“The guides do not recommend acupuncture and homeopathy for allergic rhinitis”
According to Dr. Roger Reig, when patients “use these alternative therapies, basically what they are doing is delaying their correct treatment and this can lead to rhinitis to evolve and complicate”.
Spring blood alters … although it also alters something more than that. Do you have pollen and allergies? Anyway, Dr. Albert Roger Reig is responsible for reminding us that pollen is not always to blame for everything: “Statewide half of allergic rhinitis patients are allergic to dust mites, so not only Pollen is a major cause of allergy. ” The doctor, who is director of the Allergy Unit of the Germans Trias Pujol University Hospital (Badalona) and director of the Roger Center of Asmology and Allergy of Barcelona *, says that every time “we see more frequently” the manifestation of cross allergies, it is say, the combination of a reaction to a pollen with a reaction to a certain food. Luckily, the recent appearance “of the diagnosis by components” allows “to determine the concrete molecule to which the patient is allergic”. With regard to the use of therapies such as acupuncture and homeopathy to treat allergic rhinitis, Dr. Roger Reig warns that “when these patients use these alternative therapies, basically what they are doing is delaying their correct treatment and this may mean that the rhinitis evolves and becomes complicated “. In fact, “the guidelines do not recommend this type of treatment for allergic rhinitis,” he adds.
Allergic rhinitis has become commonplace at times. How can it affect the quality of life of those who suffer it?
Although it is not a very serious or fatal disease, it is a disease that can affect the work and leisure activities of our patients. At the children’s level, it has been shown that it can also reduce school performance … that is, it really is something that can be bothersome, and a lot, to our patients.
What exactly is an allergic rhinitis and what manifestations does it give?
The typical symptoms are sneezing, nasal discharge – often of the ‘agüita’ type more than a thick mucus -, a stuffy nose and a nasal itch. All this, in addition, is often accompanied by symptoms of conjunctivitis, such as having a red, watery and itchy eye. These symptoms appear due to an inflammation of the mucous membranes of the nose or the conjunctiva that is due to a hypersensitivity, that is, an exaggerated reaction to an allergen. Allergens are substances that do not cause any problem to a normal person; On the other hand, an allergic person does suppose that exaggerated reaction.
Primavera is a season very feared by allergic patients. Which pollens now cause rhinitis due to pollinosis?
If we rely on the data from the Iberian study, which was conducted throughout the Peninsula (Iberian), we see that at the state level the first cause of pollens that cause allergy are grasses, which would affect 55% of patients; in second position would come the pollen of the olive tree, which would affect 40%, and then come a group that would be composed of the banana of shade, cypress and weeds-herbs such as parietaria, artemisa or plantago (or plantain), that more or less would affect 20% of rhinitis patients. They are generic data but they have a wide territorial variation, since what happens in the Meseta is not the same as what happens in the Mediterranean coast. It is very important that each patient consult with their allergist to find out which pollens are predominant in their area.
Although there is always talk of allergy in the spring, we must remember that at the state level, half of allergic rhinitis patients are allergic to dust mites, so that not only pollen is an important cause of allergy.
For this pollen patient, is a dry or humid environment preferable?
We recommend that these patients reduce their stays abroad when the environment is dry and sunny. Instead, we recommend living or at least spending the holidays near the sea, where pollen concentration is lower. Globally, it can be said that a season of powerful pollens requires abundant rains at the end of winter and that spring starts very sunny. That favors pollination.
Allergic rhinitis can be the prolegomenon of asthma if it is not treated properly?
This is an absolutely crucial issue. Although rhinitis is perhaps seen as a banal pathology – despite having a great impact on the quality of life – we know that a patient with allergic rhinitis is three times more likely than the healthy population to develop asthma. And also, the aforementioned Iberian study tells us that half of patients who have rhinitis already have asthma.
Can there be cross-allergies that aggravate the process, that is, combine an allergy to a pollen and an allergy to a certain food?
