Treatment Allergy

This section is about what over the counter treatments are available (not all treatments may be available in that country) and how they help.

Please check one is not allergic or sensitive to any of the ingredients.

Aim:

To reduce the allergic reaction and let one continue their daily routine.

There are a wide range of treatments available.

Antihistamines

These drugs work by blocking the chemical histamine which is released during an allergic reaction and should be taken when one expects their symptoms for the best results.

Older anti-histamines

(can make one drowsy)

Time to Work

Duration of Action

Chlorpheniramine

15 – 20 mins

4-6 hrs

New anti-histamines (can rarely make one drowsy)	Time to Work	Duration of Action
Cetirizine	1 hr	24 hrs
Loratadine	1 hr	24 hrs
Acrivistine	15 – 20 minutes	8 hrs

Please note never to exceed the stated dose and are available in liquids and/or tablets and side effects of anti-histamines are more noticeable in older patients.

Corticosteroids Nasal Sprays

The drugs help to reduce the inflammation of the lining in the nose to help with symptoms of nasal congestion/blockage, sneezing, itchy runny nose, itchy watery eyes and groggy feeling.
They are ideal for sufferers who have regular symptoms and should be ideally used a couple of weeks before symptoms occur. It can only be used by sufferers over 18 years old and can be used continuously for three months (any longer than 3 months one should see a doctor).
Do not exceed the stated dose.

Please remember to blow your nose first and then to tilt your head forward when spraying nasal sprays to your nose, this helps to prevent the nasal spray to go back of throat and hence minimise the chance of side effects.

Long uses of steroids can make one immune system weaker and one may be more likely to catch other infections. Unless already exposed, one can get severe viral infections i.e. chickenpox, shingles, measles and should avoid contact with such patients.
Steroids taken longer than three weeks, treatment should not be stopped abruptly.
Steroids can cause a change of mood and behaviour, confusion, irritability, delusions and suicidal thoughts. These can also occur if one stops taking steroid treatment, see your medical doctor immediately.
Read all side effects of steroids, if have any concerns, talk to your pharmacist or medical doctor
Please note, short courses, nasal spray, inhalers, skin applications, eye drops and eye ointments are less likely to cause the above

Decongestants

Decongestants work by narrowing the blood vessels in the nose.
This then reduces tissue swelling and mucus product helping with congestion, allowing one to breathe more easily.
They can cause light headedness and should not be taken by anyone with a heart condition or if immunocompromised without seeing your medical doctor first.
Please note pharmacy can only sell a limited amount of Pseudoephedrine/Ephedrine decongestant tablets per sale, see your pharmacist if not sure.
They can be found in combination with cold and flu remedies and cough remedies, so please be aware not to overdose and don’t take at the same time. If one is unsure talk to your pharmacist.
Nasal sprays should only be used no longer than seven days to avoid a rebound effect. They can cause local irritation and dryness of nasal passages.

Vapour Rubs

These act locally by opening the blood vessels and produce more mucus till it starts running and so it cleans out one’s nose and remove allergens/irritants.
Some vapours can be added to hot water and the vapour creates a moist environment around your nose making the mucus runnier and removing allergen/irritant.
They are ideal if decongestants are not suitable and can be used same time as decongestant/antihistamines products if needed.

Nasal sprays (NOT decongestant or corticosteroids)

There are salt water products and have antiseptic properties.
They are used when decongestants are not suitable and wash out the nose from irritants/allergens.
They help particularly if one has mucus coming from the nose and down the back of the throat and causing a cough.
They can be used at the same time as decongestant/vapour rubs/if needed.

Saline Sprays/Drops

These are nasal spray for persons where decongestant and corticosteroid products are not suitable or favourable.

Eye Drops

These drops contain sodium cromoglicate, they help by stabilising the cells in the eye that release the chemical histamines (preventing its release) and can be used with antihistamine/steroid nasal spray.
Some drops however have a decongestants and antihistamine combination e.g. otrivine antihistamine and one should talk to their pharmacist when using with other anti-histamines and decongestants.

Sore throats

Lozenges are not suitable for very young in case they choke

Demulcent

(Glycerin)

These products help to soothe the cough and are very sweet tasting.

