A 35-year-old comes to the clinic. He states, “It’s getting close to allergy season and I need something to keep me from getting sick
A 35-year-old comes to the clinic. He states, “It’s getting close to allergy season and I need something to keep me from getting sick. Last year the doc gave me a shot, a spray, some pills, and an inhaler. They worked really well but I don’t remember what they were. Can I have those things again? I just can’t afford to miss work.”
Please answer the following questions in a narrative format:
1–Discuss the epidemiology of allergies.
2—What are your treatment options (consider pharmacoeconomic)? Compare first and second-generation antihistamines.
3– What education will you provide to the patient?
Expert Answer and Explanation
Epidemiology of Allergies
Epidemiology can be defined as the branch of medicine that studies diseases by identifying their distribution, risk factors, and possible control measures. According to a study done by Öçal, Muluk, and Mullol (2020), allergies affect more than 45% of school-aged people in the US. One of the most popular allergic diseases is allergic rhinitis.
This disease affected more than 30% of the population across the globe as of 2018 (Öçal et al., 2020). The authors report that the allergy is caused by Immunoglobin E antibodies (IgE). When the body releases IgE at a higher rate, the antibodies with target the immune system and causes a reaction that produces chemicals that lead to an allergic reaction.
The second most popular allergic condition is drug allergy. The research by Namysłowski et al. (2018) shows that one out of 10 people in the US is likely to suffer drug allergy.
The rate of drug allergy is high in hospitalized patients. This disease accounts for about 1 in every 5 anaphylactic deaths. The risk factors of this allergy include the current health conditions of the population, the type of medication, and genetic factors. People with Acetylator status and HLA type genetic factors risk contracting drug allergy.
The duration of drug administration and dose are also risk factors of the allergy. The last type of allergy is a food allergy. This disease has affected more than 40,000 children and 8% of adults in the US. The most common food allergy is caused by peanut, followed by milk (Chong & Chew, 2018). Other foods, such as eggs, tree nuts, soy, eggs, shellfish, fish, and grains with gluten, also cause food allergy.
Treatment Options of Allergies
This patient can be prescribed antihistamines to help fight the chemicals released during an allergic reaction. Tan, Sugita, and Akdis (2016) antihistamines can be used to relieve pain caused by different forms of allergies. The patient should be prescribed second-generation antihistamines. The second-generation antihistamines are appropriate in this situation because they are less central and can be used as antiallergic medications.
However, H1antihistamines have central effects on the human body and can be used as sedatives to reduce pain. Over-the-counter antihistamine that should be considered in this situation is Zyrtec. This medication works faster and is also affordable compared to others. Allegra (fexofenadine), desloratadine (Clarinex), loratadine (Alavert) or Claritin can be used as alternative medications.
Education Provided to the Patient
First, the patient should be educated on how to avoid an allergic reaction. He can do this by trying to try as much as possible to avoid the allergic stimulus that can be avoidable. For instance, if the patient is allergic to dust, he or she should try hard to avoid dust. The second educational competency should focus on educating the patient about the names of the over-the-counter medications he can buy in case he is far from the medical facility (Farrokhi et al., 2017).
The patient has visited the facility because he does not remember the medications; he was previously prescribed. Lastly, the patient can be educated about the medication schedule. The competency of this education program is to ensure that the patient maintains the medication schedule.
Chong, S. N., & Chew, F. T. (2018). Epidemiology of allergic rhinitis and associated risk factors in Asia. World Allergy Organization Journal, 11(1), 17. https://waojournal.biomedcentral.com/articles/10.1186/s40413-018-0198-z?optIn=false
Farrokhi, S., Abbasirad, N., Movahed, A., Khazaei, H. A., Pishjoo, M., & Rezaei, N. (2017). TLR9-based immunotherapy for the treatment of allergic diseases. Immunotherapy, 9(4), 339-346. https://www.futuremedicine.com/doi/full/10.2217/imt-2016-0104
Namysłowski, A., Samoliński, B. K., Lipiec, A., Zieliński, W., Sybilski, A. J., Walkiewicz, A., … & Raciborski, F. (2018). The importance of specific IgE antibodies in epidemiology of allergic rhinitis and asthma–the Epidemiology of Allergic Diseases in Poland (ECAP) survey: part one. Influence of allergy risk factors on concentration of specific IgE antibodies in serum. Advances in Dermatology and Allergology/Postȩpy Dermatologii i Alergologii, 35(5), 520. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232542/
Öçal, R., Muluk, N. B., & Mullol, J. (2020). Epidemiology of Allergic Rhinitis. In All Around the Nose (pp. 297-301). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-030-21217-9_33
Tan, H. T. T., Sugita, K., & Akdis, C. A. (2016). Novel biologicals for the treatment of allergic diseases and asthma. Current allergy and asthma reports, 16(10), 70. https://link.springer.com/article/10.1007/s11882-016-0650-5
Epidemiology of Allergies
Allergic reactions can worsen one’s health, and in the United States (U.S.), patients with some medical conditions including asthma can experience worsened health status following exposure to the allergies. These allergies are prevalent across the U.S., and their level of prevalence differ across different demographic populations.
Allergic rhinitis, is one of these allergies, and it affects 7.8% of the U.S.’s population. Still, a close to 10% of the global population is likely to experience allergic reactions related to the use of certain drugs (Mathur & Viswanathan, 2014). In children and adolescents, 8% of cases involving food allergy occur in this group.
Pharmacological interventions can help the 35-year-old patient. Recommending a prednisone medication to this patient can help reduce his risk of experiencing asthmatic attacks which occur because of the allergies. This medication is a cheaper alternative, and the patient may not have difficulty purchasing it.
The patient can take the medication in different dosages depending on number of times they want to take the medication a day. Caregivers can recommend either first or second generation antihistamines to manage allergies (Loo & Wark, 2016). The two, however differ, based on their usefulness. For instance, the former can help in the treatment of the allergy issues as well as for the purpose of sedation. The latter is purely used as an anti-allergy medication.
Patient education for the patient in the case would focus on empowering them to become aware of self-care practices, and how they can reduce exposure to the allergies. First, I would recommend to the patient to consider ventilating their rooms so that they can reduce their risk of exposure to the triggers of the asthma attacks(Loo & Wark, 2016). Another clinical advice would include reminding the patient to adhere to their medications so that they reduce their chances of experiencing these attacks.
Loo, S. L., & Wark, P. A. (2016). Recent advances in understanding and managing asthma. F1000Research, 5, F1000 Faculty Rev-2052. https://doi.org/10.12688/f1000research.9236.1.
Mathur, S. K., & Viswanathan, R. K. (2014). Relevance of allergy in adult asthma. Current allergy and asthma reports, 14(5), 437. https://doi.org/10.1007/s11882-014-0437-5.
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