Over-the-counter medications may ease allergy woes
By Capt. Jennifer Wang, 375th Medical Group
/ Published May 15, 2013
SCOTT AIR FORCE BASE, Ill. -- Allergic rhinitis, also known as hay fever, is one of the most common chronic conditions worldwide. An estimated 16.9 million adults and 6.7 million children suffered from seasonal allergies in 2011. The healthcare costs associated with treating these individuals are as high as $5.5 billion per year.
Typically, seasonal allergies are caused by pollen producing trees in the spring, grasses in the summer, and weeds in the fall. Indoor triggers such as dust mites, pet dander, and cockroaches may contribute to year-round allergy symptoms.
Allergic rhinitis is the inflammation of the nasal passages, and results from our immune system's heightened reaction to the triggers mentioned above. Symptoms include sneezing, runny nose, congestion, itchy and watery eyes. These symptoms may range from being mildly annoying to severely impacting day-to-day life.
The goals of treatment are to control symptoms while improving quality of life. A variety of over-the-counter medications are available for self-treatment, and are easily accessible in the local stores.
Oral antihistamines are often considered the first-line agents for the treatment of seasonal allergies. They help relieve itching, sneezing, and runny nose, but have little effect on nasal congestion.
What can you expect to find in the OTC section of a store? Diphenhydramine (Benadryl), chlorpheniramine (Chlorphen), and clemastine (Tavist) have been available as OTC medications for years. They are generally well tolerated, but drowsiness is the most common side effect. In addition, they may cause dry mouth, difficulty urinating, and constipation.
Medications like loratadine (Claritin), cetirizine (Zyrtec), fexofenadine (Allegra) are generally non-sedating agents. They have fewer side effects, but are more expensive. With the availability of generics on the market, these OTC medications are now more affordable.
Which group of antihistamines is better? The World Health Organization now recommends non-sedating antihistamines as the preferred agents based on their safety profile, how well they work, and convenient once-daily dosing.
Oral decongestants like pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE) are ideal for targeting nasal congestion associated with allergies. Oral decongestants may cause loss of appetite, sleeplessness, and elevated blood pressure. Taking pseudoephedrine in the morning can offset sleeplessness associated with its use. Despite the risk of increased blood pressure, it's generally safe to use in patients with controlled high blood pressure.
Studies have shown that oral decongestants, in combination with antihistamines are more effective in treating allergy symptoms than either agent alone. Available products combining an antihistamine and pseudoephedrine are Claritin-D, Zyrtec-D, and Allegra-D.
In an effort to avoid methamphetamine abuse, medications containing pseudoephedrine are considered controlled substances and are only available behind the counter (e.g. Sudafed, Claritin-D, Zyrtec-D, Allegra-D). They are available in the local pharmacies without a prescription, but have quantity limitations. A signature and identification are required for the purchase of these products. How does this affect the patients at this facility? Since all medications obtained at this facility require a written prescription or electronic order entry, these medications will be processed according to controlled substance regulations.
In addition to oral decongestants, there are also nasal decongestant available over-the-counter. Oxymetazoline (Afrin) is suitable for providing fast and short-term relief of nasal congestion. It does not help with sneezing, itching, or runny nose. Most importantly, it should only be used for three days because of its potential to worsen congestion if used long-term.
Neti pots have gained popularity as one of the alternative options for treating nasal allergy symptoms. The active ingredient saline is safe to use and relatively inexpensive. Studies have shown reduction in allergy symptoms after three to six weeks of usage.
With the allergy season fast approaching, what's the bottom line when you need to choose an OTC product? Oral antihistamines are first line. An oral decongestant can be added in the case of severe nasal congestion. Products containing pseudoephedrine are controlled substances, and can be purchased behind the counter in a local pharmacy or obtained with a valid prescription for up to 180 days of medication at this facility. Nasal decongestant spray provides fast relief but is for short-term use only. Nasal saline is a proven safe, and inexpensive alternative alone or in conjunction with other medications for treating seasonal allergies.