Medications

Sneezing, itchy nose, throat, and ears

These are the most common complaints of the allergy sufferer. These symptoms can be associated with seasonal triggers such as grass, tree, or ragweed pollen, or perennial triggers such as dust mites, roaches, or pets. The first-line treatment for these symptoms are antihistamines. When exposed to an allergen, the mast cell, which is found all over the body, especially in connective tissue such as the skin, releases histamine. Antihistamines block the action of histamine and prevent the allergic reaction from taking place. The most popular OTC antihistamines are diphenhydramine (Benadryl), clemastine (Tavist), and chlorpheniramine (Chlor-Trimeton).

Some of these products' manufacturers have used the side effect of sleepiness to create a new product out of the same drug. Popular examples include Unisom, Nytol, and Sominex. In fact, diphenhydramine is almost as popular as a sleep aid as an allergy product.

Side effects

Be careful when driving. Over-the-counter allergy products may impair your judgment as much as alcohol, and when combined with alcohol, may affect you even more. Also, men with enlarged prostates may experience urinary retention while taking these products. For moderate to severe symptoms, or if the side effects of the treatment are intolerable, a patient will benefit greatly from consulting an allergy specialist and gaining access to one of the second generation antihistamines that have a much improved side effect profile. Another class of products available to treat these products is mast cell stabilizers.

Nasalcrom nasal spray recently was made available over the counter for the treatment of allergic rhinitis. This product boasts an impressive safety profile, but is limited as far as usefulness. To achieve maximum benefit, one would need to use Nasalcrom (cromolyn sodium) three to four times per day and give the medicine up to one month to start to work. Some patients swear by it.

Congestion, sinus pain

These symptoms may or may not be associated with allergies. If you don't have sneezing, an itchy nose, throat, or ears, you may want to avoid combination products that have antihistamines to minimize occurrences of dry mouth and sedation. The principal therapy for these symptoms is decongestants. Decongestants can be taken orally or topically. The most popular oral decongestants is pseudoephedrine (phenylpropanolamine was previously used but it has been discontinued by the FDA). These same products are also available in prescription strength. Decongestants work by shrinking the mucous membranes, thereby decreasing the surface area. Unfortunately, when the medication wears off, so does the symptom relief. Also, many patients get very jittery and shaky while taking these products. These patients don't usually do well on coffee or other forms of concentrated caffeine, either. If these symptoms persist, it would be wise for the patient to consult with an allergist or other sinus specialists such as an otolaryngologist (ear, nose, and throat doctor) for further evaluation or treatment.

Remember though, if you do not have allergy symptoms, you do not need to take a combination product with antihistamines. Often times, decongestants may come with guaifenesin, an expectorant to loosen the phlegm or mucus and assist with drainage. Although in theory, this is a good idea, in most OTC products, it is given at such low dosages, it does not do much. You usually need the much higher dosages of prescription products to do any good. If congestion is particularly bothersome, you may want to use an OTC decongestant spray for a few days to help relieve the symptoms and allow some of the more long-term prescription and OTC medications to kick in.

Side effects

Use of topical decongestants such as phenylephrine (Afrin, Neo-Synephrine, Vicks Sinex) or oxymetazoline (Afrin Original Nasal Spray, Neo-Synephrine 12 hour) for more than three to four days may lead to a mucosal dependence (or addiction), making it more difficult to wean off of these medications. Also, if a patient abuses these products, they may irreversibly damage the nasal mucous membranes.

Post-Nasal Drip

This symptom is very difficult to treat. The causes can be an allergy, infection, or a nasal structural abnormality. Antihistamine decongestant products are the OTC treatment of choice. I would recommend, however, seeing an allergy or sinus specialist for a more specific etiology so that treatment can be optimized.

Cough of two-week duration or less

This kind of cough in the absence of other underlying medical problems such as chronic bronchitis or emphysema, or without other associated symptoms such as a fever is probably due to a cold. I usually recommend a product with a cough suppressant such as dextromethorphan and a decongestant such a pseudoephedrine to dry the post-nasal drip. If the drip is particularly bad, one can add an OTC antihistamine to help dry the drip further. I would especially recommend this at night when being sleepy is not as big of an issue.

Cough of more than two weeks duration

Now we are approaching the category of "chronic cough." The overwhelming majority of chronic coughs are related to three causes. These include:

• Allergy and asthma
• Sinus infection
• Gastroesophageal Reflux (heartburn)

If a cough persists for more than a few weeks, one should see an allergist, otolaryngologist, or a pulmonologist (lung specialist).

Itchy, runny eyes

Most over-the-counter medications treat the symptoms of eye allergies using a topical decongestant (oxymetazoline, naphazoline) and an antihistamine (pheniramine).

Another factor to consider when choosing an OTC allergy medication is cost. Generic versions of many antihistamines and decongestants are available at a much lower cost than brand-name products and are equally effective. Ask your pharmacist about generic alternatives.

Remember that OTC medications can help manage symptoms, but they do not treat the underlying cause of your allergies. If your symptoms are interfering with your daily life or are not adequately controlled with OTC medications, see an allergist for a comprehensive evaluation. Prescription medications, allergy shots (subcutaneous immunotherapy), or sublingual immunotherapy may provide better long-term control.

It is also important to note that many allergy medications are available in combination products that treat multiple symptoms at once. While these can be convenient, they may also increase the risk of side effects. Always read the label carefully and avoid taking more than one product that contains the same active ingredient.

If you are pregnant, breastfeeding, elderly, or have other medical conditions, speak with your doctor before taking any new medication, including OTC products. Some medications that are safe for most adults may not be appropriate for everyone.