Allergies are the body’s excessive reaction to certain foreign objects or so-called allergens to the skin. When allergens enter a person’s body, through various ways, either inhaled, ingested, or in contact with the skin, the immune system of an allergic person becomes active and excessive. Symptoms of allergic dermatitis of all kinds, can be redness, itching, bumps, irritation and so on.
Although allergies are genetic, a person still has an allergy risk of 5-15 percent without considering the presence or absence of history of allergy in the patient’s parents. Given the large number of allergens outside the family history (genetics), you should pay close attention to what might be the trigger factors for allergies, such as food type, air condition, or other trigger factors.
Allergy can not be lost completely, which can be done for allergy sufferers is to prevent or avoid of materials that can cause allergies. So it’s important for you to know what can trigger your allergic reaction and avoid it.
How to prevent allergies is to avoid the substances that trigger allergic reactions appear, but if an allergic reaction has already appeared, you can treat it with antihistamines such as CTM, Cetirizine, or Loratadine.
Occasionally oral medication does not reduce allergic symptoms. When allergic reactions are not reduced then performed a steroid shot or commonly called an allergy shot.
What is Allergy Shots?
Allergy shots are injection of allergens into the body to desensitize, thereby reducing the symptoms of an allergic reaction. This action is also known as allergen immunotherapy. Allergy shots are long-term immunotherapy programs where the injection is done within a certain period of time for several years.
Allergy shots have two main concepts: immunotherapy and desensitization:
1. Immunotherapy is the process of boosting the immune system so it can adapt effectively and provide a more accurate response to pathogens, including various sources of allergens.
The immune system consists mostly of white blood cells. One type is an antibody that can protect the body from foreign pathogens that can harm the body, such as disease.
When the body is exposed to sources of allergies (eg pollen, animal skin, and fungus), white blood cells produce antibodies against allergens. However, in this process white blood cells will also produce a chemical called histamine, which can cause common signs of allergies such as rash and difficulty breathing.
2. Desensitization; The theory commonly used in fighting or controlling allergic reactions. Desensitization is a process in which antibodies will be subject to allergens with increasing doses. That way, the immune system will be trained to continue to recognize the allergen without having to produce too much histamine, which can cause allergic reactions.
Although allergy shots can not guarantee the cessation of allergy symptoms, but this injection can stop allergy symptoms for a long time. This means that a person can also re-experience an allergic reaction after stopping getting an allergy injection.
Who Should Get Allergy Shots and Expected Outcomes
Allergy injections are recommended for pediatric and adult patients. However, allergy shots are very beneficial for children and the elderly because of the condition of their immune system.
However, allergy shots are often not given to children aged five and under, as they may not have the ability to control allergy symptoms and side effects from allergy shots well.
Pregnant women or women who wish to become pregnant should discuss allergy shots with their doctor. Meanwhile, allergy shots should not be administered to patients who have been diagnosed with cardiovascular disease or are taking medications that are contraindicated with the drug used.
Allergy shots can be recommended for those who are often around their allergens, such as patients allergic to animal skin but still want to keep their pets. In addition, allergy shots are an appropriate option if patients do not want to rely too heavily on drugs or if they only reduce a few allergy symptoms.
Allergy shots can be beneficial for allergies caused by seasons or insect bites such as wasps or bees.
Unfortunately, allergy shots can not be given to patients who have food allergies or are prone to lymphoma.
The injection only takes a few minutes. However, the doctor may ask the patient not to leave the room for about 30 minutes to monitor any negative reaction due to allergy shots.
Allergy shots do not cause immunity to the pathogen. These injections also can not cure allergies. However, allergy shots can prevent certain allergy symptoms from worsening. Patients can also be aware that their allergy symptoms are becoming less common, or stop for years.
How Allergy Shot Work
Before allergy shots can be given, patients should undergo a series of tests, such as allergy tests, aiming to determine the cause of an allergic reaction. Doctors should also examine the body’s reactions to allergies, medicines that have been consumed and why the drug can not cure allergies, as well as the patient’s commitment to the allergy injection program, especially since the program consists of several injections to be given at different times over several years .
The program consists of two stages. In the build-up phase, injections are more often performed, for example once or twice each week. This stage can last for at least half a year. After an effective dose has been obtained, the maintenance phase will begin. In this stage, the injection is given for a longer period of time. However, the allergy injection period depends on the body’s reaction to the effects of allergy shots in the first stage.
