Discussion: Epidemiology of Allergies

Discussion: Epidemiology of Allergies

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Discussion: Epidemiology of Allergies

Peer reply : pharma DB

1- Yaima

Discuss the epidemiology of allergies.

There are several different types of allergies that are relevant when discussing the epidemiology of allergies disease. These include allergic rhinitis, drug allergy and food allergies. Allergic rhinitis affects between 10-30% of the total population. Some degree of sensitization is indicated by the presence of IgE antibodies (immunoglobulin E antibodies produced by the immune system that target immune cells causing chemical release leading to an allergic reaction). Adverse drug reactions are common and are thought to affect up to 1 in 10 of the general population worldwide. To further this, the relative risk is approximately double for hospitalized patients. The incidence of cases of anaphylaxis that result in fatal outcomes may also be linked to drug allergies. The most prevalent food allergen is the peanut, closely followed by milk and shellfish. Common food allergies include: Peanuts, Milk, Shellfish, Eggs, Tree nuts (e.g. walnuts, almonds, pine nuts, brazil nuts, pecans), Soy, Grains with gluten (e.g. wheat, barley, rye, oats), Fish. The severity of these allergies can vary significantly, and some individuals may not experience significant effects with dietary intakes, although a sensitive response is observed in an experimental testing environment.

What are your treatment options (consider pharmacoeconomic)? Compare first and second-generation antihistamines.

You can treat allergy symptoms with over the counter and prescription medications, as well as allergy shots. Lifestyle changes like using air filters and avoiding triggers are important, too. Different medications can treat allergies, including steroids and allergy shots, but usually the first thing to try is an antihistamine. While the first-generation H1 antihistamines have a central effect and, thus, are also used as sedatives, second-generation H1 antihistamines have less central effects and are used primarily as antiallergenic drugs. Histamine is a biologically active substance that potentiates the inflammatory and immune responses of the body, regulates physiological function in the gut, and acts as a neurotransmitter. Drugs that antagonize these effects by blocking or inhibiting histamine receptors (H receptors) are called antihistamines. Antihistamines are divided into two classes (H1 antihistamines and H2 antihistamines), based on the type of H receptor targeted. H1 antihistamines are mostly used to treat allergic reactions and mast cell-mediated disorders. This subtype is further divided into two generations. While the first-generation H1 antihistamines have a central effect and, thus, are also used as sedatives, second-generation H1 antihistamines have fewer central effects and are used primarily as antiallergenic drugs. H2 antihistamines are indicated primarily for gastric reflux disease because they reduce the production of stomach acid by reversibly blocking the H2 histamine receptors in the parietal cells of the gastric mucosa. Use of most H1 and H2 antihistamines is contraindicated during pregnancy and childhood. First-generation H1 antihistamines are specifically contraindicated in angle-closure glaucoma and pyloric stenosis.

What education will you provide to the patient?

To reduce your exposure to the things that trigger your allergy signs and symptoms (allergens):

Stay indoors on dry, windy days. The best time to go outside is after a good rain, which helps clear pollen from the air.

Delegate lawn mowing weed pulling and other gardening chores that stir up allergens.

Remove clothes you’ve worn outside and shower to rinse pollen from your skin and hair.

Don’t hang laundry outside – pollen can stick to sheets and towels.

Wear a pollen mask if you do outside chores.

Use the air conditioning in your house and car.

If you have forced air heating or air conditioning in your house, use high-efficiency filters and follow regular maintenance schedules.

Keep indoor air dry with a dehumidifier.

Use a portable high-efficiency particulate air (HEPA) filter in your bedroom.

Clean floors often with a vacuum cleaner that has a HEPA filter.

References

Muñoz-Furlong A. Food allergy in schools: concerns for allergists, pediatricians, parents, and school staff. Ann Allergy Asthma Immunol. 2015; 93(5) (suppl 3):S47-S50.

Decker WW, Campbell RL, Manivannan V, et al. The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project. J Allergy Clin Immunol. 2018;122(6):1161-1165.

