Medication is the most common way to deal with allergies. It is important to understand how the different types of medications work and when to use them. There are six basic types of medications to control your allergies.
Antihistamines: There are many types of prescription and over-the counter antihistamines (eg., Clarinex, Allegra, Benadryl, Xyzal, and Zyrtec). Antihistamines should be used as needed to control allergy symptoms such as itchiness, drainage, sneezing, and congestion. Antihistamines have no long-term benefit so do not need to be taken when you do not suffer from allergy symptoms. Aside from medications that you take by mouth, some antihistamines may be applied directly to the eyes (eg., Pataday, Optivar) control itchy, watery eyes or to sprayed into the nose (eg., Astelin, Astepro) to address nasal itchiness and congestion. Antihistamines may also be used preventively when you are at risk of allergen exposure.
Corticosteroid Nasal Sprays: Nasal corticosteroid sprays (Nasonex, Veramyst, Nasocort AQ) are very common. They only work if used daily. Single use or “”as needed”” use will not be effective since the benefit from nasal corticosteroids take 1-2 weeks. Nasal sprays reduce nasal swelling, inflammation, and drainage. The side effects of nasal steroid sprays are minimal since the steroid has little penetration into the bloodstream. They are not addicting.
Nasal Salt Water (Saline) Sprays: Salt water or saline solutions that may be acquired as an over-the counter nasal spray (Nedipot, Ayr spray, Ocean Spray) or made yourself is very safe and may be used as many times as you wish. The benefit of salt-water solutions is that it physically cleanse the nose of allergens. It also “”washes out”” the mucous that may be trapped in your nose and sinuses.
Antileukotrienes: Antileukotrienes (Singulair) address allergies in a different pathway than antihistamines by blocking the late phase allergy response. This phase occurs several hours later and causes congestion and runny nose. Asthmatics also use these medications to control their attacks. Antileukotrienes must be used on a daily basis during your season to be effective.
Nasal and Oral Decongestants: Nasal decongestants such as Afrin or Neo-Synephrine are over the counter medications that reduce swollen nasal membranes. They clear nasal passages almost immediately and are useful in treating temporary severe nasal congestion. Nasal decongestant sprays are safe to use for only 3-5 days. Prolonged use leads to rebound congestion or “”nasal spray addiction””. Oral decongestants are primarily over-the counter such as pseudoephedrine (Sudafed) and phenylpropanolamine. They may also be considered for temporary relief of nasal congestion. Oral decongestants may cause anxiety, urination difficulty (enlarged prostate), worsened high blood pressure, and an increased heart rate. Patients with high blood pressure, enlarged prostate, or heart problems should consult with Dr. Pasha before using decongestants. Please note that some decongestants are combined to reduce the number of pills and are often given the suffix “”-D”” such as Claritin-D, Allegra-D.
Corticosteroids: For those of you who have severe allergies, nasal polyps, or severe sinus infections, Dr. Pasha may recommend corticosteroids such as Prednisone or a Medrol Dose Pack. Corticosteroids have many potential side effects especially when used for the long term. Prescribed steroids must be used exactly as prescribed for its entire course. Do not stop the use of the drug without consulting Dr. Pasha as conditions may become worse if suddenly stopped. Review the side effects profile in detail with your prescription package and report any side effects to Dr. Pasha.