Apart from all possible problems and reactions, the program can last for about five years. However, immunologists or allergists may decide to stop allergic injections due to certain situations.
Allergy injections are similar to vaccinations, which means they do not require any preparation. This action also takes place very quickly.
Some doctors can provide immunotherapy very quickly (rush immunotherapy), but this action requires a very high skill because the risk is also great. In this case, allergy shots are given in a much shorter time period, not in a matter of days but in a matter of hours. Patients at high risk will experience severe reactions.
Possible Risks and Complications of Allergy Injections
The patient may experience an allergic reaction due to the injection of the allergy itself. This reaction can be localized, meaning that this reaction will only occur at the injected, or systemic, part of the body, which is more severe and can be life-threatening because it can occur in several organs of the body. Hazardous systemic reactions are called anaphylaxis. Anaphylaxis is an emergency and one of the reasons why patients are advised to stay in hospital for 30 minutes after injection.
Meanwhile, injection may cause panic attacks for some patients. Fortunately, there are already some tablets that can be used to replace injections, but these tablets may not be as effective as allergy shots.
There are also times where allergy shots do not work at all due to various things. One cause is the level of allergens. If the patient is continuously exposed to the allergen, then the possibility of an allergy injection can not provide sufficient relief. There is also the possibility of too few doses. *)
Danger and Side Effects of Steroid Medication Use
Corticosteroids are known to have strong effects as anti-inflammatory in rheumatoid arthritis, severe asthma, chronic asthma, chronic inflammatory diseases and various immunologic disorders. Because of its anti-inflammatory effects and as an immunoregulator, corticosteroids play an important role in the treatment of allergic medicaments of both acute and chronic diseases. But in addition to its benefits, because of its many side effects also cause the use of these corticosteroids should be appropriate and appropriate way.
Natural and artificial corticosteroids are largely divided into mineralocorticoids and glucocorticoids. Although at present in new preparations increasingly attempted to have only a glucocorticoid effect, it still has little minerelocorticoid effect.
Although there seem to be various effects on physiological function, corticosteroids appear to affect the production of certain proteins from cells. The steroid molecule enters the cell and binds to a specific protein in the cytoplasm. The resulting complex is brought into the nucleus, causing the formation of mRNA which is then returned to the cytoplasm to aid the formation of new proteins, especially enzymes, thereby causing corticosteroids to affect various processes. Corticosteroids also have an effect on eosinophils, reducing the amount and blocking against the stimulus. In topical application can also reduce the number of mast cells in the mucosa. Corticosteroids also work synergistically with β2 agonists in raising cAMP levels in cells.
Indications for allergic diseases
- The main indications are for severe severe allergic reactions that can endanger life, such as asthmatic status, anaphylaxis, and dermalitis exfoliativa. In addition, also for severe allergic reactions that are not life-threatening but very disturbing, such as severe contact dermatitis, serum sickness, and severe acute asthma. Another indication is for severe chronic allergic diseases while awaiting the results of conventional treatment, or to address the acute exacerbation situation in patients taking long-term low-dose corticosteroids, should be raised in doses if an exacerbation occurs.
- Because corticosteroid treatment, especially with long-term, cause many unwanted effects then before starting treatment should be considered profit and loss first.
- In acute asthma use corticosteroids with other combinations of drugs in a timely manner, according to the concept of inflammation that occurs in asthma
The use of corticosteroids in asthma
- Record well what allergic or immunological conditions are responding well to previous corticosteroids. Corticosteroids are only used when conventional medicine does not help, so for asthma patients give first metilxantin and adrenergic drugs. Also avoid the use of corticosteroids in patients receiving viral vaccine.
- Use corticosteroids with the lowest possible doses that can control the disease The goal to relieve the disease is more acceptable than to relieve symptoms. Where possible use short-acting corticosteroids (prednisone, prednisolone, etc.), and for long-term use if used topically eg beige for skin grabbing and inhalation for the treatment of chronic asthma. Limit the use of corticosteroids for 5-7 days only, or if necessary long-term therapy give an intermittent dose a day interval in the morning. Corticosteroids administered 3-4 times a day, or at night, further suppress the function of the adrenal glands rather than those given once daily or in the morning.
