Dallas Allergy

I. ANTIHISTAMINES

A. Purpose – to prevent or relieve symptoms of allergies such as itching, sneezing, runny nose and watery eyes. Because these medications work by blocking the histamine receptor, they work best if taken on a daily basis to prevent symptoms (i.e. by blocking histamine receptors before histamine is released in an allergic reaction).

B. Classes of antihistamines

1. First Generation (e.g., Benadryl, Chlortrimeton, Dimetapp, Atarax, many others) – these are generally very effective in controlling allergy symptoms, but may require multiple doses per day and often cause drowsiness (or sometimes irritability in young children). These medications may also aggravate prostate problems in men.

2. Second Generation (e.g. Claritin, Allegra, Zyrtec, Xyzal) – these newer medications are comparably effective to the first generation antihistamines in controlling allergy symptoms, but usually are less likely to cause any drowsiness or behavioral side effects (with the exception of Zyrtec, which may cause a mild degree of drowsiness).

C. Additional important notes

1. Contrary to warning labels mandated by the FDA, antihistamines may safely be taken by people who have asthma. A position statement addressing this issue has been published by the American Academy of Allergy, Asthma & Immunology.

2. Antihistamines do not lose effectiveness with continued use. Allergy exposures change over time. An antihistamine that works very well when the pollen count is 500 may be much less helpful when the pollen count is 1500.

II. DECONGESTANTS

A. Purpose – to relieve blockage of nasal passages caused by swollen membranes. These medications are generally taken on an “as needed” basis.

B. Types of decongestants

1. Oral decongestants – pseudoephedrine (the active ingredient in Sudafed) and phenylephrine. These medications are often prescribed in combination with antihistamines (e.g., Actifed, Tavist-D, Bromfed, Claritin-D). They work by causing blood vessels to constrict; thus, they are not recommended for people who have high blood pressure. These medications may aggravate prostate problems in men. Higher doses (usually found in prescription form) may cause insomnia and other caffeine-like effects.

2. Topical decongestants – these medications are available as over-the-counter nasal sprays. The most common forms are oxymetazoline (long-acting preparations, e.g., Afrin) and phenylephrine (short-acting preparations, e.g., Neo-Synephrine). While these medications are very effective in relieving nasal congestion, their use should be limited to no more than 5 days in order to prevent “rebound congestion” (i.e., worsening nasal congestion caused by prolonged use of topical decongestants) and addiction.

III. ANTI-INFLAMMATORY MEDICATIONS

A. Purpose – to reduce runny nose and congestion associated with chronic nasal allergies. These medications are effective in controlling allergies only when they are taken on a daily basis. Depending on the formulation, results may not be seen until several days to weeks after starting the medication.

B. Nasal sprays – Prescription

1. Intranasal steroids (e.g., Beconase, Flonase, Nasacort Aq, Nasarel, Nasonex, Omnaris, Rhinocort Aq, and Veramyst) – these preparations are very effective in reducing allergic inflammation. They do not work immediately, but significant improvement in nasal symptoms is often seen within several days after starting these medications. For people with well-defined seasonal allergies, these products are particularly helpful in preventing seasonal symptoms when started one or two weeks before the beginning of the season and continued until the end of the pollen season.

C. Additional important notes – the nasal corticosteroid medications may be taken on a daily basis indefinitely without concerns for steroid side effects to the rest of the body. The greatest risk in taking these medications is the potential for nosebleeds caused by excessive dryness of the nasal membranes. This may be minimized by directing the spray away from the nasal septum (where the lining of the nasal membranes is naturally the most sensitive). If a nosebleed occurs, stop the medication for a period of one week and use some nasal saline spray as needed to loosen any bloody crusts, then resume at half of the original dose for maintenance.

IV. MISCELLANEOUS

A. Atrovent nasal spray – this medication is taken on an “as needed” basis for relief of excessive runny nose that is not controlled with antihistamines and topical nasal corticosteroid medications. This medication is effective for reducing runny nose of any cause (e.g., allergies, colds or “skier’s nose”), much like turning down a drippy faucet. The only potential side effect is excessive drying of the nasal membranes.

B. Antihistamine nasal sprays – Astelin and Patanase nasal sprays – these are antihistamine nasal sprays that may be taken twice daily as needed to control allergy symptoms. They are rapidly effective, but may cause some sedation and have an unpleasant aftertaste.

C. Saline nasal spray – Salt water nasal sprays are available over-the-counter in many generic and brand names, and are very effective for removing pollens from the nasal passages after outdoor activity; for loosening nasal secretions causing congestion; and for preventing nosebleeds due to excessive drying of the nasal membranes during the winter months. Because saline is so useful and absolutely harmless, it should be part of everyone’s “ammunition” for fighting allergies. The more saline is used, the more effective the treatment.

Some nasal products:

• Ocean Spray, Ayr Spray and others – these products produce a fine mist but don’t put much volume into the nose
• Sinus Rinse (Neil-Med) – easy to use and delivers a large volume of saline
• ENTSol – easy to use
• Netti pot – traditional but inconvenient
• Grosson nasal irrigator – used with a Water-Pik allows the most control but is more costly

Click here for more allergy medication tips or nasal irrigation instructions.