Did you say allergy?

Runny nose, red and watery eyes, difficulty breathing, redness and itching of the skin. These symptoms are suggestive of a common condition that affects more than 30% of the population: ALLERGY.

Allergies can occur at different organs, cause symptoms of many types, and be triggered by various allergens.

What are some possible causes to allergic phenomena?

Factors involved in allergic reactions:

FAMILY PREDISPOSITION

Also called atopy, it determines the risk of allergic reaction in children:

WAY OF LIFE

Changes in the environment, housing and lifestyle:

• We travel increasingly
• We eat unusual foods
• We plant in our gardens plants of all kinds
• Increase in the number of pets

Air pollutants could be a cause of allergic phenomena, but they appear more as aggravating factors.

How allergies are diagnosed?

At the onset of suggestive signs, such as runny nose, stinging eyes, sneezing in bursts, the medical expertise of the allergist is essential. It aims to establish the diagnosis of allergy and to define the relevant allergen(s) responsible(s) of the reaction, to set up a specific effective treatment for the allergen.

EXAMINATION AND HISTORY

Rigorous and thorough, it must confirm the hypothesis of allergy and help to establish a first list of responsible allergens. Everything will be screened:

• History of symptoms (duration, nature, frequency, triggers, etc.)
• Family history of allergy, as well as personal history
• General environment
• Lifestyle, living areas, eating habits
• Professional activities and leisures

Several consultations may be necessary to evaluate everything, but that balance is essential to the diagnosis and identification of the involved allergen(s).

PHYSICAL EXAMINATION

General examination and focused discussion on the affected organs (skin, lungs, nose, bronchi) are needed. It allows the allergist to assess the impact of the allergy. It directs to further investigation that eventually may be necessary.

Which are the different allergic testing options?

How taking care of allergy?

Treating allergy is to address both : the symptoms and what causes it.

EVICTION OF THE ALLERGEN

Removing contact with the allergen avoids the triggering of allergic reactions. To relieve symptoms, some medications have been proven. To fight against the immune dysfunction that leads to allergy, desensitization therapy is the gold standard.

Once the allergen(s) is/are identified, it should be avoided as much as possible, which is sometimes very demanding! A good environmental control will reduce exposure to the allergen.

Which are the different type of allergies?

ALLERGY TO DUST MITES

The indoor environment of the house, especially the bedroom, is to be reorganized to reduce the number of these microscopic organisms who are responsible for allergic reactions. The bedding includes all the conditions for the development of dust mites: heat, humidity, and especially our dander (dead skin) on which they feed.

It is therefore recommended:

• Reduce temperature (18-19 ° C maximum)
• Ventilate daily 30 minutes even if it's cold outside, and when it’s hot and moist.
• Maintain moisture in the bedroom between 40 and 50%
• Getting rid of items like stuffed animals and pillows
• Prefer washable floor coverings carpets, curtains and blinds
• Remove dusts of furniture, and frequently vacuuming
• Use dust mite covers of medical quality for the protection of mattresses, pillows, etc. These constitute an effective barrier avoiding contact with dust mite allergens.

ALLERGIES animal dander

Avoid contact with domestic animals and the places they usually frequent.

If there is a pet at home, consider the separation of the family and the pet, which is difficult but essential because these allergies can develop into asthma.

You must know that :

• Non-allergenic animals do not exist
• “Do not touch” is not enough
• The washing is not effective
• There is no product that makes the animal non-allergenic

ALLERGIES TO POLLENS

Pollen is the most difficult allergen to avoid because of the fact that we can’t remove it from nature. Its particles are so small, they are transported by the wind and invisible. However, to reduce exposure to pollen here are some tips during the pollen periods:

• Avoid eating outside and nature walks
• Wash your hair and change your clothes after a walk outside
• Avoid mowing the lawn or to be present while mowing
• Prefer air conditioning rather than the wide open windows

What is an allergic reaction?

Allergy is when the immune system overreacts to a substance in the environment that is usually safe.

The substances which cause the sensitivity of the immune system are called allergens. For example, dust mites, pollens and pets are common allergens.

The antibodies involved in allergic reactions are IgE. IgE bind to cells called mast cells and results in the release of chemicals including histamine. This is histamine which causes the allergy symptoms : respiratory, skin, digestive, according to each individual and according to the allergen to which the individual is hypersensitive.

