ALLERGY AND HAYFEVER

If you suffer from an itchy and runny nose, watery eyes, sneezing, and a tickle in the back of your throat, then you probably have an allergy. An allergy means a hypersensitivity to a particular substance called an allergen. Hypersensitivity means that the body’s immune system, which defends against infection, disease, and foreign bodies, reacts inappropriately to the allergen. Examples of common allergens are pollen, mold, ragweed, dust, feathers, cat hair, makeup, walnuts, aspirin, shellfish, poison ivy, and chocolate.

There are four common types of allergic responses, although many substances can cause more than one type of response in a given person:

• Itchy and runny nose, watery eyes, sneezing, and a tickle in the back of your throat. This type of allergy is sometimes called allergic rhinitis and is commonly caused by exposure to allergens in the air, such as pollen, dust, and animal feathers or hair. It is called hay fever when it occurs seasonally, in response to ragweed in the fall.
• Hives or other skin reactions. These commonly result from something you eat or from skin exposure to an allergenic substance, such as poison ivy or chemicals. Allergic skin reactions may also follow insect bites or an emotional disturbance.
• Asthma.
• Sudden, generalized itching, rapidly followed by difficulty breathing, and possible shock (extremely low blood pressure) or death. This rare and serious allergic response, called anaphylaxis, usually occurs as a response to certain injections (including allergy shots), drugs (including antibiotics such as penicillin and many arthritis drugs such as celecoxib [CELEBREX]), and insect bites as from a bee or wasp. This reaction may become increasingly severe with repeated exposures. Anaphylaxis is a medical emergency requiring an immediate trip to an emergency room, clinic, or doctor’s office. If you are likely to have an anaphylactic response to an allergen, such as a bee sting, in a locale where medical attention may be out of reach, you should obtain a prescription from a doctor for an emergency kit containing injectable epinephrine to keep with you, and learn how to use it.

How to Treat Allergic Symptoms

The best way to treat an allergy is to discover its cause and, if possible, to avoid the substance. Sometimes this is easy, but in many cases it is not. If, for example, your eyes swell, your nose runs, and you break out in hives each time you are around cats, avoid cats and you have solved your problem.

If, however, you sneeze during one particular season (typically, late spring, summer, or fall) each year or all year round, there is not too much you can do to avoid the pollens, dust, or grass particles in the air. Some people find relief in an indoor retreat where it is cooler, closed, and less dusty, but this is not always possible.

If you can’t seem to figure out the cause of your allergy, have tried eliminating most of the common allergens from your environment, and are still suffering significant discomfort, you may have to see your doctor or another health professional. It is possible that you may be an appropriate candidate for skin testing and may be referred to a doctor specializing in allergies.

Beware of the allergist who sends you home with a long list of substances to avoid because they gave positive patch tests. Even if you avoid all of them, you may be left with your allergy if none of the substances on the list is the particular one responsible for your symptoms.

When identifying the cause of your allergy is not possible, you may choose to treat the symptoms. Allergy symptoms are caused primarily by the release of a chemical in your body called histamine, and a class of drugs known as the antihistamines is the most effective initial treatment available. We recommend that you use antihistamines in a single-ingredient preparation to treat your symptoms. Another choice are the steroid-containing nasal sprays.

Allergic rhinitis should not be treated with topical nasal decongestants (drops, sprays, and inhalers) that are recommended for treating the temporary stuffy nose of a cold. Allergies are long-term conditions, lasting for weeks, months, or years, and use of these topical decongestants for more than a few days can lead to rebound congestion (an increase in nasal stuffiness after the medication wears off) and sometimes permanent damage to the membranes lining the nose. If you think your congestion is caused by allergies, don’t use an OTC nasal spray, or you may eventually find that you cannot breathe through your nose without it.

Drugs for Allergy

Antihistamines: Of all the products sold for allergy, we recommend that you use a single-ingredient product containing only an antihistamine. Antihistamines are the most effective ingredients you can buy for treating an allergy, and you will minimize the adverse effects by buying the single-ingredient formulation.

