During the long course of evolution, human beings gradually developed an exquisitely sensitive immune system. Designed to protect against disease, one of its main jobs is to distinguish between foreign agents and one’s own healthy tissues, a job that in modern society has become much more difficult. We now live in high-density urban environments and come into contact with countless agents both natural and synthetic. Allergies are one result of the body’s defenses becoming confused, with high cost to society. Last year alone, sales of Zyrtec, the leading allergy remedy in the United States, exceeded $300 billion.

Allergies are extremely common in the general population, and people often suffer from more than one. In the National Health and Nutrition Examination Survey, over 8,000 people were interviewed and given blood tests for 19 common inhalant allergens. Antibodies to at least one allergen were present in 44 percent, while 34 percent had symptoms suggestive of allergic disease.

Once an allergic substance enters the body (through ingestion, inhalation or injection), it is degraded, and taken up by various immune cells in the body that eventually produce a cell called IgE which is specific to that agent, called an allergen. Upon repeated exposure to allergens, the immune systems’ memory immediately secretes these IgE antibodies. This complex then binds to mast cells in the body, which mediates an inflammatory reaction by releasing a chemical called histamine, resulting in the common allergy-related symptoms, which commonly include itchy eyes, runny nose and plugged sinuses.

Other symptoms that may be the result of additional body responses include fatigue, headache, digestive complaints, abdominal pain, asthma and skin reactions. In an effort to distinguish other illnesses from those mediated by allergy, patients at my office, Manakai o Malama, are frequently offered a blood test to check for specific allergies. Among the most common environmental allergens are dust mites, mold, animal dander and pollens. Foods such as nuts, eggs and shellfish are other common causes of allergic symptoms. Medications such as certain antibiotics and aspirin might also cause severe reactions.

Not all allergic responses are severe. IgE allergy is typically rated on a scale of one to six. A level-one reaction may be barely noticeable, while a six could result in throat swelling, shortness of breath and, in the worst case, become life-threatening. The allergic triad consists of atopic dermatitis (eczema), allergic rhinitis and asthma, and is correlated with higher IgE levels, greater disability and more health care.

Suspected allergies should first be medically evaluated. A simple blood test can provide a great deal of useful information. Sometimes allergic symptoms are present but the blood test is negative. A useful intervention at that point may be to do a three-week elimination diet during which the majority of common allergens are held back. Most of the time symptoms are then much improved. If so, foods are added back one at a time such that if symptoms return, the cause is clear.

Once an individual is able to identify the most troublesome allergens, environmental avoidance is always the best first line of defense. It might mean getting new bed pillows in the case of a mite or mold allergy or, in other cases, staying away from peanuts or shrimp.

Once opportunities for allergen avoidance are optimized, there are many effective medications available over the counter and by prescription, which have varying side effects. Oral antihistamines are commonly used. Also available are many types of eye drops and nasal sprays. In more severe cases some patients will receive immunotherapy, which calls for regular injections from an allergist.

Another emerging treatment approach supported by the American College of Allergy, Asthma and Immunology involves administering immunotherapy under the tongue rather than by injection. Sublingual immunotherapy, or SLIT, offers several specific advantages over injection immunotherapy. SLIT can be self-administered by patients or caregivers, does not require injections and carries a much lower risk of untoward reactions compared with injection immunotherapy. Sublingual immunotherapy is given every day for several months of the year. The first dose is given in the doctor’s office, but after that it is given at home because it’s relatively safe.

Allergies are a common ailment in modern society. Over-the-counter and prescription drug treatment consume substantial health care resources. When allergies are suspected, the first move should be to obtain a clear medical diagnosis from a qualified health care provider, one that identifies specific allergens. Allergen avoidance is the safest and most effective first-line treatment, followed, if necessary, by medication. For severe cases that are difficult to manage, self-administered, sublingual immunotherapy is an emerging option.

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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.