Spring Allergies & New OTC medications

Spring has definitely arrived in Northern California and our air has been filled with tree pollen for several months. You can tell by the sniffles and sneezes of the afflicted and you can also tell by the ads: TV spots selling remedies for drippy, congested noses, itchy eyes and other symptoms are everywhere. New this year: ads for Flonase, a nasal steroid spray that just became available over the counter. It joins Nasacort, a spray in the same class that went from prescription to over-the-counter status a year ago. And they both sit on store shelves next to antihistamines such as Claritin, Allegra and Zyrtec that were prescription drugs just a few years ago. Older over-the-counter antihistamines, such as Benadryl, and decongestants, such as Sudafed and Afrin, remain available as well. Don't expect the ads to help you sort out what might work best for you. Here's what you need to know about these non-prescription options.

Believe (some of) the hype about the newly-accessible steroid nasal sprays. These drugs work by fighting inflammation and they are in the single most effective drug class for treating nasal allergies. These are very effective medications that can help to prevent allergy symptoms, when used correctly. But that does not mean they work for everyone and they can cause side effects for some patients.

Possible side effects include nasal irritation and nose bleeds. Labels caution that some children using the sprays may experience slower growth, so a doctor should be consulted if a child needs them for more than a few months. Depending on your insurance coverage, you may have to pay more, because your insurer no longer covers the cost. For a number of patients, the nasal sprays that still require a prescription work better and/or have fewer side effects. Remember, there's a right way to use these sprays. They should be used daily during your vulnerable season or seasons, ideally starting before your symptoms do. The idea is to turn an army of inflammatory cells around before they recruit more soldiers. It's also important to administer the sprays correctly, so that they end up inside your nasal passages, without causing irritation. Antihistamines still have a role. These drugs target histamine. That's a chemical your body releases, causing sneezing, a runny nose and itchy eyes, when you come in contact with allergy-triggering substances. Antihistamines work faster than the steroid sprays, which can take a week or so to reach full effectiveness. They also can be cheaper, because they are available in generic store-brand versions. Antihistamines make perfect sense for someone who suffers a few sneezy days each season and doesn't want to use a spray for weeks or months. Look for one that does not make you sleepy. It's a myth that older, sedating antihistamines, such as Benadryl, are extra effective against nasal allergies.

Be careful with decongestants. Decongestants such as Sudafed work by shrinking swollen blood vessels in the nose. They can raise blood pressure and cause jitters and some people are more susceptible than others. Decongestant sprays such as Afrin — unlike the steroid nasal sprays — can be used for just a few days at a time because they are habit forming and can cause rebound symptoms. There are also a number of decongestant OTC eyedrops (such as Visine), which can be associated with similar side effects. It is therefore advisable to use these medications sparingly.

Make sure to keep us and your other medical providers in the loop. Over-the-counter treatments should not take the place of professional care — especially if you have never been formally diagnosed with allergies, if you have additional medical problems or if your symptoms persist or worsen. It is also important to consider the possibility of a potential drug interaction between medications you take for other medical conditions and common allergy medications. An allergist can test you to find out what's causing your symptoms and offer additional treatments which are usually more effective. Those include allergy shots and drops and, for a few patients who qualify, newer immunotherapy pills that desensitize people to grass and ragweed pollens.

If these over the counter products do not give you the relief you need or if you are experiencing side effects when you use them, please make sure to contact our office so that we can discuss with you some of the newer prescription products which have become available.

Given current climactic conditions, it is likely that pollen counts will remain high for the next several months. Let us do our best to help keep you and your family healthy so you can enjoy our beautiful California springtime.

Download April 2015 Newsletter (opens in PDF)