ASK THE DOCTOR: Medications offer relief from allergies
By DR. JIM MITTERANDOQ Every spring my allergies flare up. What should I take? I see TV commercials about allergy medicines. Are the prescription allergy medicines any better? Should I use eye drops for my itchy eyes?
A Although notorious during spring and fall, allergies can occur in any season of the year, causing lots of sneezing and sniffling.
Seasonal allergies result from the body’s reaction to allergens such as pollen from plants, molds, and pet dander, all of which inflame the nasal lining and cause release of histamines that trigger sneezing, itchy eyes, runny nose and congestion.
In children, parents may mistake allergies for a prolonged cold. Youngsters with allergies often have ‘‘allergic shiners,’’ dark circles underneath their eyes, and may constantly rub their noses.
Mostly, allergies are a nuisance. But they can make asthma worse; often treating allergies improves asthma. Fortunately, relief can be found in an array of allergy medications.
Many of the older, less expensive over-the-counter antihistamines for allergies work well: Chlortrimeton, Tavist and Benadryl, to name three. These antihistamines can be sedating, which can limit their use.
Newer antihistamines such as Allegra, Claritin, Clarinex and Zyrtec are less likely to cause sedation and, therefore, have become quite popular. The newer antihistamines may not be anymore effective than the older over-the-counter medications but are more convenient with once daily use and certainly are more expensive. Claritin is now available over-the-counter and is a lot cheaper than its prescription competitors. Many insurance companies will no longer pay for Claritin since it is now available over-the-counter.
In people with mild allergies, antihistamines work just fine and should be taken only as needed. People who have daily allergy symptoms that last for more than several weeks may require more preventive treatment with a prescription nasal steroid spray (such as Beconase, Flonase, Nasonex, Rhinocort and Vancenase) that decreases the allergic reaction and stops the release of histamine.
The nasal steroid sprays are the most effective treatment for allergies. They also reduce the need for antihistamines. Unlike antihistamines, which should be taken only when needed, steroid nasal sprays should be used every day to prevent allergy symptoms. Steroid nasal inhalers have a rare risk of causing cataracts and glaucoma.
A prescription, antihistamine nasal spray, Astelin, is also available but is not as effective as the nasal steroid spray. The over-the-counter, nasal spray, Nasalcrom, helps to prevent allergy symptoms but, also, is not as effective as the nasal steroid sprays. These medications may be useful if a steroid nasal spray is not tolerated.
Decongestants such as pseudoephedrine (i.e. Sudafed) or those combined with antihistamines (Tavist-D, Claritin-D) help treat the symptoms of nasal congestion but do not treat the underlying allergic reaction. Decongestants should not be taken long-term, because they may affect blood pressure or urination. Avoid using decongestant nasal sprays such as Afrin or Neosynephrine for allergies unless you have sinus pain since they can cause rebound nasal congestion if used for more than four days.
The asthma medication, Singulair, has recently been marketed for treatment for seasonal allergies. Singulair is an anti-inflammatory drug that is not as effective as a nasal steroid spray. This medication may be useful for people with severe allergies to add to their regimen of a steroid nasal spray and antihistamine.
Homeopathic medicines provide an alternative to the above medications that may be effective for some allergies.
Allergic conjunctivitis (red, irritated, itchy eyes) is often relieved by antihistamine pills and steroid nasal sprays. Avoid rubbing your eyes, which will release more histamine and cause more itching and redness. If the eye symptoms are not relieved, try an over-the-counter antihistamine eye drop such as Ocuhist. Prescription eye drops are available if you need further treatment; these include: Patanol, Zaditor, Crolom, Alocril and Alamast which prevent allergic eye symptoms.
Patients often ask whether they should undergo skin testing to evaluate their susceptibility to possible allergens. Skin testing involves the doctor pricking the skin with small pins containing different allergens, such as ragweed or pet dander, and then looks for welts, signs of allergic reaction.
I recommend skin testing if antihistamines and nasal steroids do not help and the patient and I are considering allergy shots, which are effective about 50 percent of the time and somewhat of a nuisance.
After all, getting allergy shots require visits to the doctor’s office every two weeks for several years and exposes the patient to the risk of anaphylaxis (a severe, potentially life-threatening reaction that can cause the upper airway to swell and blood pressure to fall drastically). But for the rare person with severe allergies who do not get relief with other allergy treatments, the benefits outweigh the risks and nuisance.
Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.
Copyright 2003 The Patriot Ledger
Transmitted Tuesday, April 22, 2003