Allergy Medication - getting the facts...
Discover the truth about allergy medication, including oral antihistamines, nasal antihistamines, decongestants, and nasal sprays...
allergy medication is widely prescribed all over the world. While some of these medicines are available by prescription, there are many available over-the-counter. If you watch television or read magazines, you have probably seen some of the numerous ads for allergy related medication, since these products are often marketed toward the consumer directly.
In recent years there has been a great increase in the types of medicines available for those with allergies, as well as an increase in the number of allergy sufferers who take prescription medication. Currently, about 50% of those with allergies take prescription medication and 35% of those with allergies take over-the-counter medicine for relief. There is room for improvement, however. 65% of allergy doctors and physicians were only partially satisfied with the allergy medication available and more than half of allergists surveyed were prescribing more than one medication for their patients.
The medication we will discuss falls into four categories:
• oral antihistamines
• nasal antihistamines
• nasal sprays
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Oral antihistamines are the most commonly prescribed allergy medication. They relieve allergy symptoms by blocking histamine, the chemical “culprit” that causes many symptoms. Antihistamines are classified as H1 blockers and H2 blockers, depending on the type of receptors (on the surface of cells) that they act on. H1 receptors are associated with human tissue involving capillaries, and H2 receptors predominate in the lining of the stomach.
Antihistamines do not offer anything in terms of permanent relief, nor do they relieve nasal congestion. They temporarily relieve symptoms such as: sneezing, itching, nasal drainage, and hives. For an in-depth discussion about allergy symptoms, including a useful “symptom analyzer” tool, click here to visit our allergy symptoms section
The original antihistamines have drawbacks that include being short-acting, making it difficult to concentrate, and drowsiness. The major side effect of this allergy medication is drowsiness. Most of us think of histamine negatively, since we associate it with allergic reactions. However, histamine is actually a neurotransmitter which helps nerve cells communicate, thus allowing our brains to work properly. An “antihistamine,” therefore, would block the normal way our brains function.
The manufacturers warn patients who take this medicine to avoid activities in which you need to remain alert, such as: driving, operating machinery, and performing physically dangerous tasks. People who can not avoid these activities are advised to take this medication only at night. It is interesting to note that driving under the influence (DUI) applies to medication as well as alcohol. You can therefore be cited for DUI if you are driving while taking antihistamines!
Some of the older antihistamines include drugs such as:
• Benadryl (diphenhydramine)
• Chlor-Trimeton (chlorpheniramine)
This type of allergy medication causes several side effects. Aside from the drowsiness and inability to concentrate that we mentioned above, other side effects include: increased anxiety, nausea, loss of libido, depression, fatigue, loss of appetite, difficulty with urination, tremors, dry mouth, gastritis, and dizziness. Click here if you would like to learn about treating your symptoms without allergy medication.
Despite their side effects, many doctors feel that allergy medication such as Benadryl is important enough to be included in every medicine chest. Since Benadryl is effective, easily absorbed, and works quickly, it is an important medication to have if there are children in your family or in case of emergency situations.
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featured allergy medication - benadryl
Benadryl is an antihistamine that can relieve allergy symptoms such as: itchy, watery eyes; sneezing; runny nose; coughing; red eyes; and redness from hives and rashes. Benadryl also relieves itching from a variety of conditions, such as: insect bites, sunburn, bee stings, poison ivy, and poison oak.
Benadryl works by blocking the effects of histamine, a chemical that our body makes which can constrict air passages and cause inflammation. This type of allergy medication offers temporary relief from allergy symtoms; it doesn't cure, it simply suppresses symptoms.
Benadryl comes in the form of a tablet, capsule, and liquid. It is offered in a range of products, including:
• A non-drowsy formula that works up to 8 hours
• A non-drowsy formula that works up to 8 hours, with added decongestant
• A one-a-day formula
• A liquid formula for children as young as two years
• A cream or lotion for skin irritation
The usual adult dosage of Benadryl is 25 to 50 milligrams, 3 or 4 times daily. The sleep-aid dosage is 50 milligrams at bedtime.
The usual child dosage of Benadryl is 12.5 to 25 milligrams, 3 to 4 times daily. A child should not take more than 300 milligrams a day.
