Not all allergy triggers are possible to avoid. Remember reactions may occur indirectly, for instance after sitting on a sofa where a cat or dog has been, or contact with clothes of people who have pets. If reactions occur to dust, pollen or animals, wash their face and hands and give a dose of antihistamine.
Antihistamines are good for allergic rhinitis, urticaria and angioedema. We recommend that patients take a long-acting non-sedating antihistamine e.g. cetirizine, loratidine, fexofenadine in preference to Piriton. They don’t relieve the itch of eczema – so don’t bother using them for itchy eczematous skin.
MDI inhalers always need to be delivered with a spacer, even in older children and adults. Either the MDI should be used with a spacer or it should be changed to a dry-powder device, otherwise the medicine won’t get into the lungs.
Use of a salbutamol inhaler more than 3 times a week may mean poor asthma control. Check the patient’s compliance, inhaler technique and asthma management plan – it may well need amending.
Although adrenaline auto-injectors may rapidly settle an anaphylactic reaction, there is no definitive evidence that they save lives. Adrenaline is rapidly broken down in the body (in less than 5 minutes). All patients who have been treated with an auto-injector must immediately go to hospital so they can be assessed to ensure that the reaction is not getting worse again. If the patient has asthma, it should also be reviewed at that time.