Sometimes allergies appear after many years of exposure to the allergen, but sometimes they appear more quickly or spontaneously. Whenever possible, avoidance of the allergen minimizes the risk of allergic reactions.

Are pollen and food related?

Allergy symptoms are caused by a specific immune system response following exposure to an allergen. A substance that triggers an allergic reaction in one person may be completely innocuous to another person.

Subcutaneous immunotherapy can be used to desensitize the immune system to certain allergens.

These allergens include:

What is oral allergy syndrome?

Oral allergy syndrome, or pollen-food syndrome, is an allergic reaction that occurs when a person experiences nasal allergy or hay fever symptoms while eating nuts or fresh fruits or vegetables. These symptoms usually affect only the mouth and throat.

This syndrome is caused by the structure of the proteins that trigger these allergy symptoms. Some labile proteins in raw fruits and vegetables are very similar to those in pollen. The most common combinations are listed below.

CROSS-REACTIONS BETWEEN POLLEN AND FOOD

The allergens that cause oral allergy syndrome are heat-sensitive proteins. That means a person with this syndrome could potentially experience allergy symptoms while eating an apple but not when having a slice of apple pie.

About 10% of people will experience localized symptoms in the mouth and throat. The risk of anaphylaxis is believed to be around 1.7%. Anyone who thinks they may have oral allergy syndrome should have cutaneous scarification testing done to pinpoint what foods they are allergic to. Though the risk of anaphylaxis is very low, it is difficult to predict how severe an allergic reaction may be. That is why it’s best for these people to avoid the fresh fruits and vegetables that trigger symptoms.

RISK OF HAVING AN ALLERGIC REACTION TO A FOOD BASED ON DIFFERENT FACTORS

Source: Sicherer, SH. “Clinical implication of cross-reactive food allergens.” Clinical Journal of Allergy and Immunotherapy, 2001; 108(6)881-90

What types of allergens are present in the environment?

Dust mite allergies

Take steps to reduce the number of dust mites in your home, especially in your bedroom. The excrement of these microscopic organisms triggers allergic reactions.

Bedding is a breeding ground for dust mites. It’s warm and moist and has plenty of dead skin cells for them to feed on.

Recommendations:

• Turn down your thermostat (keep it at 18°C or 19°C max).
• Air out your home daily for 30 minutes, even if it’s hot and humid or cold out.
• Keep humidity between 40% and 50%.
• Get rid of stuffed items such as plush toys and cushions.
• Install washable flooring instead of carpeting and blinds rather than drapes.
• Dust your furniture thoroughly and vacuum frequently.
• Use medical-grade dust mite covers on your mattresses, pillows, and other linens to form a protective barrier between you and dust mites.

Pet allergies

Avoid all contact with pets and stay away from areas they use.

If you have a pet, try to keep it out of your living areas. Tough as it may be, it’s worth it to prevent asthma.

Did you know?

• There is no such thing as a hypoallergenic pet.
• Allergies can’t be prevented by simply not touching pets.
• Washing your pets isn’t a solution either.
• No product can make a pet hypoallergenic.

Pollen allergies

Pollen is the most difficult allergen to avoid since it cannot be eliminated from the environment. Pollen particles are so small they are invisible and can be carried by the wind.

You can, however, take the following steps to reduce your pollen exposure when pollen levels are high:

• Avoid picnics and nature walks.
• Wash your hair and change your clothes after walks.
• Avoid mowing the lawn and stay indoors when the lawn is being cut.
• Turn on the air conditioning instead of opening up the windows.

What is immunotherapy?

Allergen immunotherapy or desensitization is the only known cure for allergies.

There is now an international consensus on this experience-based approach, as evidenced by the World Health Organization’s recommendation on immunotherapy.

Immunotherapy does not work for every allergy sufferer or every type of allergy.

Talk to your doctor to find out if immunotherapy is right for you. Immunotherapy may help, but it involves:

• Repeated doctor’s visits
• Waiting 30 minutes after each injection
• Waiting for treatment to work

Discuss any questions you have with your allergy specialist.