2- Triana

1.Discuss the epidemiology of allergies.

Allergic diseases are the most common chronic conditions lasting throughout the patient’s life. They not only cause significant deterioration in the quality of life of patients but also lead to significant absenteeism and reduced productivity, resulting in very high costs for society (Kuna, et al., 2016).There are several different types of allergies that are relevant when discussing the epidemiology of allergies disease. These include allergic rhinitis, drug allergy and food allergies.While AR is influenced by genetic predisposition, the symptom presentation also depends on environmental exposures. In addition, the disease can co-present with other diseases, such as asthma and other infectious diseases, which could further complicate the disease diagnosis. A robust association of rhinitis was found among individuals with allergic and non-allergic asthma. Among patients with persistent and severe rhinitis, asthma was found prevailing.

2.What are your treatment options (consider pharmaco-economic)? Compare first and second-generation antihistamines.

Discussion: Epidemiology of Allergies

Discussion: Epidemiology of Allergies

Effective and safe treatment of allergic diseases is therefore one of the main challenges for public health and should be carried out by all the specialists in family medicine, internists and pediatricians in collaboration with allergists, otorhinolaryngologists and dermatologists. Antihistamines are most commonly used in the treatment of allergies. Several dozen drugs are available on the pharmaceutical market, and their generic forms are advertised widely as very effective drugs for the treatment of allergic diseases (Kuna, et al., 2016).The total cost of allergic diseases brings both reduced quality of life and also direct costs of drugs and health services as well as indirect social costs such as the absence from work; it also decreases productivity and concentration and generates learning disorders and concomitant diseases (Kuna, et al., 2016).

Histamine plays an important role in human physiology, influencing immunoregulation of the acute and chronic inflammatory response through 4 different types of receptors, called H1, H2, H3, and H4. Drugs classified in the first generation of antihistamines (sometimes called “classical” antihistamines) act non-selectively. Apart from all histaminic receptors they also block muscarinic, adrenergic (or adrenoreceptors) and dopaminergic receptors, causing cardiovascular, urinary and gastrointestinal adverse reactions (Kuna, et al., 2016).The described characteristics and easy usage as well as affordable price led to the inclusion of the second generation antihistaminic drugs in all global and local recommendations as the drugs of choice in all forms of allergic rhinitis and urticaria. The most frequently cited are ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines, which discusses pharmacotherapy and presents the second generation anti-H1 drugs in the first place, recommending them in all adults and children (Kuna, et al., 2016).

3.What education will you provide to the patient?

A primary focus of patient education is the importance of avoiding exposure to allergens. Patients should be well prepared with multiple methods to eliminate or minimize indoor allergens such as mold, pet dander, and dust mites. For example, indoor mold may be controlled by eliminating excess moisture with dehumidifiers and frequently cleaning damp areas such as bathrooms with a bleach-and-water solution. Pets may be avoided altogether, or dander may be limited by using high-efficiency particulate arrestance (HEPA) air filters and allergen-resistant bedding. Dust mites may be reduced by avoiding carpet, frequently washing drapes and bedding, and wiping surfaces with a damp cloth or mop daily. Outdoor allergens, such as pollen from trees, grasses, and weeds are more difficult to control. Exposure may be decreased by showering before bed, keeping windows shut, and using an air conditioner (Felicia Spadini, MSN, 2016).

Reference

Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advance practice nurse prescribers. Philadelphia: F.A. Davis Company.

Kuna, P., Jurkiewicz, D., Czarnecka-Operacz, M. M., Pawliczak, R., Woroń, J., Moniuszko, M., & Emeryk, A. (2016, December). The role and choice criteria of antihistamines in allergy management – expert opinion. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5183790/

Allergic Rhinitis: Counseling Points for Better Patient Outcomes. (n.d.). Retrieved from https://contemporaryclinic.pharmacytimes.com/journals/issue/2016/april2016/allergic-rhinitis-counseling-points-for-better-patient-outcomes.

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