Your Home Environment
People are now exposed to a chemical soup at home and in the workplace. Buildings are tightly sealed for energy efficiency and may trap chemical gases and dust from a variety of sources. Cleaning agents left on floors and other surfaces dry and can eventually circulate on dust particles throughout the house or workplace and be inhaled with each breath. Fire retardants and other chemicals used in fabrics and foams in furniture, mattresses, and electrical insulation can be irritating to the airway. Mold can flourish wherever there is humidity—in basements, crawl spaces, bathrooms, air conditioners, and automobile air ducts.
It is crazy to treat the symptoms of allergies if you don’t examine your environment and try to eliminate what’s causing the problem in the first place. If you lived in a house with faulty wiring that kept blowing fuses or tripping the circuit breakers every day, it would be foolish to ignore the underlying problem. Continually throwing the circuit breaker to the on position or replacing fuses might leave you vulnerable to a fire. In the old days, people sometimes stuck a penny in the fuse box to bypass the warning system completely. No doubt some homes burned down as a result.
We know of one family that moved into a charming old house. Within a few months, the dad starting sniffling and sneezing. Then he developed asthma for the first time in his life. Not long after, both children also became congested and had periodic bouts of asthma. They were all treated with various medications to relieve their symptoms. It wasn’t until they moved that their symptoms eventually went away and their need for allergy and asthma drugs disappeared.
No dermatologist in his right mind would keep prescribing prednisone to someone who showed up with a poison ivy outbreak every other week. At some point the dermatologist would tell this patient to stay away from poison ivy to avoid the itchy, red rash in the first place. We wish allergists and lung experts would do more than prescribe antihistamines, bronchodilators, and corticosteroids for their patients. If they actually visited their patients’ homes or workplaces they might discover the cause of the symptoms.
Of course, that is not going to happen. Instead, you will have to become your own Sherlock Holmes, sniffing out the culprits if you can. In some cases it might even be worthwhile to employ a certified environmental engineer to look for sources of allergens in a house or apartment. Watch out for charlatans, though. There are lots of quacks out there who would love nothing more than to sell you a pricey home inspection and cleanup. Make sure that whoever analyzes your living space isn’t selling a service or recommending an organization they have a financial relationship with.

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ALLERGIES

•    Install an Aprilaire HEPA-type air filter
•    Use a high-quality vacuum cleaner (Miele)
•    Rinse your nasal passages with saltwater
•    Try vitamin C
•    Experiment with the herbs stinging nettle and butterbur
•    Try Nasal Crom (cromolyn) spray to prevent allergy symptoms
•    Look for loratadine, an over-the-counter antihistamine
•    Ask your doctor about a steroid nasal spray
•    Consider pseudoephedrine for symptomatic relief

Breathing is basic. Most of the time we take it for granted. But if your nose is congested and your sinuses are stopped up, you are miserable. For one thing, your head feels as if it’s full of cotton. Studies have found that people suffering from allergies frequently experience sleep difficulties, fatigue, poor concentration, drowsiness, irritability, delayed reaction times, memory problems, and cognitive impairment. When you are in the middle of an allergy attack it is hard to drive safely even if you are not sneezing. Making decisions or operating other kinds of machinery can also be problematic.
Paradoxically, although antihistamines are the mainstay of allergy treatment, they can also cause drowsiness, delayed reaction times, sedation, and cognitive impairment. Even the so-called second-generation nonsedating antihistamines that are so heavily advertised to consumers may not be as benign as drug companies would have you believe.  When given in doses that are adequate to relieve symptoms, some of these nonsedating antihistamines may also make people drowsy and impair performance.

Research has shown that driving skills are affected with both the older and the newer antihistamines. A massive study conducted for the National Highway Traffic Safety Administration discovered that driving while drowsy—no matter what the cause—increased the risk of a crash or near crash by four to six times.
Physicians often think of allergies as more of a nuisance than a life-threatening condition. But we now realize that impairment poses huge risks if people are driving. And allergy symptoms don’t just occur in the spring and fall, when pollen is in the air. Nowadays many folks are congested all year long. At last count, 50 million people are sensitive to things like dust mites, cat dander, cockroaches, mold spores, and pollens from oak, elm, and maple trees as well as ragweed and rye, blue,and Bermuda grasses.24 Symptoms include nasal stuffiness, runny nose, itching, sneezing, and coughing. Chronic sinusitis, which may develop as a consequence of allergies, affects more than 30 million people. And asthma, which can be life threatening, often has an allergic and inflammatory component.
What is so scary about these statistics is that they keep going up. No one knows why, but it appears that more people are suffering than ever before.

