Allergy Treatment Options


1. Avoiding Allergens

This approach is used mainly for allergies caused by food, drugs, venom, latex and animal dander. This can also include occupational allergies, and to a lesser extent, depending on the suspected cause, asthma, rhinitis and eczema. When using allergen avoidance, it is important to know that there may be interactions resulting from cross reactions between, to name a few, latex and fruits and vegetables as well as tree pollen and fresh fruits. While it may appear simple, avoiding allergens may be difficult to achieve, costly and may not be completely successful. Some specific techniques for avoidance are listed below:

  • Avoidance of outdoor activities in the morning when pollen release is highest
  • Keep windows closed and air condition vents clean
  • Limit the presence of pollenating plants in the area
  • Avoid damp environments
  • Avoid dense landscaping near the house
  • Prevent moisture accumulation indoors around pipes, AC, refrigerator and bathroom
Dust/Dust Mites
  • Eliminate carpet or use synthetic carpet
  • Regular and frequent vacuuming: best with high-efficiency particulate air (HEPA) vacuums
  • Regular changing of filters in heating/air conditioning systems
  • Use of impervious pillow and mattress covers
  • Regular washing of bedding in hot (>140 F) water
  • HEPA filters in bedroom
Animal Dander
  • Remove pet from bedroom or confining pet to space not regularly occupied
  • Regular washing of pets

2. Daily Medications

These treatments can be self-administered and do not necessarily need to be based on an accurate diagnosis. Examples include the use of over-the-counter or prescription medications such as:

  • Topical nasal sprays (Flonase, Nasacort)
  • Oral antihistamines (Claritin, Zyrtec, Allegra, Clarinex, Xyzal)
  • Topical antihistamine sprays (Astelin, Olopatadine)
  • Leukotriene inhibitors (Singulair)

While these medications are very effective and affordable with minimal side effects, they do require regular use for maximum response.

Rescue Medications

This approach is often part of an individual’s emergency self-treatment plan for acute attacks such as for acute tongue swelling or anaphylaxis that can result from insect bites, food, medication and other types of allergies. EpiPen (Epinephrine) is the treatment of choice for serious, life threatening allergic reactions.

3. Immunotherapy

This treatment works similar to a vaccine. It involves administration of an allergen either beneath the skin (subcutaneous) or under the tongue (sublingual) to induce allergic tolerance and reduction of allergic symptoms. This method effectively reorganizes the body’s immune system to reduce the response to one or multiple specific allergens. Successful response to immunotherapy requires:

  1. Identifying the offending allergens
  2. Providing an adequate therapeutic dose for treatment
  3. Treating for an adequate period of time

How does it work?

Once an allergy test identifies the specific allergens responsible for a patient’s symptoms, we will determine what dose strength to start with. Therapy involves an injection beneath the skin or pill administration under the tongue typically once weekly at home in 10 week increments. Initially the strength of allergen will be very low but will be increased every 10 weeks, if tolerated well, until a maintenance dose is achieved. The maintenance dose is the target dose where maximal allergen is delievered without significant systemic or local reactions. The maintenance dose is then given over a period of 3-5 years.

  1. Allergy test to identify specific allergens
  2. Mixing of custom allergy vials/sublingual tablets
  3. Start therapy at low dose once weekly
  4. Advance in strength every 10 weeks if tolerated
  5. Once advanced to maintenance dose, continue for 3-5 years

Important things to know

  • Breakthrough symptoms are not uncommon with large allergen exposures such as a heavy pollen season or exposure to a very dusty environment.
  • Even with successful immunotherapy, some medications still may be necessary for complete control of symptoms.
  • Cannot be used for food allergies