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Tell me about Allergies!

Allergy Medications


Allergy medications are the second of the three ways to treat allergies (the first was avoiding the allergen, and the third is immunotherapy (allergy shots or drops).  

Antihistamines

Antihistamines are one of the body's main chemical messangers of allergy.  Antihistamines are very helpful if you have allergies- but they can work against you if you don't.  If you don't have allergies, the antihistamine will thicken your secretions without giving you any benefit!

By Mouth:  The first medication most people think of is Benadryl, an antihistamine.  Benadryl is one of the older (first-generation) antihistamines.  It is very effective, but has the use-limiting side effect of making many people very drowsy.  Most first generation antihistamines are available over the counter (without a prescription needed)

Newer, second-generation antihistamines (Claritin, Clarinex, Zyrtec, Allegra, Xyzal) have been formulated to avoid the drowsiness (although Zyrtec in particular will still make some people drowsy, so taking the once daily dose near bedtime is a good idea).  Claritin (loratadine) and Zyrtec (cetirazine) are available without prescriptions.  Claritin (loratadine), Zyrtec (cetirazine) and Allegra (fexofenadine) are available in generic formulations. 

In the Nose:  Sometimes it is better to use the antihistamine topically, limiting most of its action to the nasal area where symptoms are occurring.  Astelin and Astapro are twice-a-day and once-a-day versions of the antihistamine azalastine.  Patanase is another topical antihistamine option.

In the Eyes: There are 2 basic types of OTC allergy eye drops. The first is a combination of antihistamine and decongestant. The antihistamine component is effective at managing the itching of allergy. The decongestant is effective in decreasing redness of the eye. The decongestant has a rebound effect if used long term. That is, when drops are stopped, the redness is worse than before using the medication. Therefore, the drops should only be used for a maximum of 3 days at a time. Brand names for this combination are Naphcon-A, Opcon, Vixine-A. They can be used for people 6 years and older, 1-2 drops in each eye as needed, a maximum of 4 times a day. 

The second type of OTC allergy eye drop contains only one medication, ketotifen. This is an antihistamine and mast cell stabilizer. Both of these actions helpd minimize allergy eye symptoms. These can be used long term without major problems. Brand names for this medication are Alaway, TheraTears Eye Itch Relief, Visine All Day Eye Itch  Relief, Zaditor and Zyrtec Itchy Eye Drops. People 3 years and older can use this eye drop, 1 in each eye, 1-2 times daily.

Leukotriene Modifiers

Leukotrienes are another of the body's chemical messangers of allergy.  Unlike histamine, however, it is more active in the late response to an allergic stimulus (occurring 2-4 hours after exposure to allergen).  The main leukotriene modifier used in the US today is Singulair (montelukast). 

Nasal Steroid Sprays

Nasal steroids are one of the cornerstones of allergy treatment.  The nice thing about the sprays is that since they're used in the nose, there is minimal absorption by or effect on the rest of the body.  In very young children, there may be some delay of growth, but studies have shown no impact on ultimate height.

The most common side effect of nasal steroids is irritation or mild bleeding of the septum (dividing wall between the two halves of the nose).  This usually occurs because of direct irritation by the tip of the spray bottle rubbing here, or because the spray is directed at this area.  This can be avoided by exactly how you spray the spray.  Hold the tip of the bottle just AT the entry into that side of the nose.  Tilt is slightly outward, toward the eye on that side (but still INSIDE the nose).  If you cross hands, using the left hand to spray in the right nostril and vice versa, you'll get the angle right!

Two more serious side effects of nasal steroid use are a thrush (yeast) infection in the back of the nose, and a septal perforation (hole between the two sides of the nose).  Fortunately, these are both very rare!

Occasionally people find a particular spray too drying, or associated with headaches or are bothered by the smell of a spray or its taste going down the throat.  If this happens to you, don't give up on nasal steroids.  There are a number of 'cousins' in this group- and frequently people who have problems with one do very well on another.  Let your doctor know you need to try another one.

There is some evidence that nasal steroid sprays may increase intraocular pressure.  If you have glaucoma and are using a nasal steroid spray, it is important to have your intraocular pressure checked regularly.  If there is an upward trend to this, stop the spray and let the prescribing physician know what's happening.

Here are specific sprays- with the trade name first, followed by the pharmacologic or generic name in parentheses.  The only two nasal steroid sprays currently available in generic form are flunisolide and fluticasone. 

Beconase AQ (beclamethasone)
Flonase (fluticasone proprionate)
Nasacort AQ (triamcinalone)
Nasarel (flunisolide) No website found
Nasonex (mometasone)
Omnaris (ciclesonide)
Rhinocort Aqua (budesonide) No website found
Veramyst (fluticasone furoate)

Decongestants

Decongestants help with a stuffy nose from any cause- allergies, colds, etc.  They are highly effective, but have some major side effects and disadvantages.  Always read labels carefully, and understand what medicines you are taking!

Decongestants may not be right for you if you have:

High Blood Pressure (hypertension).  Decongestants can make blood pressure go up.   If  you are using a decongestant and tend to have high blood pressure, check your blood pressure at least once a day.  If there is an upward trend, stop the decongestant and let your doctor know.

Prostate enlargement.  Decongestants can worsen the urination problems that can occur with an enlarged prostate. 

Glaucoma.  Decongestants can increase intraocular pressure.  Monitor regularly, and stop if there is an upward trend.
 

Rapid heart beat.  Decongestants can cause the heart to beat more rapidly.  If this is a problem for you, or occurs when you are taking a decongestant, discontinue it.

Sleep problems.  If taken near bedtime, decongestant can cause problems falling asleep or staying asleep in a small portion of the population.  One way around this is to use short-acting decongestant (i.e., not the 12-hour or 24-hour formulations), and take the last dose in mid-afternoon.

Oral: The two main oral decongestants used in the US today are pseudoephedrine (in the original Sudafed) and phenylephrine (in the current Sudafed on drugstore aisles).  Products labelled Sudafed PE contain phenylephrine.  Pseudoephedrine-containing Sudafed is available without a prescription, but it is kept behind the pharmacist's counter (since it can be used as an ingredient to produce illegal methamphetamines).  If you want a pseudoephedrine-containing medication, ask the pharmacist.  You'll have to show your driver's license, and sign for the medication in a record book.

Both forms of decongestant are available in generic medication made by numerous different companies.  Read the small print on the labels for the content.

Topical: Sometimes it is more convenient to use a decongestant nasal spray such as Afrin.  This is sprayed into the nose, and works within 10 minutes to relieve nasal congestion.  It has the same side effects as oral decongestants.  USE ONLY FOR 3 DAYS AT A TIME!!!  Topical decongestants work so well that sometimes people are tempted to continue using them.  This leads to trouble, since over time the amount of medication needed and the frequency needed increases as the nasal lining becomes accustomed to the dose.  This can lead to...
 

Rhinitis Medicamentosa, or addiction to topical nasal spray. People with this affliction may be using their nasal spray as frequently as every 10 minutes.  Overuse of the nasal decongestant has led to rebound congestion that just gets worse and worse.  If this describes you - and you can't go 'cold turkey', please see your ENT doctor or allergist for help in developing a strategy stop your dependence on this medication!

Other Topical

NasalCrom.  This nasal spray contains cromolyn, a mast-cell stabilizer.  This means that NasalCrom makes it harder for the allergic cells in the nose to release their histamine and other allergy-symptom-causing chemicals. IT is available over-the-counter (no prescription needed).