Last week’s article presented over-the-counter medications for the symptoms of hay fever (allergic rhinitis). Several readers wanted to know what to do when the symptoms are bad, and all the pills, potions, and powders don’t work. When that occurs, it’s time to visit the allergist (in addition, ear, nose, and throat and primary care doctors may offer treatment).

After a careful history is taken to identify any specific irritants, allergy testing is performed. There are basically two forms of allergy testing: skin pricking with a needle, where a small dose of the irritant (called the allergen) is placed under the skin, or a blood panel, which detects the specific IgE antibodies against the allergen. The skin prick test will show a reaction within 15 minutes, and it’s more accurate than the IgE blood panel, which takes several days to return results. However, the IgE blood test is easier to do and is less expensive.

When the specific allergen is known (keep in mind that it is not uncommon for an allergy test to be positive to an allergen that does not truly provoke a response, known in the business as a false positive), immunotherapy, which desensitizes the patient to the allergen, is begun.

There are two types of immunotherapy: the common “allergy shot” and sublingual (under-the-tongue) administration of the known allergen, beginning with a very low dose. Over time, this dose is gradually increased, thereby suppressing the body’s response to the allergen.  The advantage of the allergy shot is that it’s more effective at relieving symptoms, but it has the disadvantage of requiring a shot at the doctor’s office in case of a severe reaction. The advantage of the sublingual therapy is that it can be done at home, but it is less effective.

Regardless of the type of allergen administration, therapy usually continues for 3 to 5 years, after which the immunotherapy is discontinued.   Fortunately, often the severe symptoms do not return.  If they do, they’re usually much milder and controlled with the over-the-counter medications.

Dr. Charlie Barnett is a contributor to KnoxTNToday, where he writes a weekly column, DocTalk, sharing his expertise on health and wellness management.

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