In a recent publication on the Cleveland Clinic website, Dr. Frank J. Eidelman, MD, MBA, FAAAAI, offers some helpful tips to manage spring allergies. Dr. Eidelman remarks that one out of five individuals have some type of allergy, and the intensity can range from very mild to severe. He also notes that individuals with mild allergies typically do not experience allergy issues to the extent that it affects their day-to-day routines. In those people, when appropriate, they may elect to use an OTC allergy medication, as needed.
In the article, Dr. Eidelman, says, “But as you get further along that spectrum, the severity of the illness can become disabling. People feel very sick, they can’t get out of bed, they can’t sleep — it can be intense. So, it all depends on where they are on that spectrum of intensity.”
Dr. Eidelman indicates that some patients with allergies report a significant impact on quality of life and may experience symptoms such as itchy, swollen, and watery eyes, nasal congestion, repetitive sneezing, and, if the patient has asthma, their lungs can become irritated. He also notes that some people have trouble going to work or school and often feel tired due to sleep disturbances from allergy symptoms.
In the article, Dr. Eidelman says that many of the best nasal medications are now available OTC. He adds that the options fall under a few different categories, such as antihistamines, including older antihistamines, or first-generation antihistamines like diphenhydramine, which are usually sedating. Dr. Eidelman advises consumers to use caution when using diphenhydramine because of its sedating effects.
He adds, “Studies have shown that when people who think they’re not sedated are put in a driving simulator, their reaction times are slower. And when left in a quiet room, these people fall asleep quickly. It’s very deceiving. You might think the medication isn’t affecting you, but you’re compensating in some way and when you’re put to the test, you may not function well. Also, it depends on your age. As you get older, the effects are more profound.”
He also mentions second-generation antihistamines, including medications like loratadine, fexofenadine, and cetirizine, which are generally much less sedating or nonsedating. Other OTC medications mentioned include decongestants and nasal sprays for relief of nasal congestion, sinus pressure, and postnasal drip. He advises that patients with hypertension and cardiovascular issues avoid the use of decongestants. Moreover, Dr. Eidelman notes that pseudoephedrine is effective in relieving congestion and can be found as a single product or in a combination medications with antihistamines, but these are also associated with adverse effects that are more pronounced in older individuals. The allergy expert mentions that a better choice would be a topical nasal steroid such as fluticasone, budesonide, mometasone, or triamcinolone.
With regard to this drug class. Dr. Eidelman states, “Topical nasal steroid sprays are the gold standard for moderate to severe nasal allergies. They work well, but the thing to keep in mind is that they don’t have an immediate effect. That’s the downside.”
Dr. Eidelman also remarks that some of the clinical benefits associated with nasal steroid sprays is that they do prevent a lot of allergy symptoms by thwarting inflammation, and topical nasal steroids are nonsedating and typically do not have adverse effects, but you have to use them every day. Finally, the allergy expert notes that if one does not see relief after using OTC allergy drugs, one should consider seeing an allergy doctor to discuss allergy immunotherapy.
Patients with allergy issues who have preexisting medical conditions and/or taking other medications who elect to use OTC allergy medications should always consult their pharmacist or primary healthcare provider before taking these products to ensure that there are no possible drug-drug interactions or contraindications. Additionally, Dr. Eidelman recommends that individuals with tree pollen or plant allergies avoid the use of herbal remedies for allergies.
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