A major adverse effect of antihistamines is drowsiness. If they make you drowsy, you should avoid driving a motor vehicle or operating heavy machinery while taking these drugs. Even if they don’t make you drowsy, they may still slow your reaction time. Additionally, keep in mind that drowsiness is increased dramatically by adding other sedatives, including alcoholic beverages.

The amount of drowsiness produced by an antihistamine differs depending on the person who takes it and the antihistamine that is used. Of antihistamines classified by the FDA as safe and effective for OTC use, those causing the least drowsiness are chlorpheniramine maleate, brompheniramine maleate, pheniramine maleate, and clemastine. For daytime use, we urge you to use one of these.

Other FDA-approved antihistamines causing a great deal of drowsiness include diphenhydramine hydrochloride and doxylamine succinate, which are the ingredients in some currently available OTC sleep aids.

The advent of the less sedating but dangerous prescription antihistamines, the first of which were astemizole and terfenadine, now banned, has lessened the tendency of physicians and patients to use the lowest possible dose of the older, less expensive, and safer antihistamines such as chlorpheniramine maleate, the active ingredient in Chlor-Trimeton and dozens of other prescription and over-the-counter allergy medicines. By trying a lower dose, you may find that you significantly reduce the sedating effects. There are now other, less dangerous nonsedating antihistamines on the market.

Another common adverse effect of antihistamines is dryness of the mouth, nose, and throat. Other less common adverse effects include blurred vision, dizziness, loss of appetite, nausea, upset stomach, low blood pressure, headache, and loss of coordination. Difficulty in urinating is often a problem in older men with enlarged prostate glands. Antihistamines occasionally cause nervousness, restlessness, or insomnia, especially in children.

For antihistamine treatment of allergies, your first choice should be a low dose of chlorpheniramine in an OTC single-ingredient product such as Chlor-Trimeton. Check the label and be sure that nothing else is in the product. Chlor-Trimeton Decongestant and Dimetapp both contain an additional ingredient that is not necessary for the treatment of allergy. Less expensive store brand or generic equivalents are often available and should be purchased if possible. If you can’t find them, ask the pharmacist.

You should not use antihistamines for self-medication if you have asthma, glaucoma, or difficulty urinating due to enlargement of the prostate gland.

Nasal decongestants: Many over-the-counter products sold for allergies contain amphetamine-like nasal decongestants, such as pseudoephedrine hydrochloride or ingredients found in many oral cold preparations (see earlier discussion on oral decongestants for colds). Some of these adverse effects and adverse reactions (such as jitteriness, sleeplessness, and potential heart problems) occur even more frequently when they are used to treat allergies, because allergy medication is usually taken for a longer period of time than a cold remedy is.

More to the point, nasal decongestants do not treat the symptoms most frequently experienced by allergy sufferers: the runny nose, itchy and watery eyes, sneezing, cough, and the tickle in the back of the throat. They treat only a stuffy nose, which is not the major problem for most allergy sufferers.

Examples of OTC nasal decongestants that are labeled to treat symptoms “without drowsiness” (since they do not contain antihistamines) include Afrinol and Sudafed. We do not recommend the use of these products for allergies.

Combination allergy products: As usual in the OTC market (particularly in the cold and allergy area), most products available are fixed-combination products using a “shotgun” approach to your ailment. The majority of allergy combination products contain antihistamines and nasal decongestants; some also contain pain relievers. We do not recommend any of these for self-treatment.

It is our opinion that nasal decongestants should not be used for allergy symptoms that are appropriate for self-treatment. The likelihood of adverse effects is increased by taking a combination product, and decongestants are seldom useful for allergy symptoms.

Examples of OTC combination drugs for allergy, which we cannot recommend, are Actifed Cold & Allergy Tablets, Chlor-Trimeton Allergy-D 12 Hour Tablets, and Drixoral Cold & Allergy Tablets. Many of the combination cold products that we urge you not to use are also marketed for allergic symptoms and hay fever. We do not recommend using any of these products for allergies either.