Yes, it really does happen and we see it more and more frequently every time. Until not too long ago this was a challenge for the allergist at the diagnostic level. But recently, with the appearance of the diagnosis by components, we can determine the specific molecule to which the patient is allergic. These molecules (the best known can be LTP or profilins) can be in both pollen and food at the same time and therefore these patients ‘do’ both respiratory symptoms when in contact with pollen as a food reaction when they ingest the food.
How do I know if I’m allergic?
That is the crux of the matter. First, in medicine there always has to be a clinical history. So, this clinical history has to be suggestive, that is, there must be an apparent relationship between what the patient explains and the suspicion of allergy. For example, in the case of pollens it is very easy: a patient who explains to you that every year and at the same time of the year has the symptoms of rhinitis, is that it is very suggestive of allergy; but that is not enough, because we have to prove it. The most common is to perform what is known as a ‘Prick test’, rapid skin tests, painless and can be carried out in patients of any age. Then, we test a long battery of allergens depending on where the patient lives and, based on the results, we can extend the study by requesting analytics or provocation tests.
If a clear diagnosis of allergic rhinitis is established, what medical treatments are offered?
For respiratory allergy, in this case rhinitis, the treatment is based on three pillars: first, always try to avoid contact with the allergen … if for example the patient has a cat allergy, it is recommended that you have no contact with cats, although in the case of allergy to pollen or mites it is much more complicated because we can not live inside an urn; Secondly, apart from these norms, we have to give a pharmacological treatment to control the symptoms, but since this treatment does not cure the disease, then the third pillar is specific immunotherapy, what people know as vaccines.
Many patients are often blocked by the nose due to rhinitis. Is there a risk of rebound if the nasal sprays are abused?
When we talk about nasal nebulizers, the risk affects only decongestants or vasoconstrictors, which if used should be administered in very short periods of time. However, we have other very effective nasal inhalers without these adverse effects, such as inhaled corticosteroids or topical antihistamines, and very recently we even have the combination of both in the same device.
But there are patients who complain that antihistamines, even new ones, give them asthenia, sleep or a certain apathy or lack of concentration …
This refers to when we take the antihistamine orally, which must be recognized as the most prescribed treatment in Spain to treat allergic rhinitis. But we have to say that the last generation antihistamines have a very good safety profile … they are even used in daily treatments for long periods of time coinciding with pollination. That is, surely the allergist will know what product the patient can take without there being any type of problem.
Can be effective treatments such as acupuncture or homeopathy, which many people try to see if they work?
It is a subject of debate and that is very present in the street because more and more people use alternative medicines. But the reality is that medicine has to be based on evidence and, to this day, the guides do not recommend this type of treatment for allergic rhinitis. I, in addition, here I see a very important problem and that, when these patients use these alternative therapies, in the end what they are doing is delaying their correct treatment and this can lead to rhinitis evolving and complicating, as it can be with an asthma or with a sinusutis … or it may happen that this patient, initially allergic to a single substance, becomes allergic to more substances.
Immunotherapy (vaccines) can be effective in patients with allergies to certain pollens?
Absolutely yes. We have to remember that current guidelines for the treatment of rhinitis, such as the ARIA guide, recommend that vaccines can be used in cases where they are indicated. The World Health Organization has a document on allergy vaccines where it says verbatim that specific immunotherapy is the only treatment that can alter the natural course of the disease, because it is the only one that goes against the cause of the problem. Traditionally, these vaccines had always been administered with a few punctures, which are not painful, but now we also have sublingual vaccines. We must remember that the other therapies only treat the symptoms, while with immunotherapy we go against the cause. These vaccines have to be prescribed by the allergist after having made a good diagnosis, so the final advice would be that if the patient suspects that they may have an allergy, the first thing that has to be done is an accurate diagnosis, since without this diagnosis there is no We can never apply that definitive treatment.