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pharmacy

Best defense for allergies is Plan Ahead
Pharmacy With the start of spring comes the start of seasonal allergies. Frequently called hay fever, seasonal allergic rhinitis affects nearly 36 million people in the United States and accounts for over $3 billion in medication and physician bills. Hay fever is triggered by allergens such as pollens or molds and is characterized by sneezing, watery eyes, nasal congestion, and itching.

There are three major groups of medications that are used to treat hay fever. These include antihistamines, decongestants, and nasal sprays.

Over the counter (OTC) antihistamines like Benadryl®, Chlortrimeton® and generic equivalents have been the “gold standard” for classic allergy symptoms for years. They are inexpensive and provide superior relief of symptoms such as watery eyes, runny nose and itching. However, they do not provide relief of congestion and they have many side effects that can be bothersome, inconvenient, and dangerous. The traditional antihistamine, diphenhydramine, the active ingredient in Benadryl®, can cause, among other effects, drowsiness. It is highly sedative (because of this, diphenhydramine is the active ingredient in many over-the-counter sleep aids). The medication can impair one’s ability to drive and function normally and elderly people should use it with caution because of the increased risk for falls. Paradoxically, diphenhydramine can cause excitability in pediatric patients and therefore may not be the best choice when the need for an antihistamine is warranted.

There is an alternative nasal spray, available OTC. Unlike steroid, it reduces the allergic response prophylactically Because of the troublesome side effects associated with the classic antihistamines, second generation antihistamines have been developed. Loratadine (the active ingredient in Claritin® and Alavert®) is now available over the counter. Allegra, Clarinex and Zyrtec are available only by prescription but are expected to have over-the-counter status in the next few years. While these may have fewer side effects, they may also be less effective and cost more.

Decongestants are also useful in treating allergy symptoms. Sudafed® or pseudoephedrine, is the most common decongestant and will relieve the “stuffiness” associated with hay fever. Oral decongestants can cause a rise in blood pressure, so caution must be taken for those with a history of hypertension. Combination antihistamine and decongestants are available and offer the convenience of twice daily dosing. Examples include: Claritin D® (available without a prescription, but behind the counter), and Allegra D® and Zyrtec, which are available by prescription only.

If antihistamine and/or decongestants are not sufficient in relieving symptoms, nasal sprays might help. These typically contain a decongestant or a steroid. Decongestant nasal sprays such as Afrin® provide immediate relief, but their use should be limited to no more than three days due to the side effect of “rebound congestion” which can be worse than the initial congestion. More useful for the symptoms of sneezing and runny nose associated with seasonal allergies are the nasal steroids. Flonase®, Nasacort®, Nasonex® and Rhinocort® are some of the more common ones. These are very important in nasal allergy treatment because they have little or no side effects, can be used long term if necessary, and are safe to use in children. Unfortunately, here in the United States, they are available only by prescription and can be expensive.

However, there is an alternative nasal spray, available OTC, which can be considered. It is called Nasalcrom® (cromolyn sodium). Unlike steroid sprays, it reduces the allergic response prophylactically. In other words, you need to use it BEFORE an allergic reaction. If it is started during allergy season, it may take up to two to three weeks for maximum effectiveness. So when it comes to allergy season, it’s just best to plan ahead!

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"Best defense for allergies is Plan Ahead"
   authored by:
PHARMACY
Tamara Dulin, R.Ph., is a registered pharmacist with Nightingale Home Health Care in Carmel, Indiana. A 1991 graduate of Butler University College of Pharmacy, she has spent the majority of her career in consulting. She is a past president of the Ind...



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