This section is intended to complement the presentation you might have heard Dr Morgan give on this topic.
Over the past few decades, many medicines used to treat allergic conditions have become available over the counter. Previously, a prescription was necessary for almost all of these medicines.
A secret is even many health care authorities (doctors, nurses, etc) do not have all the knowledge necessary to pull the best choice off the medicine shelf. You are referred to the terms and conditions to reinforce that the following is not a substitute for a doctor’s medical advice. This might serve, however, as a useful supplement to the advice Dr Morgan has given you after directing you to buy a treatment over the counter.
One key point is that allergy medicines are safe and effective for those suffering from mild and sometimes moderate allergic diseases. Medicines are unable to adapt their beneficial effects to high levels of severity. For this reason, allergy medicines typically fail to work for those with severe allergies. More advanced treatments such as desensitization would then be required.
Just about everyone has heard the word antihistamine, as well as names of common ones. But how do they fit in to treatment of allergies?
Keep in mind antihistamines are very safe medicines but at the same time can have only a smaller degree of effectiveness. Those who strongly prefer medicines taken by mouth would probably first try these medicines. The following table lists current over the counter antihistamines.
The following table reviews just a few of the differences among antihistamines. As you can see, choosing the right one can be complicated.
| Med | Sleepy? | Duration | Comments |
|---|---|---|---|
| Fexofenadine (Allegra) | Zero (does not cross blood-brain barrier) | Roughly 16 hr | Probably safe in pregnancy, but others have better ratings |
| Loratadine (Claritin) | Rare | Longer than fexofenadine but not quite 24 hr | Similar to desloratadine |
| Levocetirizine (Xyzal) | Minimal | May reach 24 hr | Similar to cetirizine |
| Cetirizine (Zyrtec) | Occasional | May reach 24 hr | Similar to levocetirizine |
| Diphenhydramine (Benadryl) | Common (including subtle sedation) | Usually not more than 6 hr | Less preferred in most situations |
Nasal sprays are more recently available medicines compared to antihistamines. By now they are also widely known to the public.
Anti-inflammatory steroids are the active ingredient... but aren’t they harmful? The key is these are topical steroids, meaning the medicaion is designed to have its effect on a surface and not absorb into the rest of the body. The amount of medicine can then be very small. These factors make steroid nasal sprays safe even for long-term use.
Overall, nasal steroid sprays are a more aggressive treatment than oral antihistamines. A little known fact is that when a nasal spray is working well, its benefits include most of the effects of an oral antihistamine. Therefore, there is not usually more improvement from taking both together.
Adding to the complexity of choosing the right nasal spray, recall there are also a number of useful prescription sprays with yet further different features!
| Med | Claim to Fame | Comments |
|---|---|---|
| Fluticasone dipropionate (Flonase) | Most widely used and known | Alcohol suspension has rosy smell and can be drying or irritating for some |
| Fluticasone furoate (Flonase Sensimist) | More potent but also softer mist spray | No smell or taste and more ergonomic side actuator |
| Mometasone (Nasonex) | Similar potency to fluticasone DP | Most recent addition to OTC steroid sprays |
| Triamcinolone acetonide (Nasacort) | Reputed to be mildest spray | Less potent but therefore also better for milder nasal allergies |
| Budesonide (Rhinocort) | Smallest possible spray volume is not drippy | Best in pregnancy, according to legacy rating system |
Other medicines could be filed as a miscellaneous category. Some of these are highly popular and well known. But, in cases of allergic disease other than mild, their correct usages are actually very narrow and limited.
| Med | Purpose | Comments |
|---|---|---|
| Guaifenesin (Mucinex) | Thin (but not decrease) secretions | Effect might be small or due to other active ingredients |
| Pseudoephedrine (Sudafed) | Short-term for stuffy nose (but no other nasal symptoms) | Behind the counter (quantity restrictions) |
| Phenylephrine | Short-term for stuffy nose only (as above) | Reputed to be somewhat less effective than pseudoephedrine |
| Oxymetazoline (Afrin) | Very short-term for stuffy nose | Danger of “addiction” with rebound stuffiness on withdrawal if used too many days |
| Ketotifen (Zaditor) | Treat eye allergies | Comparable to safe and effective prescription antihistamine eye drops |
| Naphazoline (Visine) | Very short-term for red eyes | Also subject to “addiction” and, as decongestant, does not treat other allergy symptoms |
Now we must keep all these medicines in mind as well as the interplay of their distinct features to choose a regimen to take.
One approach is to divide nasal allergies into component symptoms. Usually, we can consider 4 “cardinal” symptoms. The following 4 miserable sufferers illustrate these symptoms for us.
Truly putting it all together, we can then match the usual beneficial effects of various medicines to each of these nasal symptoms.
| Med | Stuffy Nose | Runny Nose | Sneezing/Itchy Nose | Itchy Eyes |
|---|---|---|---|---|
| Oral Antihistamine | ||||
| Steroid Nasal Spray | ||||
| Decongestant (Oral or Spray) | ||||
| Eye Drop Antihistamine |
Hopefully this gives some idea of the considerations that go into choosing the best over the counter allergy medicines. Even though consumers enjoy a huge variety of useful medicines over the counter, having the knowledge to make the best choices is quite another matter!
Does Dr Morgan use this kind of pattern recognition to devise medicine regimens? Well, yes, but keep in mind there are many useful prescription medicines as well as even more sophisticated treatments like allergy shots to consider also.
Finally, as in life in general, sometimes there is more than one right choice, or the right choice for the same person can change over time depending on other circumstances.
Thank you for visiting www.lasvegasallergy.com!