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It's important to remember that if you suffer any severe allergic reaction-such as anaphylactic shock or asthma that causes shortness of breath or difficulty breathing, or any other extreme discomfort-you should seek medical attention immediately. In fact, if you've ever had a previous severe allergic reaction, you should ask your health care professional about carrying a kit with you to treat anaphylactic shock and be sure you've been taught to give yourself an injection from the kit. If you have to use the kit, be sure you also get medical help immediately. Until help arrives, lie down and raise your legs above the level of your chest to increase the blood flow to your heart and brain.

The first course of treatment is avoiding the allergen. (For more details, see the section on Prevention.) Your health care professional may also prescribe medications, recommend over-the-counter remedies, or suggest allergy shots. Although there is no cure for allergies, one of these strategies or a combination of them can provide varying degrees of relief from allergy symptoms.

Your health care professional may prescribe some medications that can be used alone or in combination. These include:

• Antihistamines counter the effects of histamine that is released in response to the allergen. Antihistamines relieve sneezing and itching in the nose, throat, and eyes; reduce nasal swelling and drainage; and are used to treat hives. The older drugs (called first generation antihistamines)-brompheniramine, chlorpheniramine, diphenhydramine, hydroxyzine and tripolidine-cause drowsiness, increase the risk of vehicle and occupational injuries.

Some of the newer (second generation) antihistamines, such as fexofenadine (Allegra), loratadine (Claritin), desloratadine (Clarinex) and cetirizine (Zyrtec), have fewer side effects. Some people, however, do experience mild side effects including drowsiness, dizziness, headache, nervousness, nausea, diarrhea, abdominal discomfort, dry mouth, dry skin or itchiness, or discoloration of urine with some of these medications. You should always let your health care provider know what other medications you are taking.

In November 2002, the FDA approved Claritin as an over-the-counter (OTC) allergy medication. The product was previously available only as a prescription drug and is indicated for seasonal allergic rhinitis.

Two other second generation antihistamines, azelastine (approved in 1996) and ketotifen (approved in 1999) are approved for topical use only; azelastine in the nose and eyes, and ketotifen in the eyes only.

To treat eye symptoms of allergic conditions, such as inflammation, itching, watering, and burning, your health care professional may prescribe an antihistamine eye drop that blocks histamine release. Don't use any other eye drops while using these and be sure to remove contact lenses to apply the drops to your eyes.

If you are pregnant, keep in mind that some of these antihistamines' effects on an unborn baby are untested; similarly, their effects on breast milk or nursing infants are in some cases not known. Always tell your health care professional if you are, could be, or could become pregnant, and discuss your situation with him or her before taking any medications. Both Zyrtec and Claritin are category B for pregnancy, meaning they appear to be completely safe.

• Topical nasal steroids are anti-inflammatory drugs that stop the allergic reaction. They decrease the number of the histamine-releasing cells in the nose and reduce mucus secretion and nasal swelling. These corticosteroid nasal sprays include mometasone (Nasonex), triamcinolone acetonide (Nasacort AQ), fluticasone propionate (Flonase), and budesonide (Rhinocort). Although they are generally safe when used at recommended doses, side effects of these medications may include:

• stinging or burning of the nose

• sneezing after application

• bleeding nose

• perforated septum (inside center of nose), extremely rare

• headache or lightheadedness

• unpleasant (or loss of) taste or smell.

Once used only to manage acute symptoms, corticosteroids inhalants are the preferred first-line therapy for children as well as adults with persistent asthma, according to updated guidelines issued in June 2002 by the National Asthma Education and Prevention Program (NAEPP) of the National Heart, Lung, and Blood Institute. The update stresses that inhaled corticosteroids are preferred for controlling and preventing asthma symptoms, and for improving lung function and quality of life. In addition, the update reflects new data that provide reassuring evidence on the safety of inhaled steroid use at appropriate doses in children. The report states that large clinical trials have shown the potential risk of delay in growth linked to inhaled corticosteroids is temporary and possibly reversible.

• In June 2003, the FDA approved Xolair, a genetically-engineered antibody preparation administered by injection. It is indicated for adults and adolescents (12 years of age and older) whose allergy related asthma symptoms are inadequately controlled with inhaled corticosteroids.

• Cromolyn sodium (Nasalcrom) is a nasal spray that in some people helps to prevent allergic reactions from starting. When administered, it can safely inhibit the release of chemicals like histamine from the cells. It has few side effects-which may include stinging or burning of the nose, headache, bad taste, runny nose or postnasal drip, or a rash-when used as directed, and significantly helps some people with allergies. While tests have shown it is unlikely to harm an unborn baby, don't use cromolyn sodium without first talking to your health care professional if you are pregnant. It's not known if this medication passes into breast milk; talk to your health care professional if you are nursing.