- Complications that may occur for long-term use should be closely monitored such as glaucoma, cataracts, gastritis, osteoporosis, and so on. Do not discontinue long-term and high doses of corticosteroid abruptly because it will lead to insufficiency of the supraadrenal gland and the exacerbation of the disease being treated.
- The recommended protocol for stopping long-term corticosteroid treatment is as follows. Start the reduction carefully (eg 2.5-5 mg of prednisone every 3-7 days) and monitor the condition of the illness. If an increase in disease activity raise the dose again, then try again reduce with a lower dose. Try to be given once daily dose in the morning and then given every 2 days. Add a dose of corticosteroids when the patient is under stress, for mild stress (gastroenteritis, influenza, otitis media, pharyngitis, or mild surgery) is added for 2 days, while for severe stress (trauma or major surgery) add a dose of corticosteroids to 3- 4 days or until the stress is resolved.
Side Effects of Steroids
- Much of the research was done to determine the negative effects of steroids. Based on a large retrospective or prospective study it is known potential side effects of steroid use.
- Oral corticosteroids or injections are drugs used to treat inflammation in the body.
- When injected, the route of administration is called “systemic”.
- Drugs are used to treat various diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and other autoimmune diseases.
- Systemic steroids are also used to treat asthma attacks and symptoms of allergic rhinitis. Examples include prednisone, methylprednisolone (Medrol dose package), and triamcinolone (Kenalog) injection.
- Most side effects occur in the use of short-term allergy shots, but long-term use may cause additional side effects.
Short-term Side Effects
- Most people receive steroid medication and experience side effects only temporarily. This may include increased appetite, insomnia, mood swings and behavior, flushing (facial flushing), and short-term weight due to increased water retention. These side effects usually improve after a few days after steroids have been discontinued.
- People with underlying medical conditions may also see other side effects. Those with diabetes mellitus may see an increase in their blood sugar readings, people with high blood pressure may notice their blood pressure readings rise People with glaucoma can have an increased pressure inside their eyes, people with congestive heart failure can hold water and has deteriorated this condition. People with underlying chronic diseases should be followed by their doctor while taking systemic steroids.
Long Term Side Effects Systemic steroids
- When systemic steroids are used for long periods of time, or when steroids are taken on several occasions, more serious side effects can occur. It is for this reason that the dose and duration of systemic steroids should be minimized whenever possible. Some side effects can be reduced by taking systemic steroids every day instead of daily, even if the total dose is the same. Many side effects are reversible if steroids are stopped, while other side effects may be permanent.
- Side effects of long-term steroid use include: glaucoma, cataracts, high blood pressure, heart disease, diabetes mellitus, obesity, Gastrpoesephageal (GERD), osteoporosis, myopathy, increases in some types of infections and Cushing’s syndrome
- People taking long-term systemic steroids should be closely monitored for the above diseases, and should take medication to prevent osteoporosis. These medications may include additional calcium and vitamin D, along with drugs to prevent bone loss called bisphosphonates. Examples of bisphosphonates include alendronate (Fosamax), risedronate (Actonel) and ibandronate (Boniva). Frequent bone mineral density measurements should also be performed on people taking long-term systemic steroids.
Side Effects of Steroids in the Body
The side effects of steroids on the human body are numerous and can cause some serious side effects including cancer, but many sports users choose to ignore information about side effects, even using the excuse of “only drug abuse causing side effects” but any drug that changes the body’s homeostasis will have an effect.
Looking at the various effects on organs in more detail we can see how steroids can affect every different part of the body:
- Brain: Research has shown a pattern between high testosterone levels and aggressive behavior, which is often perceived as a user involved in violence. Often steroids have been used as a reason for aggressive person behavior. High dose users also have an effect on psychotic syndrome and high anxiety levels. Other effects that arise are, sleep disorders, euphoria, high levels of paranoia, various stages of depression, with some users experiencing extreme mood swings, and changes in their personality. A large number of users become dependent on the use of steroids which can then lead to addiction
- Face: The result of steroid use in high levels of water retention (edema) leading to the user becomes “round face” with swollen cheeks. In women reports showing the effect of facial hair growth is quite common, bad breath is a fairly common effect as women’s voices become husky by the deepening of the sound. Steroids also often affect the skin of the face and body by causing cholesterol
- Eyes: Long-term use of steroids can actually damage the eyes, resulting in eye infections, cataracts or glaucoma
- Hair: Male pattern baldness is common in both women and men because conversion of high levels of testosterone becomes dihydrotestosterone or DHT, causing the hair follicles to shrink, which only then produces very fine hair. Finally with the continued use of steroids the hair follicles die causing permanent baldness.