The most common side-effects associated with Benadryl are as follows:
• dry mouth, nose, and throat
• disturbed coordination
• upset stomach
• chest congestion
• excessive calm
This allergy medication should be used cautiously by people with glaucoma, peptic ulcer, urinary obstruction, enlarged prostate, asthma, chronic lung disease, an over-active thyroid, high blood pressure, or heart disease.
Benadryl may cause excitability in young children. Do not give Benadryl to children younger than 6 years of age unless directed to do so by your doctor.
People over 60 years of age are more likely to experience dizziness and low blood pressure.
This allergy medication may cause drowsiness.click here to learn more about benadryl
Second Generation Antihistamines
The newer antihistamines, or second generation antihistamines, are supposedly less likely to cause the drowsiness associated with the older medications, so they are often referred to as “nonsedating.” claritin has been recently made available over-the-counter, but most of the nonsedating antihistamines require a prescription. In general, if these newer antihistamines do not work well for a patient, doctors will then resort to the original, first generation antihistamines.
The newer, second generation antihistamines include:
• zyrtec (cetirizine)
• allegra (fexofenadine)
• clarinex (desloratadine)
• claritin (loratadine)
Click here to see the best antihistamines in a side-by-side comparison
featured allergy medication - zyrtec
xyrtec is one of the newer, second-generation antihistamines that are less likely to cause drowsiness and psychomotor impairment. Doctors prescribe this allergy medication to treat a wide variety of allergies, including: animal dander, mold, dust, hay fever, and skin conditions.
Zyrtec works by blocking the effects of histamine, a chemical that our body makes which can constrict air passages and cause inflammation. This type of allergy medication offers temporary relief from allergy symptoms; it doesn't cure, it simply suppresses symptoms.
Zyrtec comes in the form of a tablet and syrup to be taken by mouth. It usually is taken once a day and may be taken on a regular basis or when allergy season is most potent. Tablets are offered in 5 mg and 10 mg, while the syrup is labled 5 mg/5mL.
For adults 12 years and older, the typical starting dose is 5 or 10 mgs once per day.
For children 6 to 11 years of age, the typical starting dose is 5 or 10 mgs per day, or one to two teaspoons of syrup.
Zyrtec can be given to children as young as 6 months. Check with your doctor for the proper dosage.
The most common side-effects associated with Zyrtec are as follows:
• dry mouth
• abdominal pain (children)
• coughing (children)
• diarrhea (children)
• headache (children)
• nosebleed (children)
• sleepiness (children)
• sore throat (children)
• wheezing (children)
If you have kidney or liver disease, your dosage of Zyrtec may need to be reduced.
When taking Zyrtec, you should avoid drinking alcohol or taking sedatives, tranquilizers, sleeping pills, or muscle relaxants. Combining Zyrtec with these substances can lead to increased drowsiness and reduced mental alertness.
This allergy medication can cause drowsiness. Do not drive a motor vehicle or operate dangerous machinery until you know how your body reacts to Zyrtec.
This is a relatively new class of antihistamine, available by prescription, that is administered directly into the nose. The nasal antihistamine is steroid free and helps patients to be symptom free for up to 12 hours. The first allergy medication of this type is known as astelin (azelastine).
Some doctors feel that spraying this drug directly into the nose will increase concentration of the drug where it is needed and thus increase their patients' relief from allergy symptoms. The drug does, however, have side effects. It can cause headaches, sedation, and it has a bitter taste when the spray drips down from the nasal passages.
Dr. Andrew Lerrick, an otolaryngologist at Rush Presbyterian St. Luke’s Medical Center, explains that oral antihistamines are the most popular choice for treating allergy symptoms, but he feels that nasal antihistamines work better.
Dr. Lerrick cites a study in which patients used a nasal antihistamine called astelin (mentioned above) to treat symptoms of allergic rhinitis. Patients reported that the Astelin worked better than allergy medication they had taken previously. They also felt the Astelin helped eliminate their congestion and helped them to sleep better.
There is another nasal antihistamine that is awaiting FDA approval; it is currently undergoing clinical trials.
featured allergy medication - astelin
Astelin is an antihistamine with a difference. It is administered as a nasal spray that focuses allergy medication precisely where it is needed. Doctors prescribe Astelin for allergy symptoms, symptoms that are unrelated to allergies. Astelin can relieve hay fever symptoms, congested nasal passages, and post nasal drip.
