Peer reply : pharma DB 1- Yaima Discuss the epidemiology of allergies. There are several different types of allergies that are relevant when discussing the epidemiology of allergies disease. These include allergic rhinitis, drug allergy and food allergies. Allergic rhinitis affects between 10-30% of the total population. Some degree of sensitization is indicated by the presence of IgE antibodies (immunoglobulin E antibodies produced by the immune system that target immune cells causing chemical release leading to an allergic reaction). Adverse drug reactions are common and are thought to affect up to 1 in 10 of the general population worldwide. To further this, the relative risk is approximately double for hospitalized patients. The incidence of cases of anaphylaxis that result in fatal outcomes may also be linked to drug allergies. The most prevalent food allergen is the peanut, closely followed by milk and shellfish. Common food allergies include: Peanuts, Milk, Shellfish, Eggs, Tree nuts (e.g. walnuts, almonds, pine nuts, brazil nuts, pecans), Soy, Grains with gluten (e.g. wheat, barley, rye, oats), Fish. The severity of these allergies can vary significantly, and some individuals may not experience significant effects with dietary intakes, although a sensitive response is observed in an experimental testing environment. What are your treatment options (consider pharmacoeconomic)? Compare first and second-generation antihistamines. You can treat allergy symptoms with over the counter and prescription medications, as well as allergy shots. Lifestyle changes like using air filters and avoiding triggers are important, too. Different medications can treat allergies, including steroids and allergy shots, but usually the first thing to try is an antihistamine. While the first-generation H1 antihistamines have a central effect and, thus, are also used as sedatives, second-generation H1 antihistamines have less central effects and are used primarily as antiallergenic drugs. Histamine is a biologically active substance that potentiates the inflammatory and immune responses of the body, regulates physiological function in the gut, and acts as a neurotransmitter. Drugs that antagonize these effects by blocking or inhibiting histamine receptors (H receptors) are called antihistamines. Antihistamines are divided into two classes (H1 antihistamines and H2 antihistamines), based on the type of H receptor targeted. H1 antihistamines are mostly used to treat allergic reactions and mast cell-mediated disorders. This subtype is further divided into two generations. While the first-generation H1 antihistamines have a central effect and, thus, are also used as sedatives, second-generation H1 antihistamines have fewer central effects and are used primarily as antiallergenic drugs. H2 antihistamines are indicated primarily for gastric reflux disease because they reduce the production of stomach acid by reversibly blocking the H2 histamine receptors ...

1. Peer reply : pharma DB
1- Yaima
Discuss the epidemiology of allergies.
There are several different types of allergies that are relevant
when discussing the epidemiology of allergies disease. These
include allergic rhinitis, drug allergy and food allergies.
Allergic rhinitis affects between 10-30% of the total population.
Some degree of sensitization is indicated by the presence of IgE
antibodies (immunoglobulin E antibodies produced by the
immune system that target immune cells causing chemical
release leading to an allergic reaction). Adverse drug reactions
are common and are thought to affect up to 1 in 10 of the
general population worldwide. To further this, the relative risk
is approximately double for hospitalized patients. The incidence
of cases of anaphylaxis that result in fatal outcomes may also be
linked to drug allergies. The most prevalent food allergen is the
peanut, closely followed by milk and shellfish. Common food
allergies include: Peanuts, Milk, Shellfish, Eggs, Tree nuts (e.g.
walnuts, almonds, pine nuts, brazil nuts, pecans), Soy, Grains
with gluten (e.g. wheat, barley, rye, oats), Fish. The severity of
these allergies can vary significantly, and some individuals may
not experience significant effects with dietary intakes, although
a sensitive response is observed in an experimental testing
environment.
What are your treatment options (consider pharmacoeconomic)?
Compare first and second-generation antihistamines.
You can treat allergy symptoms with over the counter and
prescription medications, as well as allergy shots. Lifestyle
changes like using air filters and avoiding triggers are

2. important, too. Different medications can treat allergies,
including steroids and allergy shots, but usually the first thing
to try is an antihistamine. While the first-generation H1
antihistamines have a central effect and, thus, are also used as
sedatives, second-generation H1 antihistamines have less
central effects and are used primarily as antiallergenic drugs.
Histamine is a biologically active substance that potentiates the
inflammatory and immune responses of the body, regulates
physiological function in the gut, and acts as a neurotransmitter.
Drugs that antagonize these effects by blocking or inhibiting
histamine receptors (H receptors) are called antihistamines.
Antihistamines are divided into two classes (H1 antihistamines
and H2 antihistamines), based on the type of H receptor
targeted. H1 antihistamines are mostly used to treat allergic
reactions and mast cell-mediated disorders. This subtype is
further divided into two generations. While the first-generation
H1 antihistamines have a central effect and, thus, are also used
as sedatives, second-generation H1 antihistamines have fewer
central effects and are used primarily as antiallergenic drugs.
H2 antihistamines are indicated primarily for gastric reflux
disease because they reduce the production of stomach acid by
reversibly blocking the H2 histamine receptors in the parietal
cells of the gastric mucosa. Use of most H1 and H2
antihistamines is contraindicated during pregnancy and
childhood. First-generation H1 antihistamines are specifically
contraindicated in angle-closure glaucoma and pyloric stenosis.
What education will you provide to the patient?
To reduce your exposure to the things that trigger your allergy
signs and symptoms (allergens):
Stay indoors on dry, windy days. The best time to go outside is
after a good rain, which helps clear pollen from the air.
Delegate lawn mowing weed pulling and other gardening chores
that stir up allergens.

