one in 2-5 million injections given), serious allergy reactions can occur while receiving allergy injections. One cannot predict who will have a severe reaction. Even after years of receiving allergy shots, a patient can experience a reaction.
Eczema, also known as dermatitis, is a general term for many types of skin inflammation. The most common form of eczema is atopic dermatitis. The other forms of eczema include: contact eczema, seborrheic eczema, Nummular eczema, Neurodermatitis, stasis dermatitis, and dyshidrotic eczema. Symptoms, diagnosis, and treatment of eczema may vary from person to person and may depend on the type of eczema.
Sinus infection (sinusitis) signs and symptoms include headache, fever, and facial tenderness, pressure, or pain. Treatments of sinus infections are generally with antibiotics and at times, home remedies.
Allergic rhinitis symptoms include an itchy, runny nose, sneezing, itchy ears, eyes, and throat. Seasonal allergic rhinitis (also called hay fever) is usually caused by pollen in the air. Perennial allergic rhinitis is a type of chronic rhinitis and is a year–round problem, often caused by indoor allergens, such as dust, animal dander, and pollens that may exist at the time. Treatment of chronic rhinitis and post nasal drip are dependant upon the type of rhinitis condition.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Sinus headache is caused by a sinus infection or inflammation of the sinus cavities. The primary symptom of a sinus infection is pain and increasing pressure overlying the area and associated tenderness to the touch. Treatment of a sinus headache depends on the cause.
Before treating a cold, the flu, or allergies with over-the-counter (OTC) medications, it's important to know what's causing the symptoms, which symptoms one wishes to relieve, and the active ingredients in the OTC product. Taking products that only contain the medications needed for relieving your symptoms prevents ingestion of unnecessary medications and reduces the chances of side effects.
Mold exposure may cause symptoms in people who are sensitive to molds. Symptoms of mold allergy include sneezing, runny nose, wheezing, coughing, redness of the eyes, and rash. Prevent mold growth by keeping indoor humidity low, between 30%-50%, using bathroom fans when showering, repairing plumbing leaks quickly, and using an air conditioner during humid seasons.
Genetic disease is a disorder or condition caused by abnormalities in a person's genome. Types of genetic inheritance include single inheritance (for example, cystic fibrosis, sickle cell anemia, Marfan syndrome, and hemochromatosis), multifactoral inheritance, chromosome abnormalities (for example, Turner syndrome, and Klinefelter syndrome), and mitochondrial inheritance (for example, epilepsy and dementia).
Common sources of indoor allergens include dust mites, cockroaches, molds, pets, and plants. Managing allergies caused by indoor allergens means reducing your exposure to them.
Occupational asthma is a type of asthma caused by exposure to a substance in the workplace. Symptoms and signs include wheezing, chest tightness, and shortness of breath. The usual treatment for occupational asthma involves removal from exposure and the use of bronchodilators and inhaled anti-inflammatory medicines.
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