ANTIHISTAMINES (Z yrtec, Clarinex, Allegra, Xyzal, Benadryl)Antihistamines are used to treat hayfever/ allergic rhinitis- conjunctivitis and hives/urticaria. They block the effects of histamine, which is the chemical released during an allergic reaction. This eliminates or reduces the symptoms of an allergic reaction.
“First generation, sedating” antihistamines can cause drowsiness in some people. They are usually available over the counter. Examples include diphenhydramine (Benadryl) and chlorpheniramine (ChlorTrimeton).
“Second generation, low or non-sedating” antihistamines are not as sedating and have less potential for side effects.
Examples include cetirizine (Zyrtec) , levocetirizine (Xyzal) , desloratidine (Clarinex), fexofenadine (Allegra). Loratidine (Claritin) is available over the counter.Common antihistamine side effects include:– Dry mouth– Drowsiness– Restlessness/ Irritability– Constipation
– Difficulty urinating, specially in men with prostate problems
Topical antihistamines are also available and efficacious. Nasal antihistamine preparations include azelastine (Astelin) and Patanase. A combination nasal steroid- antihistamine nasal spray is also available (Dymista). Ophthalmic preparations include Patanol, Elestat, Bepreve, and Optivar. A non-steroidal anti-inflammatory eye drop (Zaditor) is available over the counter and may relieve eye symptoms. Combination decongestant and antihistamine preparations, such as Naphcon are also available but have increased risk of decongestant related side effects and rebound (see Decongestants section below)
Corticosteroids are a type of “controller” medication for allergies that reduces the inflammation which causes the swelling and mucus production in the lining of the nose and airways. Corticosteroids are very effective for treatment of asthma and allergies. They are different from the anabolic steroids which have been abused by some athletes. They are potent and should be used under the supervision of a doctor.
Corticosteroids are available in creams or ointments to be applied to the skin, in nasal sprays, in inhalers for asthma patients, eye drops, and orally or by injection.
Topical steroids applied to the skin come in different strengths. While they are very potent, care should be taken not to use topical steroids long-term without a doctor’s supervision, since this can lead to thinning or discoloration of the skin and other complications such as steroid dermatitis.
Nasal steroids are very effective in the treatment of allergic rhinitis and nasal polyps. The most common side effect is a mild nose bleed which clears up after stopping use. Patients with glaucoma and cataracts should be monitored when using a nasal steroid. Nasal septal perforation has also been reported, and can be prevented by pointing the spray away from the nasal septum when spraying.
Steroid eye drops can also be used short-term to relieve severe allergic symptoms, but long-term use should be avoided to prevent cataracts, glaucoma, and eye infections.
Inhaled steroids are considered the most effective long-term treatment for the control of asthma. Side effects can include:
– Oral thrush or a fungal infection of the mouth and tongue, this is easily avoided by gargling with water after using the inhaler
– Long term use of high doses of inhaled steroids can potentially result in transiently reduced rate of growth (half an inch in the first year of use, generally without ongoing effect). The benefit of asthma control and improved quality of life generally offsets any side effects.
Oral or Injectable steroids are usually used for short-term treatment of a severe allergic problem such as an asthma flare, nasal congestion, eczema or hives, etc.
Short-term side effects include weight gain, increased appetite, muscle cramps, heartburn, upset stomach, difficulty sleeping, and emotional instability. These usually resolve once the steroids are stopped.
Long-term use (months to years) can result in stomach ulcers, cataracts, weaker bones, high blood pressure, elevated blood sugar, thin skin and easy bruising and increased susceptibility to infections.
DECONGESTANTS (SUDAFED, etc.)
Decongestants shrink the swollen lining of the nose and dry up mucus produced during an allergic reaction. They do this by constricting blood vessels. They do not work to control the inflammation that goes on during an allergic reaction They are available over the counter and by prescription and are often combined with an antihistamine. They come in liquid, pill, and nasal spray formulation.
Side effects include:
– Trouble sleeping
-Increased blood pressure and/ or heart rate
People who use a decongestant nasal spray for more than 4 days continuously can develop “rebound rhinitis” or “rhinitis medicamentosa” which causes the nasal congestion getting worse, and results in difficulty discontinuing nasal spray use.
High blood pressure,Glaucoma andProstate problemsshould not use decongestants since these can result in difficulty controlling their blood pressure, worsening of glaucoma, or increased difficulty urinating.
ANTI-LEUKOTRIENE MEDICATIONS (SINGULAIR, ACCOLATE)
Anti-leukotrienes block the action of chemicals produced in the body called leukotrienes which are involved in airway muscle spasms and swelling of the lining of the airways and the nose. They are available in tablet form, by prescription only. They are used to treat mild to moderate asthma, often combined with inhaled steroids, and Singulair (montelukast) is approved for treatment of allergic rhinitis in children and adults.
Brand Names: Singulair(Montelukast)
Available in 4 mg and 5 mg chewable tablet, 10 mg tablet and 4 mg granules
Accolate (Zafirlukast)Available in 10 and 20 mg tablets
Precautions:: Not for acute treatment of asthma exacerbation.
Singulair chewable tablets contain phenylalanine.
May interfere with drugs metabolized in the liver such as anti-seizure medications. Accolate has also been reported to affect effectiveness of warfarin (blood thinner) and calcium channel blockers.
Common Side Effects:: Headache, GI upset, hives, upper respiratory infection
Accolate has had rare reports of livery dysfunction
EPINEPHRINE INJECTOR (EPIPEN, TWINJECT)
Epinephrine injection is used to treat life-threatening allergic reactions called anaphylaxis caused by insect bites, foods, medications, latex, and other causes.
Use: Epinephrine injection comes as a single-dose (or 2 doses, in the case of Twinject) pre-filled automatic injection device to be injected into the thigh. It should be used when you are experiencing symptoms of a generalized anaphylactic reaction like throat closing, tongue swelling, difficulty breathing or wheezing, hives, and/ or dizziness.
Under certain conditions, you may need a second epinephrine injection to treat an allergic reaction if the symptoms do not improve at least 15 minutes after the first injection. Follow the directions on your prescription label carefully and Use epinephrine injection exactly as directed.
Call 911 or go to the ER immediately after using an epinephrine injection. Emergency medical treatment and monitoring will be necessary after an anaphylactic reaction.
Precautions: Epinephrine injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- Pale skin
- Difficulty breathing
- Pounding, fast, or irregular heartbeat
People with a history of high blood pressure, irregular heart beat, heart disease, and stroke need special care, monitoring, and possible medical treatment after using epinephrine. Be sure to contact your doctor and go to the ER after using epinephrine.
How to use an Epi-Pen video from Youtube:
strong>Source:: Medscape Plus National Library of Medicine
Source:: Physician’s Drug Reference 2006