TYPES OF IMMUNOTHERAPY

EFFICACY

What drug therapy is available?

Drugs can be used to alleviate symptoms and reduce the inflammation caused by allergies.

There is now broad international consensus on drug treatments for allergies, especially asthma and nasal allergies.

What allergens are present in each season?

Here’s a quick reference chart.

When is the best time to start immunotherapy?

It’s best to wait until the end of pollen season before starting immunotherapy. That means you can begin tree pollen immunotherapy in mid-June, for instance. In fact, you can start any time before late January, i.e., three months before the next tree pollen season begins. The same applies for grass pollen. You can start any time between October and late March. Weed pollen immunotherapy can be started any time between mid-October and late May before the next pollen season begins.

Here’s a quick reference chart.

Are densesitization treatments dangerous?

In the case of immunotherapy, we are not talking of vaccine (a vaccine being injected with an infectious organism, bacteria or virus, in a harmless form, in order to prevent or halt the serious illness it would caused), we are talking about strengthen the tolerance to allergens.

The injected allergens are harmless and if the administration protocol of the treatment is scrupulously followed, the risk of severe systemic reaction is very low.

For your safety, always follow these guidelines:

• Wait 30 minutes after each injection in the doctor's office
• Measure and record the induration at the injection site
• Do not increase the dose if the measured induration is greater than 5 cm
• Do not increase the dose during the pollen season

Can one space or skip doses?

No. This would require the doctor to revise doses downward, which would have consequences like slowing the progression of treatment and thus delay the results.

What immunotherapy treatments are available?

In Canada, immunotherapy treatments are available in injectable or sublingual forms. Injectable treatments are divided into two types. The "peri annual" are administered throughout the year according to a protocol which last 3 to 5 years. The "pre-seasonal" that target a single allergen and must be administered before the involved pollen season and to be repeat every year for 3-5 years. Treatments tablets are available for certain allergens only, such as ragweed or grass and should be used as recommended by each manufacturer.

What possible reactions could be related to injectable treatments?

Local and immediate reactions at the injection site are possible but usually disappear within hours. More severe systemic reactions can occur within 30 minutes of injection, hence the importance of respecting the observation period at the doctor's office. Swelling at the injection site may occur, it is usually not dangerous. It can persist for up to several days after the injection.

Your patient is beginning immunotherapy, what should he know?

Immunotherapy is a gradual exposure of the body to allergens to which it is sensitive, in order to become tolerant. Desensitization is effective and the effects persist even after the end of the treatment. Treatments in the form of subcutaneous injection are prepared according to the needs of each patient and are administered throughout the year for 3 to 5 years. It is also possible to target a single allergen and administer the treatment before the specific pollen season and repeat it annually. Treatment tablets are available; they are formulated for a single class of pollens.

We invite you to consult our brochure for more information

Your patient is beginning desensitization to hymenoptera venoms, what should he know?

Immunotherapy is the gradual exposure of the body to hymenoptera venoms such as honeybees, wasps and hornets, and is the only known effective method to prevent a serious and dangerous allergic reaction in a sensitized person. Desensitization is about 98% effective and the effects persist even after the end of treatment. The treatments in the form of subcutaneous injection takes place in two phases of progression, always under medical supervision.

We invite you to consult our brochure for more information

Prescription form

The single Allergo prescription form allows to write a prescription for each of the different types of desensitization:

• Select the desired type of desensitization: peri-annual (glycerinated allergen) or pre-seasonal (alum-precipitated allergen); desensitization to hymenoptera venoms.
• Check the box for beginning a treatment or a maintenance kit
• Select the desired allergen doses and / or add allergens
• Return the form to the patient so that he can bring it to his pharmacy. The pharmacy will order the treatment.

Allergo prescription form

Pre-seasonnal desensitization protocol

The pre-seasonal immunotherapy protocol is included in each treatment kit. It stands as a reference for patient assessment before each injection, for the method of administration, dosage, possible reactions, compliance and contraindications.

Pre-seasonnal desensitization protocol

Peri-annual desensitization protocol

The peri-annual immunotherapy protocol is included in each treatment kit. It wants to be a reference for patient assessment before each injection for the method of administration, dosage, possible reactions, compliance and contraindications.

Peri-annual desensitization protocol