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Treatments and drugs
By Mayo Clinic staffThe first treatment for controlling dust mite allergy is avoiding dust mites as much as possible. When you minimize your exposure to dust mites, you will have allergic reactions that are less often or less severe. However, it's impossible to completely eliminate dust mites from your environment. You may also need medications to control symptoms.
Allergy medications
Your doctor may tell you to take one of the following medications to improve nasal allergy symptoms:
- Antihistamines reduce your body's production of a chemical that is active in an allergic reaction. These drugs relieve itching, sneezing and runny nose. Prescription antihistamine tablets include desloratadine (Clarinex) and fexofenadine (Allegra). Azelastine (Astelin) is a prescription antihistamine taken as a nasal spray. Over-the-counter antihistamine tablets (Claritin, Zyrtec), as well as antihistamine syrups for children, also are available.
- Corticosteroids delivered as a nasal spray can reduce inflammation and control symptoms of allergic rhinitis. These drugs include fluticasone (Flonase) and mometasone furoate (Nasonex). Nasal corticosteroids provide a low dose of the drug and are not associated with the long-term risk of oral corticosteroids.
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Decongestants can help shrink swollen tissues in your nasal passages and make it easier to breathe through your nose. Some over-the-counter allergy tablets combine an antihistamine with a decongestant. Oral decongestants can increase blood pressure and shouldn't be taken if you have high blood pressure or cardiovascular disease. In men with an enlarged prostate, the drug can worsen the condition. Talk to your doctor about whether you can safely take a decongestant.
Over-the-counter decongestants taken as a nasal spray may briefly lessen allergy symptoms. If you use a decongestant spray for more than three days in a row, it can contribute to congestion.
- Cromolyn sodium prevents the release of an immune system chemical and may reduce symptoms. You need to use this over-the-counter nasal spray several times a day, and it's most effective when used before signs and symptoms develop. Cromolyn sodium doesn't have serious side effects.
- Leukotriene modifiers block the action of certain immune system chemicals. Your doctor may prescribe this prescription tablet, montelukast (Singulair), if you can't tolerate corticosteroid nasal sprays or an antihistamine nasal spray. Possible side effects include headache. Less common side effects include abdominal pain, cough, dental pain and dizziness.
Asthma medications: Long-term control
Medications for long-term control of asthma are usually taken daily. Long-term control drugs include:
- Inhaled corticosteroids, the most commonly used long-term asthma medications, reduce inflammation in your airways. These drugs include fluticasone (Flovent Diskus), budesonide (Pulmicort), triamcinolone (Azmacort), flunisolide (Aerobid), beclomethasone (Qvar) and others. These drugs generally have few side effects.
- Long-acting beta-2 agonists (LABAs), such as salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer), are long-acting bronchodilators that relax muscles of the airways and open them up. These inhaled medications are used to treat persistent asthma in combination with inhaled corticosteroids. A long-acting bronchodilator isn't used as a stand-alone therapy and shouldn't be used for quick relief of asthma symptoms.
- Inhaled leukotriene modifiers open airways, reduce inflammation and decrease mucus production. These drugs include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo CR). These may be used alone or as a supplemental drug for asthma that is more difficult to manage.
- Inhaled cromolyn reduces certain immune system reactions. It's considered a second choice to inhaled corticosteroids and needs to be taken three or four times a day. Your doctor may also recommend using a cromolyn inhaler before exercise or before exposure to an unavoidable allergen to help prevent an asthma attack.
- Theophylline, taken as a daily pill, is a bronchodilator that may be used to supplement treatment with an inhaled corticosteroid.
Asthma medications: Quick relief
Quick-relief, or rescue, medications are used as needed for rapid, short-term relief of symptoms during an asthma attack or before exercise, if your doctor recommends it. Only use these medications as often as your doctor tells you to. If you need to use these medications too often, your doctor probably needs to adjust your long-term control medication. Keep a record of how many puffs you use each day. Quick-relief medications include:
- Short-acting beta-2 agonists (SABAs), such as albuterol, are inhaled bronchodilators that act within minutes. The effect lasts four to six hours.
- Corticosteroids taken orally or by injection treat severe asthma attacks or very difficult-to-manage asthma. Examples include prednisone and methylprednisolone. These medications relieve airway inflammation. They may cause serious side effects when used long term, so they're only used as necessary.
Other therapies
- Immunotherapy, a series of allergy shots, can "train" your immune system not to be sensitive to an allergen. One to two weekly shots expose you to very small doses of the allergen, in this case, the dust mite protein that causes an allergic reaction. The dose is gradually increased, usually during a three- to six-month period. Maintenance shots are needed every four weeks for three to five years. Immunotherapy is usually used when other simple treatments are not satisfactory.
- Nasal lavage is the use of a saltwater (saline) rinse for your nasal passages. Your doctor may suggest a saline rinse to help lessen congestion, sneezing and postnasal drip. You can purchase over-the-counter saline sprays or nasal lavage kits with devices, such as bulb syringes, to administer a rinse. You can make your own solution by mixing 1/4 teaspoon (1.2 milliliters) of salt with 2 cups (0.5 liter) of warm water.
- Ferguson BJ. Environmental controls of allergies. Otolaryngology Clinics of North America. 2008;41(2):411-417,viii-ix.
- Platts-Mills T. Indoor allergens. In: Adkinson Jr. N, et al. Middleton's Allergy: Principles and Practice. 6th ed. Philadelphia, Pa.: Moseby, Elsevier; 2003. http://www.mdconsult.com/das/book/body/104827333-2/0/1183/241.html?tocnode=50745740&fromURL=241.html#4-u1.0-B0-323-01425-9..50041-1_1015. Accessed Sept. 9, 2008.
- Airborne Allergens: Something in the Air. U.S. Department of Health and Human Services. Bethesda, Md.: National Institute of Allergy and Infectious Diseases; 2003.
- Fletcher R. Patient information: Rhinitis. http://www.uptodate.com/home/index.html. Accessed July 24, 2008.
- German JA, et al. Environmental control of allergic diseases. American Family Physician. 2002;66(3):421-426.
- deShazo R, et al. Epidemiology and clinical manifestations of allergic rhinitis (rhinosinusitis). http:/www.uptodate.com/home/index.html. Accessed July 24, 2008.
- deShazo R, et al. Diagnosis of allergic rhinitis (rhinosinusitis). http://www.uptodate.com/home/index.html. Accessed July 27, 2008.
- Tips to remember: What is allergy testing? American Academy of Allergy, Asthma & Immunology. http://www.aaaai.org/patients/publicedmat/tips/whatisallergytesting.stm. Accessed Sept. 16, 2008.
- Tips to remember: What are "allergy shots"? American Academy of Allergy, Asthma & Immunology. http://www.aaaai.org/patients/publicedmat/tips/whatareallergyshots.stm. Accessed Sept. 16, 2008.
- deShazo R, et al. Patient information: Trigger avoidance in allergic rhinitis. http://www.uptodate.com/home/index.html. Accessed July 24, 2008.
- National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma - Summary Report 2007. Bethesda, Md.: National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.htm. Accessed Oct. 8, 2008.
- Platts-Mills T, et al. The role of allergens in asthma. American Family Physician. 2007;76(5):675-680.