Astelin works by blocking the effects of histamine, a chemical that our body makes which can constrict air passages and cause inflammation. This type of allergy medication offers temporary relief from allergy symtoms; it doesn't cure, it simply suppresses symptoms
Azelastine usually is sprayed in each nostril two times a day. Upon using this allergy medication for the first time, remove the child-resistant screw cap and install the pump. The pump unit must then be primed until a mist is visible.
For adults 12 years and older, the typical dose is 2 sprays into each nostril twice a day.
For children between 5 and 12 years of age, the usual dose is 1 spray in each nostril twice per day. In this age group, Astelin is not recommended for types of congestion other than hay fever symptoms.
The most common side-effects associated with Astelin are as follows:
• bitter taste
• loss of sensation
• nasal burning
• sore throat
Astelin can make some indivduals drowsy.
For those people with a kidney condition, their dosage of Astelin may have to be reduced.
The effects of Astelin change when it is taken with other drugs, such as alcohol, codeine, phenobarbital, Restoril, Tagamet, Nizoral, Benadryl, and Claritan.
Tell your doctor if your are pregnant, or if you become pregnant while using Astelin.
If you are scheduled for surgery, tell your doctor you are using Astelin.
This allergy medication can cause drowsiness. Do not drive a motor vehicle or operate dangerous machinery until you know how your body reacts to Astelin.
decongestants (oral & nasal)
Those of us who suffer from allergic reactions, or conditions like sinusitis, know that there is a definite need for decongestants. Our noses run, our sinuses become swollen, we can get a post nasal drip, and it becomes extremely difficult to sleep when suffering from these symptoms. Decongestants are available by prescription and over-the-counter, and they are sold in forms including pills, liquid, sprays, and drops.
This type of allergy medication is a stimulant that works by constricting the blood vessels that enter the nose, thereby reducing the fluid build-up that causes blockage in the sinus area. There are only two types of medication under the category of decongestants: psuedoephedrine an phenylephrine. There was a third type known as phenylpropanolamine, but it was recently banned by the FDA for causing bleeding in the brain.
Decongestants can be effective for treating the congestion caused by allergies such as hay fever (pollen allergy), but they are also used for viral nasal symptoms and sinusitis, where this medication helps to drain infected fluid in the nasal passages. This type of allergy medication, however, is not very helpful with symptoms such as sneezing, itching, and nasal secretions.
There are several types of allergy medication that are currently prescribed as decongestants. It is important to note that the current versions of these drugs do not contain phenylpropanolamine, the ingredient banned by the FDA. It is possible that you might have an older version of decongestant in your medicine chest. If you do, throw it out. I personally found the old version of Entex in my medicine cabinet; since I was aware of the FDA ban on one of its ingredients, I promptly disposed of this particular bottle.
Decongestants that are currently on the market include the following:
• Atrohist Plus
Decongestants are known to have side effects that you should be aware of. Unlike antihistamines which cause drowsiness, this type of allergy medication can cause insomnia. Since antihistamines and decongestants have side effects that counteract each other, it can be a good idea to take them together. Perhaps this is why many patients find the combined allergy medication, the ones that contain both antihistamine and decongestants, so effective and convenient to use.
It is a good practice, therefore, to take this medicine several hours before going to bed. Other side effects of the decongestants include: nervousness, difficulty with urination, headaches, and elevated blood pressure.
Patients are not advised to take decongestants if they have conditions such as: enlarged prostate, heart diseases, glaucoma, diabetes, or if they are taking certain types of antidepressants.
There is an important caution about nasal decongestants. A “rebound effect” that can occur when nasal decongestants are used for more than two or three consecutive days. When the rebound effect occurs, your nasal congestion can actually become worse than it was before you started using the nasal decongestant. This condition is known as “rhinitis medicamentosa,” and it cautions us not to abuse this type of allergy medication.
featured allergy medication - sudafed
sudafed is a decongestant that can provide relief from sinus congestion caused by allergic reaction, hay fever, irritated sinuses, and the common cold. Sudafed can also relieve ear congestion caused by infection.
pseudoephedrine works by shrinking blood vessels in the nose, lungs, and mucus membranes. Since blood flow to the nose and other areas is decreased, this allergy medication decreases congestion, allowing airways to open up.
