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Is it OK to continue to take antihistamine medications during immunotherapy? -- A.S., USA
It's surprising how many people ask that question. I think the reason is that we tell patients to stop their antihistamines prior to testing. But we sometimes fail to make it clear that they can resume them while taking shots.
The symptoms we experience during an allergic reaction are caused by histamine. "Anti" means "against." Antihistamines, or "against-histamine" meds can stop histamine from causing skin reactions that indicate allergy to items tested. We could report "No allergies" when you actually do have allergies. This is why a histamine test is always included in skin testing. If the histamine test fails to form a small wheal, skin testing done on that day cannot be considered valid.
When you are experiencing symptoms of allergies, this indicates that you are being exposed to things you are allergic to. Your body is releasing histamine, and it is causing a runny nose, itchy eyes, or perhaps a rash. You come in for your allergy shot and leave with an extra dose of the things that are already causing you grief. Your body pumps a little more histamine into your system. You're sniffling even more.
Your body meets this onslaught by building more antibodies to fight the offending allergens. These antibodies do battle with the allergens throughout the week, and you feel much better. But as the antibody level in your body decreases again, symptoms may return. "I can always tell when it is time for my shot!" patients often exclaim. You get another shot, more histamine is released, more antibodies are built, and the cycle starts again. For patients who experience an increase in symptoms in the hours immediately following an allergy injection, we especially recommend that they take an antihistamine before their injection.
Most patients continue to experience allergy symptoms throughout the week when they first begin shots. As injections build to a higher concentration, more antibodies are produced. Eventually symptoms are usually controlled by the immunotherapy alone. But until then, we recommend these patients continue daily antihistamines along with the injections. Ask your physician or his nurse if an antihistamine is the right choice for your need.
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Links updated 5/28/04