• Decongestants, such as pseudoephedrine, help re-establish drainage of the nasal passages and relieve symptoms such as congestion, swelling, excess secretions and discomfort in the sinus areas. These over-the-counter and prescription drugs can be taken by mouth or applied directly to the nose. Be careful not to use nasal sprays and drops for more than three or four days, or you might end up even more congested because of a rebound effect. Your health care professional may advise you to take an antihistamine in combination with a decongestant to relieve other allergic symptoms. Decongestants may produce side effects such as nervousness, insomnia, rapid heartbeat, and elevated blood pressure.

Over-the-counter cold and allergy products containing the decongestant phenylpropanolamine (PPA) were removed from the marketplace in November 2000, based on FDA concerns over the propensity of this particular decongestant to lead to strokes, particularly hemorrhagic strokes. Some of these medications were quickly replaced with non-PPA formulas, but a handful of others were pulled and not replaced at retail.

Some over-the-counter products should not be used by people with high blood pressure, diabetes, or other medical conditions, or if they've taken an MAO inhibitor in the last 14 days. If you have any medical conditions, be sure to consult your health care professional before self-treating. In addition, the American College of Allergy, Asthma and Immunology says steroid injections should not be used to treat pollen allergies because the side effects are greater than with other therapies.

• Immunotherapy, also called allergy vaccine therapy, which consists of a series of injections, is the only available treatment that has a chance of reducing the allergy symptoms over a longer period of time. Patients receive subcutaneous injections of increasing concentrations of the allergen(s) to which they are sensitive. These injections reduce the amount of antibodies in the blood and cause the body to make a different protective antibody. Many patients with allergic rhinitis (hay fever) will have a significant reduction in their pollen allergy symptoms and in their need for medication within 12 months of starting immunotherapy. Controlled studies have also shown that allergen immunotherapy is effective for patients with allergic conjunctivitis, allergic asthma, and stinging insect (Hymenoptera) hypersensitivity. Patients who benefit from immunotherapy may continue it for three to four years and then consider stopping. Although many patients are able to stop the injections with good long-term results, some do get worse again after immunotherapy is stopped.

In the cases of food allergies, while antihistamines and decongestants can help alleviate some symptoms, the best course of action is to completely avoid the trigger food.

The primary treatment for skin eczema is aimed at alleviating symptoms. To relieve itchiness and eczema, your health care professional might recommend initially a room-temperature bath to remove crusted skin, followed by immediate application of a moisturizer, which helps conserve the skin's natural moisture. Two FDA-approved topical medications, Protopic (tacrolimus) and Elidel (pimecrolimus) are available for the treatment of eczema.

Topical coal-tar preparations also work, but they can be messy and smelly; they should not be used by pregnant women, and their prolonged use may increase the risk of skin cancer. If symptoms persist, your health care professional may recommend application of over-the-counter hydrocortisone cream or, in severe cases, oral corticosteroid medication. Although steroid creams or oral steroids may be appropriate for acute outbreaks or severe episodes of eczema, long-term use is not advisable because of the considerable risk of side effects. Topical steroid creams can cause thinning and spotting of the skin, acne, and permanent stretch marks. If used around the eyes, topical steroid medications can, in rare cases, lead to glaucoma. Eczema patients who take oral steroids for longer than the usual two-week cycle and then stop using the drug face the additional risk of severe relapse. For these reasons, long-term steroid therapy is advised only under a health care professional's supervision.

The oils of mackerel, herring and salmon are high in eicosapentaenoic acid (EPA), shown to reduce skin inflammation and itchiness. Because you would have to eat up to two pounds of fresh fish a day to get the necessary amount of EPA, it's more convenient to take one tablespoon of cod-liver oil or four 1,000 mg fish-oil capsules a day. Women who suffer from eczema may also benefit from a daily 50 mg zinc supplement; many eczema sufferers have a zinc deficiency, and zinc helps the body metabolize fatty acids. Your health care professional may recommend taking vitamin A, also found in cod-liver oil, which is essential for the repair and renewal of skin. You can take doses of up to 25,000 IU a day. As with all supplements, be sure to consult with your health care professional-he or she may or may not endorse use of supplements. Also, if you decide to take a supplement, be sure to inquire about possible adverse interactions with other medications you may be taking.