Antiseptics

(Hexylresorcinol, Benazalkonium, Cetylpyridinium, hexetidine)

These products help to keep bacteria away and thus help to soothe the throat.

Tickly cough products

(Glycerine, Honey, Lemon, Liquorice)

These have more soothing agents which act directly at the throat. They help by protecting the throat from irritants in the throat.

Painkillers for headache and/or sore throat

There are a wide range of painkillers and anti-inflammatory painkillers available and are available in a variety of forms from sachets, liquids, tablets and soluble tablets and patches.
Please check all ingredients and check one is not allergic or sensitive to them

Paracetamol

Paracetamol has no anti-inflammatory action.
It does help to reduce temperature and pain by blocking signals to the brain and is gentle on the stomach.
Paracetamol must be taken to the manufacturer’s direction. Do not exceed dose as it can be dangerous.
Please be aware Paracetamol can be found in many cold and flu products so don’t take them together or talk to your pharmacist if one is not sure.

Aspirin, Ibuprofen

These are known as NSAID – Non-Steroid Anti-Inflammatory Drugs.
They have painkilling, anti-inflammatory and lowering fever properties by helping to blocking prostaglandins.
They can cause stomach upset (extra caution must be taken with those who have a stomach ulcer) so it is important to have it with or after food.
It can also raise one’s blood pressure (extra caution on those with heart problems). They must be taken according to manufacturer’s directions as exceeding the does can be dangerous.
Please be aware that cold and flu products have NSAIDS. Do not take at same time or talk to your pharmacist if one is not sure.

Local Rash

Anti-histamine creams

There are a wide range of treatments available for an allergy rash/eczema/dry skin. The main aim is to soothe the skin and rehydrate the skin.
If one develops an allergic reaction (rash) to any products, stop using that product and try something else as there are plenty of versions and alternatives available.
The products below can be used as a combination (for best results) or individually.
Compliance and correct use is very important for effective treatment.

If one does not find one suitable or is allergic to one try another alternative in the range but please note the oilier the product is, the more it will retain water in the skin and the more effective it is, however it is harder to apply on the skin.

Order of forms which are the oiliest (oiliest at top):Ointments
Emollient and oils
Cream
Lotion

Emollients and oils

Emollients are first line treatments to improve eczema. It keeps the skin hydrated, making it more flexible and less itchy.
It should be used (add in bath) 10-20 minutes once or twice daily in Luke warm water (spending more than 20 minutes in the bath can irritate and worsen the dry skin).
It provides an oily layer over the surface of the skin and keeps the skin hydrated.
It traps water under the oily layer and prevents water being evaporated.
It also decreases the penetration of allergens and irritants (hence used in allergies).
It decreases itchiness and soothes irritated skin and has anti-cleaning properties so soaps are not needed.
One should use emollients in the same direction as the hair grows, do not rub in a circular motion onto skin (it will block pores and make eczema worse).
Be aware emollients can make the skin, bath and showers very slippery and extra care is needed especially with children and elderly, a bath mat may help.
Always once finished clean the bath or shower thoroughly after use.
Always ‘pat dry’ with a clean dry towel, do not rub the skin.
A big advantage with emollients is that it can be used to cover large areas and should be used regularly even if one has no flare-ups.
They also seem to make other treatments more effective for example when using a steroid cream (use the emollient first and then 10-15 minutes after apply other necessary treatment).

Soap Substitutes

Soaps, bubble baths, moisturising soaps can dry out your skin and leave the skin very irritated.
An alternative to soaps are soap substitutes. They leave your skin moist and less irritated; one should wash with those instead.
Most soap substitutes come in a dispenser to prevent bacterial contamination. However, we do advise if more than one member uses a product, they should have their own.
If one does not have a dispenser one should scoop cream on a clean pate, instead of dipping their hands into a pot.
Soap substitutes do not lather like soap but they do cleanse the skin.

Creams

Creams hydrate the skin like emollients and prevent water evaporating from the skin.
Some creams are also used as ‘soap substitutes’.
They should be used liberally and regularly (four to six times daily). It is not unusual to use 250g-600g of cream each week. Most people believe that is too much, but it is not.
One should take a tub to school/work and it can be used all the body if required and not just on patches. Again it should be used even if one has no flare-ups.
A good tip is to warm cream with hands to make it easier to apply.
It should be used especially after one has had a bath or shower to lock water in the skin, since it is then one loses a lot of water from ones skin when drying oneself (ideally within three minutes of bathing and showering to ‘trap’ moisture).
Rub the cream softly in a downward fashion in direction of hairline.
Do not rub vigorously.
If itching is a particular problem, creams can be kept cooled in a fridge before applying them.
Ideal for summer use.

