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Combination Therapy For Allergies: What You Need to Know

Combination Therapy For Allergies: What You Need to Know

Medically Reviewed By:
Dr. Shuba Iyengar, MD, MPH
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Dr. Shuba Iyengar, MD, MPH
After graduating from UC Berkeley, Shuba completed medical school at Duke University, earning her MPH in tandem at UNC. After a research fellowship at the NIH, Shuba completed her residency at Stanford, then fellowship in allergy-immunology at Boston Childrens/Harvard.

Shuba returned to the Bay Area to join Dr. Bocian at a large multi-speciality health system where she helped lead an allergy practice. She cofounded Allermi to make expert allergy care more accessible for all.
Written by:
Katelyn Johnson, B.S., M.B.A, CMA
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Katelyn Johnson, B.S., M.B.A, CMA
Katelyn Johnson is a freelance writer, Certified Medical Assistant, and Nationally Registered EMT with 8+ years of clinical experience across multiple specialties. She has a Bachelor’s in Biology, Master’s in Healthcare Administration, and is currently obtaining a Bachelor’s in Nursing. Katelyn is an advocate for providing patient education in an approachable way through online resources.

Allergic rhinitis (allergies) is often caused by environmental triggers that are widely prevalent throughout the United States. 

Unfortunately, this means there are millions of people that have to deal with regular nasal congestion, runny nose, asthma attacks, and other annoying symptoms. However, combination therapy can make all the difference for allergy sufferers. 

Take a look at everything you need to know about combination therapy for environmental  allergies, or allergic rhinitis. 

 

Allergic Rhinitis Overview

Allergic rhinitis is a collection of nasal symptoms created by the body’s immune response to environmental allergens. Symptoms often include nasal congestion (caused by inflammation of the nasal mucosa), post-nasal drip, runny nose, and sinus pressure. 

There are different sub-categories that allergic rhinitis, including seasonal allergic rhinitis and perennial allergic rhinitis. Seasonal allergic rhinitis waxes and wanes based on the pollen levels throughout the year; and is what most people in the United States experience. Perennial allergic rhinitis is characterized by having allergic rhinitis symptoms most days of the year and is not as comon. 

Other allergic disease processes include: 1.  allergic conjunctivitis, an allergic response in the conjunctiva of the eye and 2.  allergic rhinoconjunctivitis, where people experience both eye and nose symptoms in response to an allergen. 

Much of the time all of these various categories of allergic rhinitis are just colloquially and more generally referred to as hay fever or allergies.  

 

What Happens in Your Body With Allergies? 

So now that you know more about the term allergies, let’s dive deeper into what happens in the body when you experience these kinds of symptoms. When your body is exposed to an allergen, your immune system produces antibodies that recognize it as a foreign invader that it should attack. This response causes excess mucus production and allergic inflammation. 

inflammation

On a more detailed level, allergic reactions can be broken down into four stages. First, the nasal mucosa or skin comes into contact with an allergen, like grass or tree pollen, which causes the release of antigen peptides (tiny chains of proteins). 

The antigen peptides bond with immunoglobulin E antibodies (IgE), and this complex binds to and activates mast cells located within the skin, gut, and mucosa. Upon activation, mast cells release inflammatory messengers, like histamine and leukotrienes, . 

Histamine, leukotrienes, and other inflammatory markers are ultimately what binds to receptors like H1 receptors on inflammatory cells and eventually cause inflammation and secretion production. 

Though the process is complicated, this general idea can help understand how various allergy medications work in different ways to relieve allergy symptoms.  

 

What is Combination Therapy? 

There are many allergy medications on the market; however, many of them only relieve specific symptoms. Combination therapy, as the name suggests, is a treatment that combines several individual medications into one solution. Combination therapy attacks different symptoms from multiple directions, rather than just in one way when you use individual medications. 

 

Types of Allergy Medications in Combination Therapy

When it comes to allergy medications, oral antihistamines, specifically second-generation antihistamines and oral decongestants are the most common initial treatment option. 

Oral antihistamines work by blocking those histamine receptors mentioned above, so that the histamine cannot cause inflammation and mucus production. Oral decongestants do not actually interrupt the allergic response process directly, but rather constrict the blood vessels in the nasal mucosa to reduce inflammation. 

Leukotriene receptor antagonists are another class of oral allergy medications that bind to the leukotriene receptors mentioned above. This class includes medications like montelukast. 

Other allergy treatments include intranasal corticosteroids like triamcinolone, and intranasal antihistamines like azelastine hydrochloride, which are nasal sprays that reduce inflammation and block histamines, respectively. Oxymetazoline is another allergy nasal spray that works similarly to oral decongestants, but is more directed at the nose with less side-effects in the rest of the body..

Some patients opt for a more long-term allergy treatment called allergen immunotherapy. With allergen immunotherapy, patients receive small amounts of their individual allergen triggers (measured by testing) in increasing amounts in the form of injections or drops (sublingual immunotherapy) under the tongue. This is performed over a 3-5 year timeframe, with the peak improvement in symptoms usually occurring after a year. 

Though allergen immunotherapy can result in a significant reduction in symptoms, it often takes at least a year to feel a difference in symptoms. 

Combination therapy, especially in the form of nasal sprays, can be used in addition to allergy shots, especially during the first year when the shots have not taken effect yet. 

 

Benefits of Combination Therapy For Allergies

Combination therapy is used for several disease processes and, while beneficial for other illnesses, if you do a systematic review of clinical trials and healthcare research studies, you’ll see it offers a ton of benefits for patients with allergies. 

Solve Multiple Symptoms with One Treatment

One of the top benefits of combination therapy (i.e.  combining an anti-inflammatory with an antihistamine medication into one bottle)  for allergies is that it addresses multiple symptoms with just one treatment. This is because, with combination therapy, you are getting the effects of several medications working simultaneously  to target different symptoms. 

 

More Affordable

Because several individual medications have been combined into one, it’s far more affordable. Without combination therapy, you would have to purchase or pay a separate copay for each individual medication. Instead, since combination therapy is all in one, you often pay considerably less!  

Highly Effective

The active medications used in combination therapy each have their own proven efficacy. Then, with combination therapy, you merge them into one treatment all working at the same time. This exponentially increases effectiveness. 

Additionally, many patients are often more compliant because they only need to use one medication instead of several. In addition, because most combination therapies combine an ingredient that works very fast with something that works very slow, patients feel the effect right away and are more likely to keep using the medication. For instance, fluticasone propionate nasal spray has to be used daily for 2 weeks before it becomes effective.

 

Nasal Sprays Are The Best Combination Therapy for Allergies

Why are nasal sprays the best for allergy treatment? Oral combination therapy allergy treatments, like an oral antihistamine combined with an oral decongestant, can be somewhat effective for seasonal allergic rhinitis. However, they can cause side-effects like high blood pressure and drowsiness. 

   

Combination therapy nasal sprays like triamcinolone mixed with azelastine hydrochloride are only absorbed into the nasal mucosa, making the risk for adverse effects or adverse events much less likely. 

Additionally, combination nasal sprays for allergies treat the problem at the source rather than being spread throughout the body. 

 

Allermi: The Best Combination Nasal Spray for Allergies

Allermi is a telemedicine service that prescribes personalized combination therapy nasal spray for allergy treatment. 

You’ll get to see a board-certified, licensed provider who will develop and ship you a nasal spray with all of the medications you need to relieve your specific symptoms right from the comfort of your couch. Each nasal spray formula is unique to your own individual symptoms, down to the exact ratio of each ingredient.