- Cardiovascular Cardiovascular System: This part of steroid users should be most concerned, but usually choose to ignore until serious cardiovascular events occur. The use of steroids causes heart disease and becomes apparent because of the high increase in total cholesterol levels, causing cholesterol buildup in blood vessel walls that can also cause strokes. Also shown are decreased levels of good cholesterol (HDL) and increased bad cholesterol (LDL). Blood pressure is known to increase and blood clots in blood vessels interfere with blood flow causing damage to the heart muscle that causes heart attacks. Heart enlargement, precursor to heart failure, high blood pressure, atherosclerosis or hardening of the arteries, predecessors for coronary heart disease, high cholesterol, heart palpitations, heart attacks, stroke, anaphylaxis and septic shock
- Reproductive System: In men, the excess testosterone is converted into the female hormone estrogen that causes the development of female characteristics. For example, men experience prostate enlargement, infertility, sexual dysfunction, baldness, breast enlargement, and testicular atrophy. Excess testosterone in women has the opposite effect, leading to menstrual irregularities, deepening of voice, baldness, fetal damage, hair growth in other parts of the body, sexual dysfunction, sterility, breast reduction, and genital swelling.
Vital Organs: Continuous prolonged use of steroid and prolonged steroids can damage the liver, causing cancer, jaundice, bleeding, and hepatitis. Steroids can damage the kidneys causing kidney stones and kidney diseases
- Abdominal: Normal signs of problems with the stomach from steroid use include a feeling of swelling, a feeling of nausea that leads to blood vomiting attacks sometimes becomes apparent in vomiting caused by irritation of the stomach lining and increases stomach acid with low levels of gastric mucus
- Kidney: The kidneys are important for the removal of waste material from the blood and the regulation of salt and water levels. Another important function of the kidney is the regulation of blood pressure, high blood pressure damaging blood vessels and kidney filtering system. The occurrence of kidney problems occurs primarily with the use of oral steroids with an emphasis on blood clotting factors that lead to increased blood clots following cutting time or injury. The kidneys should work harder with the use of oral steroids as it increases the need to filter blood. Steroid users also typically resort to ultra high protein intake, sometimes far beyond the normal intake involved with weight training that can lead to kidney stones. Kidney stones can block the opening of the urinary tract causing problems with urinary excretion. High blood pressure can also cause kidney problems by damaging blood vessels by causing thickening and narrowing of blood vessels leading to reduced blood supply and filtration. Toxic products such as steroids place the kidneys under pressure and can cause electrolyte imbalance and high blood pressure. Kidney problems are reflected by lower back pain, increased swelling of the lower legs and ankles, and fever.
- Liver: The liver is the largest organ of the body used to filter harmful toxins from the blood and for storage of certain nutrients such as vitamins / minerals. It is also important for the level of management of chemicals such as protein, cholesterol, and sugar. The liver is also used for the production of bile to help digestion of food. Based on estrogen studies in the 1970s and 1980s, steroids can cause certain tumors and liver damage. The use of steroids has been shown to cause irreversible liver damage and cancer. Oral steroids are difficult for the liver for metabolism causing a decrease in the liver’s ability to clean waste products. Some fake steroids have been known to carry all types of bacteria and viruses that cause harmful liver function. Hepatocellular jaundice is obvious by yellowing of the skin and mat, can be caused by abnormalities of liver function as the liver can not effectively filter the blood.