Lotions

They are like creams but are less oily and are easier to apply (less messy) .
They have an advantage to cover large areas and/or damaged skin and/or hairy areas.
They are ideal if skin not too dry.
Again they need to be used liberally and regularly even if one has no flare-ups.
It should be applied in the same direction as the hair grows and not a circular motion as it can block hair follicles and pores making eczema worse.
If itching is a particular concern It can be kept cooled in a fridge before applying them.

Ointments

Are like creams and lock in even more moisture, but are harder to apply, it can take up to an hour to soak in and can stain clothing.
Have less additives hence good for very sensitive skin.
Thick and greasy, hence good for very dry and thickened skin.
Ideal for night time (sleeping hours ) use.
It is ideal to use at night or if one has extremely dry skin. If itching is a problem, they can be cooled in the fridge before applying them.
It is best not to use on hairy areas as they can block hair follicles which can lead to further swelling and infection.
Ideal for cold weather and/or winter use.

Shower Gels

They work like emollients, but in a shorter time.
It can be used under running water and in wash basins and are ideal for people on the go.
Again they should be used regularly and liberally.
Be aware it can make shower slippery.
A shower mat may help (tell others!) Again always pat dry and use even when one has no flare ups.

Sprays

Work like emollients and creams, the big advantage is one does not have to touch the skin.
It is ideal for very hairy skin and large areas and no bacterial contamination.

Steroidal Cream/ointment

These creams are only used sparingly when one has a flare-up on unbroken skin.
It can only be used up to seven days and restrictions do apply.
If one wants to use it outside the restricted rules then one must see a medical doctor for a prescription, because the medical doctor must asses if it is suitable to use.
They help to reduce redness and inflammation and it should be used 10-15 minutes after an emollient to get the optimum results. Do not use creams/lotions at the same time with steroidal products as this makes the steroid less effective.
Ointments tend to be used at night or in more severe ‘flare ups’.
Creams are generally used in mild ‘flare ups’ and are easier to apply.
Side effects include:
- Transient burning or stinging
- Worsening and spreading of misdiagnosed fungal infection
- Reversible thinning of the skin
- Stretch marks
- Allergic contact dermatitis
- Acne vulgaris
- Skin develops clusters of itchy and painful blisters, often on the face and neck, or is unwell with a fever and swollen local lymph nodes (signs of eczema herpeticum), this requires a same-day appointment.
- Reversible, mild hypopigmentation (change of skin colour – becomes lighter skin)
- Excessive hair growth at the site of application
- Skin thinning

The risks of skin thinning with topical corticotosteroids are increased with:

- Using potent or very potent topical corticosteroids
- Inappropriate long-term continuous use
- Treating sensitive sites where the skin is thinner, e.g. face or genital areas
- Using topical corticosteroids under occlusion, e.g. a nappy, dressing, or when applying in skin folds
- Treating large areas.

The Pharmaceutical Journal, August 2021;Online:DOI:10.1211/PJ.2021.1.98990

Calamine lotion

It is an astringent and is used to treat mild itchiness.
This includes from sunburn, insect bites, skin allergies, helps out to dry out skin irritations or other mild skin conditions.
It is applied on the skin and should be dabbed on the skin with cotton wool, always give the bottle a good shake as the calamine lotion sediment sits on the bottom.
The cream formulation should be applied as a cream.
Side effects may include skin irritation.

In regards to eye conditions: some may have a mixture of Allergy conjunctivitis and/or Bacterial conjunctivitis, and/or Styes and/or Allergy (swollen eyes) and/or Dry eyes and may need to treat those conditions as well, please refer accordingly to the above chapters and look at those treatments

Vitamins

Multivitamins are not intended to prevent long term conditions, reduce infection and is not proven (or data is weak) to help with cancer.

These are essential nutrients that the body requires in small amounts to function properly.

Herbal

Vitamins - If depressed