Range of Products
sudafed is offered in a range of products, including: Sudafed 12 Hour, Sudafed Sinus and Allergy, Sudafed Cold & Cough Liquid, Sudafed Sinus & Cold, Sudafed Nasal Decongestant, Sudafed 24 Hour Tablets, Sudafed Non-Drying Sinus, Sudafed Severe Cold Formula, Sudafed Sinus Headache, Sudafed Sinus Nighttime, Sudafed Nighttime Plus Pain Relief, Children's Sudafed Cold & Cough, Children's Sudafed Nasal Decongestant, and Children's Sudafed Nasal Decongestant Chewables.
Dosage - Sudafed Nasal Decongestant
For adults 12 years of age and older, take 2 tablets every four to six hours.
For children 6 to 12 years of age, take 1 tablet every four to six hours.
The most common side effects associated with Sudafed include the following:
• pounding heartbeat
• difficulty with urination
• trouble sleeping
It is necessary to contact your doctor if you have any of the following conditions: heart problems, kidney disease, liver disease, lung disease, seizures, enlarged prostate, glaucoma, diabetes, overactive thyroid, high blood pressure, or emphysema.
Contact your doctor if you are pregnant or become pregnant while using Sudafed.
Contact your doctor if you plan to use Sudafed while breast-feeding.
Contact your doctor if you are taking any of the following medication: sleeping pills, MAO inhibitors, tranquilizers, high blood pressure medication, muscle relaxants, or medication for depression.
nasal sprays (nonsteroid types)
The primary allergy medication in nonsteroid nasal spray is called cromolyn sodium (brand name, Nasalcrom). It is a medication that is considered to be so safe that it can be used by pregnant women. Cromolyn works by interfering with the release of histamine, so it is a good preventative agent for allergy symptoms. A side effect of cromolyn is that it can cause a slight irritation to the nose.
To benefit from Cromolyn’s antihistamine effects, patients should start taking this drug several weeks before allergy season begins. The beneficial effects of this drug are not the same for everyone, so the only way you will know how well it works for you is to try it. To help make nasal sprays work better, it is advisable to rinse your nose with a saline solution before using the spray. This cleans the nasal passages, removing mucous and helping the medicine contact the lining of the nose.
Nonsteroid nasal sprays are available by prescription and over-the-counter. Aside from Nasalcrom, some other nasal sprays in this category include:
nasal sprays (steroid types)
Steroid type nasal sprays appear to be a more effective, complete allergy medication because they counteract a greater variety of symptoms, including: congestion, post nasal drip, itching, and sneezing. There are, however, side effects that we will discuss below.
Steroid nasal sprays decrease inflammation, opening the nasal passages so breathing through the nose is easier. These drugs also work by inhibiting histamine, cytokines, leukotrienes, basophils, and mast cells. They are not readily absorbed into the bloodstream, so they cause fewer side effects than oral steroids.
Nasal sprays of the steroid variety that are used for treating allergies include:
• Nasacort (trimcinolone acetonide)
• Nasonex (mometasone)
• Flonase (fluticasone)
• AeroBID (flunisolide)
• Pulmicort (budenoside)
• Beclovent (beclomethasone)
Side effects from the use of steroid allergy medication should be monitored closely by your physician. One side effect that can be caused by repeated use of steroid nasal spray is perforation of the nasal septum, or the bone and cartilage dividing the nostrils. Other side effects include:
• nasal ulcers
• weight gain
• mood disorders
• hoarseness (from inhaled steroid medication)
• yeast infections of the throat (from inhaled steroids)
• Interference with bone growth (this affects children)
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Krohn, Jacqueline. Allergy Relief & Prevention. Vancouver, B.C.: Hartley & Marks Publishers Inc., 2000.
Kwong, Frank & Cook, Bruce. The Complete Allergy Book. Naperville, Illinois: Sourcebooks, Inc., 2002.
Pescatore, Fred. The Allergy and Asthma Cure. Hoboken, N.J.: John Wiley & Sons, Inc., 2003.
Young, Stuart; Dobozin, Bruce; & Miner, Margaret. Allergies: The complete guide to diagnosis, treatment, and daily management. Yonkers, New York: Consumer Reports Books, 1991.