In the last two articles, we explored various triggers for allergic rhinitis and how to avoid them. In this article, we will look at different treatment modalities that are available to treat nasal allergies.
Histamine is a chemical that is released in your body following allergic reactions. It causes allergic symptoms. Antihistamines block the effects of histamine. Antihistamine tablets are effective in relieving symptoms such as itchy eyes, nostrils and skin, runny nose and sneezing. They are not effective in controlling nasal congestion and stuffiness.
Older antihistamines such as Benadryl, hydroxyzine (Atarax) and Chlor-Trimeton are effective but can cause significant sedation and tiredness in some people. A study looking at the effectiveness of Benadryl concluded that it could hinder driving similar to alcohol and could slow down your reflexes while driving.
Some states consider driving with antihistamines on board as driving under the influence, which is a punishable offence. Therefore, do not drive or handle machinery after taking antihistamines, especially if they cause sedation.
Another common complaint with antihistamines is that previously effective doses of antihistamines are no longer effective, and patients believe that they have become "immune" to them. There is no scientific evidence to support this notion.
Antihistamines can also cause dryness of mouth and eyes. If you already suffer from these complaints, you should avoid taking antihistamines. In older men with enlarged prostate, antihistamines sometimes could cause worsening of urinary block and make it difficult for them to urinate. However, newer antihistamines such as fexofenadine (Allegra), Clarinex (Desloratadine) and loratadine (Claritin or Alavert) are tolerated better by most patients.
Medications such as Cromolyn (Intal) and Ketotifen (Zaditor) prevent release of histamine in the body during allergic reactions. They are safe. However, they are weak in their effectiveness, have to be taken 3-4 times daily and their usefulness may not become obvious for up to two weeks after starting treatment.
For these reasons, they are not often recommended by doctors. Afrin and other OTC decongestant nasal sprays are immediately effective. However, prolonged use (for more than four days) could make them addictive and causes a condition known as Rhinitis Medicamentosa, where your nasal symptoms get worse instead of better with their continued use.
Therefore, they should be avoided if you intend to use them over long periods of time. Similarly, nasal decongestant medications such as pseudoephedrine (Sudafed) and phenylephrine sold over the counter are effective immediately when used; they could cause anxiety, nervousness, tremors, sweating, urinary retention and palpitations, elevation of blood pressure and eye pressure and difficulty sleeping.
Therefore, you should avoid such medications if you have anxiety, hypertension, glaucoma, heart disease and urinary retention. The side effects equally apply to Claritin-D, Zyrtec-D and Allegra-D.
Phenylpropanolamine is another decongestant medication that is no longer available in this country. It caused hemorrhagic stroke in older female patients.
New kids on the block
Newer medications such as Singulair (Montelukast) and Accolate (Zafirlukast) are used for treatment of allergic rhinitis and asthma. Since 90 percent of asthma in children and 50 percent in adults are allergy induced, they are often effective when you have both conditions.
Recently, Singulair hit the headlines because of the FDA concern about its potential for causing anxiety, depression, hand tremors and suicidal tendencies. These allegations are largely unproven but warrant closer scrutiny. Until more information becomes available, consult with your doctor if you are concerned about these issues and you are taking one of these medications.
Accolate also has the potential to cause liver damage, so monitor your liver function every six months at least if you are taking the medication. You must report to your doctor if you develop yellow jaundice, pale stools, dark urine and nausea, vomiting, stomach pain and loss of appetite while taking Accolate (Zafirlukast).
Steroid nasal sprays
Intranasal corticosteroid sprays (fluticasone, Flonase, Nasacort AQ, Rhinocort Aqua, Nasonex and Omnaris) are available by prescription only. They are safe. They do not cause addiction. In fact, they have to be used daily to exert any benefit and benefits may not be obvious for up to seven days after beginning treatment! Some are approved for use even in young children because of their excellent safety profile!
A study in England showed that nasal corticosteroids do not cause cataracts. If used correctly (pointing to ears with your head looking down), their tendency to cause nosebleeds can be reduced. Occasionally, they can cause headaches. Consult your eye doctor if you have glaucoma before using them.
Intranasal corticosteroid sprays are effective if you have nasal congestion and stuffiness as main complaints. Their regular use with Sinus Rinse may help with your snoring and sleep apnea.
In the next and final article, we will discuss allergen immunotherapy (allergy injections).
Natarajan Asokan, M.D., F.A.A.P. is a board-certified allergist and immunologist and a board-certified pediatrician with more than 25 years of experience as a physician and 10 years of experience as a practicing allergist and immunologist. He treats adults and children with various allergy and immunology problems. He can be reached at 1739 Beverly Ave., Suite 118, Kingman, AZ 86409, (928) 681-5800, or www.trinityallergy.com.