Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
Treatment and prevention of allergies is our subject today.
Local allergic reactions such as poison ivy and the nickel
that is often used in watch bands is best treated by avoiding
the noxious substance and using creams that have a low dose
of steroid in them. They are often available without
prescription but of course, prescription ones are stronger.
Antihistamine creams and ointments are also now available and
will help for a short time as well.
Many people like the soothing agent aloe vera, and benzocaine
can also have a dulling effect on the itch. These are the
main ingredients in Dermoplast and Solarcaine, but one should
know that they can cause an allergic reaction themselves.
Calamine folium has a mild effect.
Pills are more effective. Mild to moderate allergic
reactions, as well as all bee stings, respond well to oral
agents. The old antihistamines were very effective (the first
I believe was Benadryl, which for some reason is not
available in this country) but tended to make a person
sleepy. Newer antihistamines have a lower rate of somnolence,
but some are less effective (Claritin, Allegra-Telfast at the
lower doses) and some were dangerous (Seldane, Hismanal--both
since taken off the market). The remaining ones are effective
and longer-acting, but are quite expensive.
Steroids, while taking longer to act, are very effective and
cheap. They do not need to be tapered if taken for less than
a week. They do have many side effects, most are minor but
uncomfortable, such as water retention.
Prevention means avoiding the precipitating substances, which
may not be so easy to do. Pollen is there no matter what we
do. Traces of peanuts show up in many foods. Detergents often
do not identify what they have in them.
What you can do is first identify what the substance that
causes a reaction is -- allergy testing is the way. The old
way to determine was by painful skin testing. Now we can do
it all by blood test.
Desensitization therapy can be started. It involves monthly
shots for a few years and has a rate of 50-60 percent
success. Depending on how much you are suffering, it may be
worth it.
Pollen can be dealt with by air cleaners or by frequently
cleaning your air conditioning filter. Often people learn in
buildings that do not do this. Write me in care of the
Yated.
A message from Glaxo, sponsor of this column. Avandia
was a revolution in diabetes management. It is a once a day
medication that works fast in making the body respond to
insulin. It is safe, and does not need dosage adjustment in
the elderly or people with kidney problems.
