In my second newsletter I will tell you what you need to know about Over the Counter Allergy Medications. Please give me a call if you have any questions.
My goal is to publish one newsletter each month to cover timely and practical issues that can improve your health. If you would like to suggest a topic or have feedback or question please email me at: steve@SteveRichardMD.com.
In late April I was carrying a dinner plate to the kitchen and tripped on a rug. I did not want to drop the plate, so I tried to take the impact on my left knee. Bad idea, as I tore a tendon in my knee. I saw a great orthopedist, Dr. Vince Dalton (http://www.vdaltonmd.com), who had me in surgery the next day. After eight weeks in a straight leg immobilizer I am almost walking normally again.
Over the Counter Allergy Medications
Hay fever, also known as allergic rhinitis, causes significant symptoms in most people, but these symptoms can be successfully treated with over the counter medications. The five primary symptoms of hay fever are:
• Runny nose or nasal congestion
• Sinus pressure
• Postnasal drip
• Itchy or watery eyes
Your choice of an over the counter allergy medication will depend upon the predominant symptoms you are experiencing. When choosing an over-the-counter allergy medication, it’s important to be aware of the different side effects associated with these drugs. If your symptoms persist longer than a week, you may want to see me to discuss other treatment options.
Why Do Allergy Symptoms Occur?
If you have an allergy to a substance, like pollen or animal dander, your immune system will be triggered when you encounter that substance, resulting in an exaggerated response. Your immune cells release histamine in an allergic reaction – histamine is a chemical produced by your body that circulates and binds to special receptors on your cells, causing a variety of reactions, like swelling of the blood vessels, itching, and increased production of mucus. Histamines can also cause hives, redness, and swelling.
Antihistamines are medications that block the histamine receptors on your cells, preventing activation in an allergic response. Antihistamines are the most commonly used medications for treatment of allergies, available in pills, nasal sprays, liquids, and eye drops. Antihistamines relieve the symptoms of an acute attack, but they work most effectively if you begin treatment before you expect to encounter allergens. This allows the medication to build up in your blood, preventing activation of histamines in an allergic reaction. If you plan to be out of doors and you know you’ll be exposed to plants or flowers that trigger your hay fever, you may want to begin taking an antihistamine before exposure.
Older antihistamines available over the counter commonly cause drowsiness and sedation because they work on all types of histamine receptors. In fact, one of the oldest antihistamines, diphenhydramine (Benadryl), is commonly used in over-the-counter sleep medications. Other older drugs include Dimetapp and Chlor-trimeton.
Other side effects associated with antihistamines include:
• Dry mouth
• Dry eyes
• Blurred vision
• Confusion (particularly in older people)
• Urinary retention
• Restlessness or agitation (particularly in children)
Newer generation antihistamines were developed to target the specific cell receptors involved in the allergic response, to reduce side effects.These medications have similar effectiveness to Benadryl or Dimetapp for treatment of allergic symptoms with less sedation, but they’re usually more expensive. Newer generation antihistamines available over the counter include:
• Cetirizine (Zyrtec)
• Fexofenadine (Allegra)
• Loratidine (Claritin, Alavert)
• Deloratadine (Clarinex)
• Levocetirizine (Xyzal)
Several newer antihistamines are available in extended release formulas to provide symptom control for 12 to 24 hours.
Antihistamine eye drops that are available over the counter include Visine-A, which contains pheniramine. Burning or stinging can be minimized by refrigerating eye drops before using them.
If you are having trouble breathing through your nose, consider using a decongestant to improve your symptoms. Decongestants shrink the swollen tissues and blood vessels in the nose to reduce congestion and production of mucus, which opens your nasal passages and improves your ability to breathe.
Oral decongestants like Sudafed and Afrinol contain pseudoephedrine, which is used illegally to make methamphetamine. As a result of new legislation, these drugs may no longer be readily available over the counter in all locations. In some areas, they are kept behind the pharmacy counter and purchase of a limited quantity is allowed with identification. There are also several combination medications available that contain both an antihistamine and a decongestant, including Claritin-D and Allegra-D.
Decongestants should be used cautiously, because they can have significant side effects, including:
• High blood pressure
• Increased heart rate
• Dry mouth
• Anxiety or restlessness
• Urinary retention
Do not use a decongestant if you have hypertension or glaucoma. If you have problems with urination, don’t use a decongestant without talking to your doctor.
Decongestant nasal sprays, including Neo-Synephrine and Afrin, contain phenylephrine, oxymetazoline, or tetrahydrozoline, and are widely available without a prescription. They work directly on the tissues in the nose and can be very effective for immediate relief of a stuffy nose. These sprays should only be used for three days or less, because long-term use can result in rebound congestion, creating a vicious cycle.
Steroids are often used in both prescription and over the counter forms to treat the symptoms of allergy by suppressing inflammation and swelling. Over the counter steroids are available as nasal sprays and topical skin creams. Nasal steroid sprays work best when taken on a daily basis to prevent allergic reactions, and they may not reach full effectiveness until a week or two after you begin therapy. They include the following:
• Fluticasone propionate (Flonase)
• Mometasone (Nasonex)
• Triamcinolone (Nasacort Allergy 24 Hour)
Creams with hydrocortisone can be purchased over the counter to treat allergic rashes from poison ivy or other exposures, although they have a lower concentration of active ingredient compared to prescription steroid creams.
Although systemic steroids have many potential side effects, they are only available by prescription. Topical steroid creams and nasal sprays that are available without a prescription are safe when taken as directed, but if your symptoms persist or worsen, you should see your doctor.
Mast cell stabilizers
When you have an allergic reaction, the mast cells in the immune system release chemicals that contribute to your symptoms. If antihistamines aren’t helping you achieve relief, you may want to consider a nasal spray with cromolyn, an over-the-counter mast cell stabilizer.
Other Over The Counter Remedies to Treat Allergy Symptoms
If you have congestion and mucus, nasal saline spray can be helpful to thin the mucous and keep your airways lubricated. If your eyes are red and itchy, artificial tears can be used for relief. Many find relief with frequent saline irrigation like you get using a neti pot. This can help reduce allergens in the nasal and sinus areas.
When to Call Me
Over the counter medications can be very effective, but they do have side effects and may interact with other medications or health conditions. Talk to your doctor before you take any over the counter medicine if you are pregnant or breast-feeding, if you’re taking other medications or supplements, or if you have a chronic health condition. Older adults should be especially cautious, as side effects can be pronounced. If your allergy symptoms become worse or if they don’t improve after a week or ten days, consider an evaluation by a healthcare professional. You may want to consider a prescription medication or even immunotherapy, if you are experiencing persistent or severe allergies.
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The information contained herein is not intended to be a substitute for professional medical advice, diagnosis or treatment in any manner, Always seek advice of your physician or other qualified health provider with any question you may have regarding any medical condition.