Allergies – What Are My Options For Treatment?

I am still getting a daily alert from the Weather Channel that the ragweed and tree pollen is very high! Last week we talked about over the counter options to help battle the ragweed effects. This week, let’s talk about the pharmaceutical options.

There are many antihistamines available by prescription only such as Xyzal, Tripohist, or Phenergan. The latter two are known as first-generation anti-histamines. They tend to cause more drowsiness. You might recognize Phenergan as a nausea/vomiting medicine also. Xyzal is considered a second-generation antihistamine like Allegra, which is now over the counter. They don’t tend to cause as much of a drowsiness effect – or they are not supposed to. ( I mentioned Zyrtec last week as tending to cause more drowsiness – though it is considered a 2nd gen.)

We already talked about the decongestants last week – pseudoephedrine and phenylephrine. Both are non-prescription in Texas, but in some states pseudoephedrine is prescription only.

There are many steroid nasal sprays which are still by prescription only, including Beconase AQ, Dymista, Flunisolide, Nasonex, Omnaris, Rhinocort Aqua, and Veramyst. “Exact mechanism of anti-inflammatory action unknown,” (Epocrates Plus, Version 15.8) but they work to unclog your nasal passages. My tip is to bend over for 30 seconds – just like Flonase and Nasacort.

Typically accompanying the drainage and inflammation of an allergy attack is a tickly cough, maybe with a sore throat. Benzonatate reduces the cough reflex, which can bring great relief when you are trying to sleep. The other two prescription antitussives (cough medicines) are codeine and hydrocodone. These are Schedule II controlled substances, which have high abuse potential, and Innovative Healthcare does not prescribe them.

At times, it is appropriate to prescribe oral steroids to help with the inflammation associated with allergies. We do have injectable steroids that we use on occasion. Steroids should be used cautiously though. They increase blood sugar, increase blood pressure, and can cause some sleepless nights. We almost always do a CBC (complete blood count) in our office to make sure you are dealing with allergies and/or a bacterial infection, which can benefit from the effects of a steroid. If we find you have a viral process going on- like the common cold or the flu – we do not recommend a steroid because the infection will take longer to clear. However, in some specific circumstances, the effect of the steroid is needed and used with caution.

A word about viral vs. bacterial vs. allergy: Viral infections DO NOT respond to antibiotics. Allergies DO NOT respond to antibiotics. Only bacterial infections respond to antibiotics. It is widely covered in the media that antibiotics are overused and overprescribed in the U.S., leading to the antibiotic resistance we see in the hospitals. All that said, your body can be fighting a virus or battling with allergies, and then when your resistance is down, a bacterial infection can set in. So if you are not better in the standard 2-3 day window after starting a particular regimen, come back to the clinic for a re-evaluation.

We will look at a more natural approach to deal with pesky allergy symptoms next week, highlighting products from Metagenics.

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