3. Remove clothes you've worn outside and shower to rinse pollen
from your skin and hair.
Don't hang laundry outside - pollen can stick to sheets and
towels.
Wear a pollen mask if you do outside chores.
Use the air conditioning in your house and car.
If you have forced air heating or air conditioning in your house,
use high-efficiency filters and follow regular maintenance
schedules.
Keep indoor air dry with a dehumidifier.
Use a portable high-efficiency particulate air (HEPA) filter in
your bedroom.
Clean floors often with a vacuum cleaner that has a HEPA
filter.
References
Muñoz-Furlong A. Food allergy in schools: concerns for
allergists, pediatricians, parents, and school staff. Ann Allergy
Asthma Immunol. 2015; 93(5) (suppl 3):S47-S50.
Decker WW, Campbell RL, Manivannan V, et al. The etiology
and incidence of anaphylaxis in Rochester, Minnesota: a report
from the Rochester Epidemiology Project. J Allergy Clin
Immunol. 2018;122(6):1161-1165.
2- Triana
1.Discuss the epidemiology of allergies.
Allergic diseases are the most common chronic conditions
lasting throughout the patient’s life. They not only cause
significant deterioration in the quality of life of patients but
also lead to significant absenteeism and reduced productivity,
resulting in very high costs for society (Kuna, et al.,
2016).There are several different types of allergies that are

4. relevant when discussing the epidemiology of allergies disease.
These include allergic rhinitis, drug allergy and food
allergies.While AR is influenced by genetic predisposition, the
symptom presentation also depends on environmental
exposures. In addition, the disease can co-present with other
diseases, such as asthma and other infectious diseases, which
could further complicate the disease diagnosis. A robust
association of rhinitis was found among individuals with
allergic and non-allergic asthma. Among patients with
persistent and severe rhinitis, asthma was found prevailing.
2.What are your treatment options (consider pharmaco-
economic)? Compare first and second-generation
antihistamines.
Effective and safe treatment of allergic diseases is therefore one
of the main challenges for public health and should be carried
out by all the specialists in family medicine, internists and
pediatricians in collaboration with allergists,
otorhinolaryngologists and dermatologists. Antihistamines are
most commonly used in the treatment of allergies. Several
dozen drugs are available on the pharmaceutical market, and
their generic forms are advertised widely as very effective drugs
for the treatment of allergic diseases (Kuna, et al., 2016).The
total cost of allergic diseases brings both reduced quality of life
and also direct costs of drugs and health services as well as
indirect social costs such as the absence from work; it also
decreases productivity and concentration and generates learning
disorders and concomitant diseases (Kuna, et al., 2016).
Histamine plays an important role in human physiology,
influencing immunoregulation of the acute and chronic
inflammatory response through 4 different types of receptors,
called H1, H2, H3, and H4. Drugs classified in the first
generation of antihistamines (sometimes called “classical”
antihistamines) act non-selectively. Apart from all histaminic

5. receptors they also block muscarinic, adrenergic (or
adrenoreceptors) and dopaminergic receptors, causing
cardiovascular, urinary and gastrointestinal adverse reactions
(Kuna, et al., 2016).The described characteristics and easy
usage as well as affordable price led to the inclusion of the
second generation antihistaminic drugs in all global and local
recommendations as the drugs of choice in all forms of allergic
rhinitis and urticaria. The most frequently cited are ARIA
(Allergic Rhinitis and its Impact on Asthma) guidelines, which
discusses pharmacotherapy and presents the second generation
anti-H1 drugs in the first place, recommending them in all
adults and children (Kuna, et al., 2016).
3.What education will you provide to the patient?
A primary focus of patient education is the importance of
avoiding exposure to allergens. Patients should be well prepared
with multiple methods to eliminate or minimize indoor allergens
such as mold, pet dander, and dust mites. For example, indoor
mold may be controlled by eliminating excess moisture with
dehumidifiers and frequently cleaning damp areas such as
bathrooms with a bleach-and-water solution. Pets may be
avoided altogether, or dander may be limited by using high-
efficiency particulate arrestance (HEPA) air filters and allergen-
resistant bedding. Dust mites may be reduced by avoiding
carpet, frequently washing drapes and bedding, and wiping
surfaces with a damp cloth or mop daily. Outdoor allergens,
such as pollen from trees, grasses, and weeds are more difficult
to control. Exposure may be decreased by showering before bed,
keeping windows shut, and using an air conditioner (Felicia
Spadini, MSN, 2016).
Reference
Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics
for advance practice nurse prescribers. Philadelphia: F.A. Davis

6. Company.
Kuna, P., Jurkiewicz, D., Czarnecka-Operacz, M. M.,
Pawliczak, R., Woroń, J., Moniuszko, M., & Emeryk, A. (2016,
December). The role and choice criteria of antihistamines in
allergy management - expert opinion. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5183790/
Allergic Rhinitis: Counseling Points for Better Patient
Outcomes. (n.d.). Retrieved from
https://contemporaryclinic.pharmacytimes.com/journals/issue/20
16/april2016/allergic-rhinitis-counseling-points-for-better-
patient-outcomes.