Common Conditions: Allergies

Ask a Nurse
by Geraldine Bednash Ph.D., RN, FAAN, American Association of Colleges of Nursing (AACN)

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Chapter 3

An allergy is a hypersensitivity to a normally harmless substance. The body's immune system perceives these substances, called allergens, as harmful and reacts accordingly. White blood cells produce antibodies that neutralize the allergen. The reaction between antibody and allergen releases chemicals, most notably histamine, that cause the body to experience a variety of uncomfortable symptoms.

Allergens can be taken into the body by inhalation, through contact with the skin, or by ingestion of food or medications. Among the most common allergens are pollens, including the pollens of trees, grasses, and weeds; molds, which reproduce by means of airborne spores; animal dander, minute bits of sloughed-off skin from animals; dust; certain foods, such as milk, wheat, eggs, peanuts, and shellfish; certain medicines; and venom from stinging insects such as bees.

Symptoms: Allergy symptoms vary depending on the individual, the allergen, and how the allergen entered the body. The most common type of reaction, generally from inhaled allergens, is allergic rhinitis, or hay fever, which is characterized by sneezing; a runny, itchy nose; nasal congestion; and itchy, watery eyes. Hives, or urticaria, are red, raised, swollen, and itchy patches on the skin. Common reactions to food and drugs, they can be isolated or spread over the body. Allergic contact dermatitis is a skin rash that occurs at the site where an allergen (such as poison ivy) has come in contact with the skin. Atopic dermatitis, or eczema, a chronic rash, may also be triggered or exacerbated by allergens. The most serious allergic reaction is anaphylaxis, which is life-threatening and is characterized by respiratory distress and shock.

Diagnosis: Skin and blood tests can determine whether symptoms are caused by an allergy, and to what substance or substances the person is allergic. A food diary, including the date and time of foods eaten, along with any symptoms, their duration, and what action you took, can help with the diagnosis of food allergies, notes Amy Berndt, MSN, MPH, RN, FNP, of the University of Nevada in Reno.

Treatment: Treatment consists of allergen avoidance, prescription or over-the-counter medications to relieve symptoms, and, possibly, immunotherapy, or allergy shots, which are regular injections of the allergen given to desensitize the body to the substance. Medications include antihistamines, which prevent the release of histamine and help reduce swelling, itching, and tearing and help dry up runny nose; decongestants, which constrict blood vessels and shrink swollen mucous membranes to stop nasal congestion; and corticosteroids, hormonelike anti-inflammatory drugs used to treat respiratory and skin allergies.

Self-care: Because allergies are a disorder of the immune system, some experts recommend that you take steps to improve your immunity.

• Increase your dietary intake of essential fatty acids, especially omega-3 fatty acids, suggests Kathy Niemeyer, MSN, RN, CCRN, of Grand Valley State University in Allendale, Michigan. Good sources of these are fish oils and flaxseed oil, she says.

• Increase your intake of vitamin C to at least 1 gram (1,000 milligrams) a day, Kathy Niemeyer suggests. There is some evidence that vitamin C lowers blood levels of histamine.

Probably the best way to control allergies is to minimize your exposure to allergens; this can actually prevent reactions from occurring. Here are some suggestions:

• Keep windows and doors closed when the pollen or mold count is high.

• Monitor pollen and mold counts and avoid outdoor activity when they are high.

• Use an air conditioner or air purifier, suggests Mary Ann Zakutney, Ph.D., RN, CFNP, of Georgetown University in Washington, D.C.

• Get rid of dust collectors such as carpeting, throw pillows, and heavy drapes, suggests Yvonne Sehy, Ph.D., RN, FNP, GNP-C, of the University of Utah in Salt Lake City.

• Use a dehumidifier to help reduce the growth of dust mites, molds, and fungi during summer humidity.

• Avoid doing yard work, mowing the lawn, and raking leaves.

• Wear a filter or mask to prevent inhalation of allergens.

• Clean your home as often as possible to remove pollen, dust, mold, and animal dander.

• Wash your bedding, synthetic pillows, and mattress pads often in hot water.

• Encase your mattress and pillows in plastic to reduce the amount of dust mite particles in the air.

• Avoid hanging clothes, sheets, and blankets outside to dry.

• When introducing new foods to children, wait 72 hours before giving them another new food so that you can see if they have an allergic reaction, suggests Janyce Cagan Agruss, D.N.Sc., RNC, NP, of Rush University College of Nursing in Chicago.

