Understand your allergy

Sneezing, a running or blocked nose, itchy eyes and a throat that never quite clears — caused by pollen, house dust mite, mould or animal dander rather than infection.

How it is diagnosed

• History first: what season, what setting, what makes it worse.
• Skin prick testing or specific IgE blood testing to confirm which allergen is responsible.
• A positive test without matching symptoms is sensitisation, not allergy, and is not treated.

What helps

• Reducing exposure where it is practical — mite covers, keeping windows shut on high-pollen days.
• Intranasal corticosteroid sprays, used daily and correctly, are the most effective medication.
• Non-sedating antihistamines for breakthrough symptoms.
• Immunotherapy where symptoms persist despite the above, or where medication is needed most of the year.

Immunotherapy for this condition

Both subcutaneous injections and sublingual drops or tablets work well for pollen and dust mite rhinitis. A course runs three to five years, and the benefit continues after it ends.

In most South African children and many adults, asthma is allergic: the same triggers that inflame the nose inflame the airways. Wheeze, cough at night, breathlessness on exertion and chest tightness are the pattern.

Getting control first

• Inhaled corticosteroid-containing therapy is the foundation; reliever-only treatment leaves the inflammation untouched.
• Inhaler technique is checked at every visit — it is the most common reason treatment appears to fail.
• Treating the nose improves the chest; the two are one airway.

Where immunotherapy fits

Immunotherapy can reduce symptoms and medication needs in allergic asthma, and in children with rhinitis it lowers the chance of asthma developing. It is only started once asthma is well controlled — uncontrolled asthma is a contraindication, because it raises the risk of a severe reaction to treatment.

Dry, itchy, inflamed skin that flares and settles. The underlying problem is a leaky skin barrier plus an over-reactive immune response; allergy often rides along with it rather than causing it outright.

Daily care

• Emollient, generously and often — this is treatment, not cosmetics.
• Short lukewarm baths, soap substitutes, cotton next to the skin.
• Topical corticosteroids of the right strength for the site, used properly during a flare and stopped when it settles. Under-treating a flare prolongs it.

The allergy question

Food allergy testing is worth doing when eczema is severe and early, or when there are immediate reactions to a food. Cutting foods out on the strength of a test alone can do harm, including causing a new allergy to a food that was previously tolerated.

An immune reaction to a food protein, usually within minutes: hives, swelling, vomiting, coughing, wheeze or collapse. Peanut, tree nuts, egg, milk, wheat, soya, fish, shellfish and sesame account for most of it.

Diagnosis

• A careful history of what was eaten, how much, and how quickly symptoms started.
• Skin prick or specific IgE testing, increasingly with component testing that distinguishes a genuine peanut allergy from pollen cross-reactivity.
• Where the picture stays unclear, a supervised oral food challenge is the definitive test.

Living with it

• Read every label, every time; recipes change.
• Carry two adrenaline auto-injectors if one has been prescribed, and know that adrenaline is given into the outer thigh at the first sign of a severe reaction — before antihistamines, not after.
• A written anaphylaxis action plan, shared with school or work.

Oral and sublingual immunotherapy

OIT raises the amount of the food you can tolerate, turning a dangerous accidental exposure into a manageable one. It runs for months of supervised up-dosing followed by an ongoing daily dose, and reactions during the programme are expected and planned for. It is offered to selected patients after a full assessment.

A large swelling around a sting is unpleasant but usually not dangerous. A reaction elsewhere on the body — hives, swelling of the face or throat, wheeze, dizziness — is systemic and needs assessment.

What to do

• Scrape a bee sting out sideways rather than pinching it.
• If you have had a systemic reaction, carry adrenaline and get referred.
• Testing identifies whether bee or wasp venom is responsible.

Venom immunotherapy

This is the clearest success story in the field: a course of venom immunotherapy protects the large majority of patients from a further systemic reaction, and is normally given for five years.

Raised itchy weals that come and go within a day, sometimes with deeper swelling of the lips or eyelids. When it lasts more than six weeks it is called chronic urticaria — and it is usually not an allergy at all.

What causes it

• Acute cases often follow a viral illness, and sometimes a food or drug.
• Chronic spontaneous urticaria is generally driven by the immune system itself; extensive food testing rarely finds an answer and often misleads.
• Physical triggers — pressure, cold, heat, exercise — are worth identifying.

Treatment

Non-sedating antihistamines, at increased doses if needed, control most cases. When they do not, further options exist and are worth a specialist review. Immunotherapy is not a treatment for urticaria.

Most reported drug allergies turn out not to be allergies. That matters: a wrong penicillin label pushes patients onto broader, less effective antibiotics for life.

Getting it right

• The timing and nature of the reaction do most of the diagnostic work.
• Skin testing and, where appropriate, a supervised graded challenge can remove an incorrect label.
• Never re-challenge yourself at home.

Subcutaneous (injections)

• Weekly injections during build-up, typically over three to four months.
• Then a maintenance injection every four to eight weeks for three to five years.
• Thirty minutes in the waiting room after every dose. Local swelling is common; tell the nurse about it, because it may change the next dose.

Sublingual (drops or tablets)

• First dose in the clinic, then daily at home.
• Hold under the tongue for the stated time, then swallow. No food or drink for five minutes.
• Mouth itching in the first fortnight is normal and settles. Stop and phone if you get wheeze, throat tightness or hives.

Oral (food)

• Up-dosing visits in a supervised setting, with a fixed daily dose at home in between.
• Dose at the same time each day, avoid exercise and hot baths for two hours afterwards, and hold the dose if you are ill.

Costs and cover

Immunotherapy is a multi-year commitment and cover varies between schemes. Ask for a written quote before you start — we would rather you plan for it than stop halfway.