- Chest: Breast development (Gynocomastia) from steroid use is very common and side effects are often seen from long-term steroid cycles or high-dose steroid use, leading to the formation of breast tissue that begins as a lump seen beneath the nipple which usually requires surgical intervention. Breast steroid female users can actually shrink in size
- Bone: The use of steroids by teenage boys in early twenties who have not stopped growing can disrupt bone growth leading to a shorter height in adulthood due to the early closure of epiphyseal growth plates. Bone pain can also be a side effect of steroid use
- Muscles and Tendons: The use of steroids can make a person feel stronger than they really are, so try to lift heavier loads than their body is actually capable of, which can cause muscle tears. The muscle can be stronger faster than the strength of the tendon then most likely a tendon rupture may occur
- Skin: The use of steroids can have an effect on the user’s skin by affecting the pores of the skin and causing roughness in the skin texture. Other skin conditions that are often seen are acne, red oily skin with pimples on the face and back. Stretch marks can also arise due to the rapid growth of muscle or skin thinning. As mentioned above steroids affect the liver and side effects are jaundice, this becomes evident by yellowing of the skin and eyes
- Immune system disorders: An impaired immune function can occur with the use of steroids with problems that occur after discontinuation and the effect becomes more visible
- Edema: Appearance that is swollen and caused by the accumulation of fluid that is widely seen as ankle swelling and fingers
- Prostate gland: The prostate gland is special for males and lies just below the bladder, its main function is the production of prostatic fluid, seminal components and also to maintain sperm activity. Steroids are known to cause enlargement of the prostate gland, and as the prosthetic gland surrounding the urethra any swelling of the prostration can cause disruption to the flow of urine. Men should be made aware that any changes in the prostate gland can also affect sexual activity. Other effects that can occur are abnormal sperm and decreased sperm count
- Blood Poisoning: Many steroid users are often afraid to go to needle exchange to get a supply of sterile needles in case they are labeled addicts, often resulting in the use, or sharing of sterile cigarette syringes, which can cause blood poisoning with a high risk of infection and infectious diseases. User injection sites can also become swollen and sore and can cause abscess which can then lead to the need for painful medical interventions
- Impotence: Taking steroids will cause the testes to reduce normal function. When stopping testosterone supplementation takes time for the pituitary gland to signal the testes to once again start testosterone manufacturing. In long term or high testosterone doses using the testes can completely stop production or can actually atrophy that can cause long delays in the initial testes of testosterone manufacturing naturally. Impotence occurs after steroid cessation, and long-term drug use leads to a lack of erection.
- Masculinization It is more common in women and is usually due to increased testosterone. The most irreversible side effects include increased facial hair, – male pattern baldness, increased acne, skin texture changes, facial and body hair growth, aggressiveness, and irritability.
- Feminization occurs only in men and occurs when excessive testosterone is converted to the female hormone estrogen. This leads to breast formation, decreased sperm count, decreased libido, shrinking testicles, soft muscle mass and impotence. With drug therapy, side effects can be reversed.
- Cardiovascular Steroid use increases cholesterol levels in the body by increasing “bad cholesterol,” which can lead to blockage in blood vessels – leaving the user vulnerable to heart disease and stroke. In addition, steroids trigger a rapid rise in weight and an increase in blood pressure, both leaving the user more susceptible to cardiovascular events. These side effects can be reversed so far if they are caught before a person has a heart attack or stroke.
- Disturbed Growth This is an important side-effect to mention for high school athletes because steroids can cause premature closure of the growth plate, causing stunted growth.
- Skin is the largest organ of the human body and is the most sensitive organ to steroids – especially in women. Large pores and growing acne problems that are not helped by typical over-the-counter drugs can occur. Stretch marks also become prominent, although they are not directly caused by steroids. They are derived from rapid weight gain and muscle growth that carries steroids.
- Neuropsychiatric Side effects of Neuropsychiatric disorders are largely based not on case reports, but have been studied by two prominent Harvard psychiatrists, Drs. Harrison Pope and Kurt Brower from McLean Hospital in Belmont. Small studies show that long-term abuse can mimic bipolar disorder. Symptoms will start with mania leading to aggressiveness, reckless behavior and a reduced need for sleep also known as “Roid rage”. Some professional athletes can look for this last side effect, because it can lead to motivation to work harder and higher levels of aggression while playing sports. This is almost always followed by deep depression which can then lead to suicidal behavior. There are psychological aspects suspected of addiction to the use of steroids that lead athletes to be addicted to the way they feel on steroids and the way they look – possibly leading to continued steroid abuse after they exercise excessively.
- American Academy of Allergy, Asthma and Immunology
- American College of Allergy, Asthma and Immunology
- The John Hopkins Sinus Center: “Sublingual Immunotherapy.” UpToDate: “Oral and sublingual immunotherapy for allergic rhinitis.”