• Be knowledgeable about product labels so that you can avoid things you react to, says Lygia Holcomb, DSN, RNC, FNP, of the University of Central Florida in Orlando.

• When allergies strike, seek relief.

• Use a cool compress to soothe itchy, red, swollen eyes.

• Flush your nose with saline nasal spray or a homemade saline solution (1 teaspoon of salt in 1 quart of lukewarm water), suggests Sharon Johnson, Ph.D., RN, FNP, CS, of San Francisco State University. This soothes irritation, keeps the nasal passages moist, and helps remove some of the offending allergens. You can bend over a sink, says Johnson, and use an enema bucket with a soft tube to spray the solution into your nose.

• To soothe the itch of hives, poison ivy, and other skin allergies, apply calamine lotion or add ½ to 1 cup of oatmeal to a tub of warm water and bathe, suggests Madeline Gervase, RN, MSN, CCRN, FNP, of Rutgers, the State University of New Jersey in Newark. Janyce Cagan Agruss of Chicago suggests a paste made from baking soda and water and applied

• to hives to reduce swelling and itching. A paper towel dipped in white distilled vinegar can also provide relief, she says. A cool bath to which you've added several spoonfuls of baking soda can also be soothing, suggests Paula Siciliano, AP, RN, MSN, GNP, of the University of Utah in Salt Lake City.

• If you have a serious allergy that may cause anaphylaxis, wear an alert bracelet and carry an emergency adrenaline kit, says Tracy Call-Schmidt, RN, MSN, FNP-C, of the University of Utah in Salt Lake City. If no kit is available and you have a reaction, Call-Schmidt suggests you pull apart a Benadryl capsule and place it under your tongue to help you breathe until emergency personnel arrive.

• Try herbal therapy. Several herbs may be helpful in treating allergies, says Kathy Niemeyer, who is a member of the American Herbalist Guild. These include stinging nettle, feverfew, ginger, and ginkgo biloba, she says. You may use the herbs in tincture form (by mixing a few drops with water or juice), except for stinging nettle, which is used in tea form only. They are also available in pill form made from standardized extracts. When taken internally, the herbs act like antihistamines.

Over-the-counter treatment: A wide range of over-the-counter medications is available to treat allergy symptoms. Brand names of oral antihistamines include the following: Allerest, Bayer Select Night Time Cold, Benadryl, Contac 12-Hour Allergy, Chlor-Trimeton, Dimetapp Allergy, Dristan Allergy, Tavist-D, Tylenol Allergy Sinus Maximum Strength, Vicks DayQuil Allergy Relief 4-Hour Tablets.

Brand names of topical antihistamines, which are applied to the skin to relieve itching, include the following: Benadryl Itch Stopping Cream/Spray/Gel and Calagel Clearly Calamine.

Brand names of oral decongestants include the following: Advil Cold & Sinus, Allerest No Drowsiness, Congespirin for Children Aspirin-Free, Dimetapp Decongestant Pediatric, Dristan Cold Maximum Strength No Drowsiness, Sine-Off Maximum Strength No Drowsiness, and Sudafed.

Some topical decongestants, which are applied directly to the nose and generally act faster than oral decongestants, are Afrin 12-Hour, Dristan 12-Hour, Neo-Synephrine 12-Hour, Otrivin Pediatric, and Vicks Sinex 12-Hour.

Combinations of oral antihistamines and decongestants are also available. Examples include Actifed, Benadryl Allergy Decongestant Medication, 12-Hour Allergy Decongestant, Dristan Cold Multi-Symptom, Novahistine, Tavist-D Antihistamine/Nasal Decongestant, and Vicks DayQuil Allergy Relief 12-Hour.

The primary antipruritic, or itch-relieving, medication available over the counter for the treatment of allergies is hydrocortisone, a topical corticosteroid that reduces inflammation. Examples include Bactine Hydrocortisone 1%, Cortaid, Lanacor, and Tegrin-HC.

Copyright © 2001 by American Association of Colleges of Nursing and People's Medical Society

About the Author

Geraldine Bednash Ph.D., RN, FAAN, Has been the executive director of the AACN since 1989. She serves as the vice president of nursing of Health Professions Education Council of the Association of Academic Health Centers and is a member of the editorial boards of several nursing publications.

The American Association of Colleges of Nursing (AACN) represents 550 schools of nursing at public and private universities and senior colleges nationwide.