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Conclusions

Allergies don’t get the respect they deserve. When you complain about your congestion, most friends and family members will barely sympathize. But allergies can slow you down and make you dangerous behind the wheel. Finding the right treatment to ease your symptoms without causing worse problems is a challenge. Combining several options, including environmental control, may be the most effective solution for solving this common problem.
•    Use a HEPA-type air filter and a dehumidifier to remove allergens from the air you breathe and make the environment inhospitable for the three Ms of allergy—mold, mildew, and mites.
•    Get a high-quality vacuum cleaner that won’t spew dust and dirt back into the air. Miele models rank high on our list.
•    Wash your nasal passages with saline. A neti pot will help.
•    Consider an herbal approach such as stinging nettle (Urtica dioica) or butterbur (Petasites hybridus). Men with prostate enlargement may find nettles especially helpful since some OTC allergy medicines may make this condition worse.

•    The natural products quercetin and bromelain may help stabilize mast cells and prevent histamine release.
•    Cromolyn (NasalCrom) is an OTC remedy that also stabilizes mast cells. It should be used preventively before exposure to allergens occurs. Cromolyn does not cause drowsiness.
•    Oral antihistamines can control symptoms, but they may also make you dangerous on the highways. Even nonsedating products may interfere with driving ability. Generic loratadine (Claritin) is now available without a prescription.
•    Among prescription allergy medicines, steroid nasal sprays offer the most effective symptom relief with a minimum of side effects. The cost is significant, since they are available only by prescription. One generic variety (flunisolide) is less expensive than brand-name products like Flonase and Rhinocort AQ.
•    Pseudoephedrine can be surprisingly effective at controlling allergy symptoms. Beware of side effects such as insomnia, nervousness, high blood pressure, and irregular heart rhythms.

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Allergy is a general term applied to certain types of hypersensitivity reactions, some of which such as hayfever are well known, but the factors that cause such reactions vary widely in their nature. In brief, an allergic reaction is immunologically mediated, and originates in an exposure to an excitatory substance referred to as an antigen, which in sensitive individuals is followed by the production of antibodies. Antigens are often protein in nature, and eggs, peanut products, wasp and bee stings, as well as drugs, can function as antigens. Subsequent re-exposure to the antigen may give rise to an antigen-antibody reaction, which is linked with the release of cell-bound histamine and other spasmogens, which in turn act upon various tissues to produce the allergic response. The response may manifest itself in several ways, such as hayfever, rhinitis, bronchoconstriction and rash or urticaria. In severe allergic reactions (anaphylactic shock), an alarming fall in blood pressure may occur with respiratory distress, and requires the immediate i.m. injection of adrenaline solution (0.5-1 ml) together with i.v. hydrocortisone 200 mg and resuscitation measures.
It should be noted that the anaphylactic reactions that occur after the first dose of certain drugs, including contrast media, are more in the nature of an idiosyncratic-toxic reaction than an immunologically mediated response, but may be no less severe, and resuscitation facilities should always be available.

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In less severe allergic reactions such as hayfever and allergic rhinitis, antihistamines are widely used for symptomatic relief. They do not interrupt the chain of antigen-antibody-histamine release, but block the access of the released histamine to the sensitized tissues. Their action is palliative and not curative, and the response to treatment is often variable.
They are usually effective in hayfever, urticaria and insect bites, but are of no value in allergic asthma. Some antihistamines also have a sedative action, which may be useful in urticaria, but undesirable in other conditions. This sedative side-effect is less marked with some of the newer antihistamines. In overdose they may cause convulsions in young patients. The extended local application of antihistamines should be avoided, as antihistamines may themselves cause an allergic-type dermatitis. Side-effects include dry mouth, blurred vision and occasional gastrointestinal disturbances. Patients should be warned that drowsiness is a common side-effect that may affect car-driving ability. Attempts have been made to desensitize susceptible patients by injections of specific antigens, such as grass pollens. The method is not without risk, particularly in asthmatic patients, and should be carried out only by experts.

Approved names               Brand names                            Daily dose range

acrivastine*                       Semprex                                  24 mg
asternizole*                      Hismanal, Pollen-Eze              10 mg
azatadine                          Optimine                                  2-4 mg
brompheniramine             Dimotane                                 12-32mg
cetrizine*                          Zirtek                                       10 mg
chlorpheniramine              Piriton                                     12-24mg
clemastine                        Tavegil                                     1-2 mg
cyproheptadine                 Periactin                                   8-32 mg
loratadine*                        Clarityn                                    10 mg
mezquitazine                    Primalan                                   5-10 mg
phenindamine*                 Thephorin                                 75-150 mg
pheniramine                     Daneral SA                                 75-150mg
promethazine                   Phenergan                                 20-75 mg
terfenadine*                     Triludan                                    60-120 mg
trimeprazine                    Vallergan                                   30-100 mg
triprolidine                      Actidil, Pro-Actidil                     7.5-15 mg

*Antihistamine with reduced sedative effects

Generic Antiallergic Medicine and Their Active Ingredients

Product Name Active Ingredient
allegra fexofenadine hcl
allegra-d fexofenadine-pseudophedrine
aristocort triamcinolone
atarax hydroxyzine
clarinex desloratadine
claritin loratadine
danocrine danazol
dexone dexamethasone
elocon mometasone
optivar azelastine
periactin cyproheptadine
singulair montelukast
tavist clemastine
zyrtec cetirizine
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