Allergy Asthma. Recent Posts. Speaking of Health. Here are a few tips to help allergy sufferers enjoy the beautiful spring weather: Oral allergy medications Oral medications are especially useful for mild allergy symptoms, and many are available over the counter. Nonsedating antihistamines can relieve itching, sneezing, runny nose and watery eyes.
Options include: Loratadine Claritin , cetirizine Zyrtec , levocetirizine Xyzal and fexofenadine Allegra all are available without prescription. Oral decongestants, like pseudoephedrine Sudafed and phenylephrine Sudafed PE can ease stuffiness, and pseudoephedrine is often combined with an antihistamine. These medications are generally well-tolerated, with minimal side effects. Common side effects Oral decongestants cause insomnia and elevated blood pressure for some people, and antihistamines can cause drowsiness.
Nasal steroid sprays For more persistent allergy symptoms, nasal steroid sprays often are the best treatment option. Over-the-counter steroid nasal sprays include: Triamcinolone Nasacort Fluticasone Flonase or Flonase Sensimist Budesonide Rhinocort These medications usually start working after a few days.
Eye drops Over-the-counter antihistamine eye drops, such as ketotifen Zaditor or olopatadine Pataday , can rapidly relieve itchy eyes.
Inhalers If you have asthma along with your allergies, inhaled medications likely will be an important part of your treatment plan. Allergy shots If you find that first-line treatments like nasal sprays and oral medications are ineffective or poorly tolerated, a series of shots to combat allergic symptoms is available.
These preparations are available by prescription only but can be life saving and should be carried by all patients with a history of systemic responses to these insects. It is especially important to carry one of these preparations if one is going to be participating in activities in remote areas.
Antihistamines can be helpful but are not adequate for a life-threatening situation. Sudafed is a decongestant and a different type of medicine. I currently use Claritin-D. Is there another medicine that will work better to clear up the drainage?
I am also on Serevent, Atrovent, Proventil and Uniphyl. I rarely take Proventil. Answer: Claritin-D can help sinus drainage for people with allergy and sinus drainage problems. Other antihistamines and decongestants can work including Allegra-D and Zyrtec-D. There are also over-the-counter antihistamine and decongestant combinations that help with sinus drainage.
It would be best to check with your pulmonary specialist. Question: Is Claritin dangerous if I am pregnant? I heard something about Claritin and Hypospadias last week in the news. Answer: All medications should be used cautiously in pregnancy. Older antihistamines, such as pyribenzamine and benadryl, are probably the safest to use in pregnancy. Claritin is FDA pregnancy category B, which is considered safe.
Question: Can you suggest a safe medicine for a nursing mother with nasal allergy allergic rhinitis and itchy eyes and skin?
Answer: First of all, every pregnant or nursing mother and her doctor must carefully weigh the benefits to the woman against the risks to her fetus or infant when using any medication. Always inform your doctor if you are pregnant, planning a pregnancy or breastfeeding before using any medicine.
That being said, nasal steroids are generally well tolerated during pregnancy and by nursing mothers. Benadryl is probably the safest antihistamine to use because it's been around the longest, although it can cause drowsiness. Many of the newer antihistamines have either not been tested, or they have been found to be present in breast milk.
Great caution should be used with all of these medications and certainly not before a thorough consultation with your doctor. Question: I have a six-month old baby with eczema, and he sneezes all the time. His eyes are not red or watery, but at night he has trouble breathing from congestion. His nose is not runny, though. There were no dropouts in the combination group.
There were 29 subjects in the fluticasone group and 31 subjects in the loratadine plus montelukast group. The groups were matched for age, sex, race, and skin-prick ragweed pollen sensitivity Table 1. Minimal adverse effects were reported by some patients: 11 complained of headache 6 in the loratadine-montelukast group and 5 in the fluticasone group. The overall and individual domains of the RQLQ were similar in the 2 groups at study entry. Total symptoms were similar at entry into the study.
Although the median values for the fluticasone group were less than or equal to those of the combination group at every point, there were no significant differences in total or individual symptom scores at any time between the 2 treatment groups Figure 3 and Table 2.
The number of eosinophils was not significantly different between the groups at either visit 1 or visit 2. The number of total eosinophils did not change significantly between the 2 visits in the loratadine plus montelukast group Figure 4.
Nasal challenge with allergens has taught us much about the pathophysiologic characteristics of allergic rhinitis. In patients with allergic rhinitis, histamine causes the acute symptoms of sneezing, itching, rhinorrhea, and, to a lesser extent, congestion experienced during the early-phase response. Although histamine is released from basophils during the late-phase response, its role is not known. Other mediators of inflammation, especially leukotrienes, prostaglandins, and kinins, are thought to also contribute to nasal congestion, which occurs during the early- and late-phase responses.
Treating patients involves the reduction of symptoms, which can be accomplished by antagonizing mediators or preventing their production. H 1 receptor antagonists have proven safe and effective in the treatment of seasonal allergic rhinitis.
Most studies show treatment with intranasal corticosteroids to be more effective than antihistamines, especially for the control of nasal congestion. Two leukotriene receptor antagonists montelukast and zafirlukast are currently approved for use in the United States for the treatment of asthma, and montelukast has recently been approved for the treatment of allergic rhinitis.
Both selectively block the cysteinyl leukotriene receptors and have been shown to effectively reduce airway eosinophilic inflammation, eosinophil chemotaxis, and peripheral blood eosinophil counts. Both doses led to significant reduction of nasal congestion, sneezing, and rhinorrhea in subjects with acute seasonal allergic rhinitis. However, this efficacy has not been demonstrated in all studies. Pullerits et al 18 showed that patients with seasonal allergic rhinitis treated with zafirlukast 20 mg twice a day had degrees of nasal symptoms similar to those in the placebo group.
In this study, treatment with beclomethasone dipropionate nasal spray led to superior control of nasal symptoms compared with placebo and zafirlukast and was the only treatment that reduced the number of eosinophils in the nasal mucosa. In another comparative study, intranasal budesonide and oral montelukast were used in patients with seasonal allergic rhinitis and asthma. Conceptually, the combination of montelukast and loratadine, 2 mediator receptor antagonists, should be more efficacious than either used alone in the treatment of allergic rhinitis.
Meltzer et al 1 showed the additive effect of montelukast plus loratadine in relieving symptoms of seasonal allergic rhinitis compared with placebo or each therapy alone. These results were not duplicated by a subsequent similar study by Lis and colleagues. Our present results show similar symptomatic efficacy between the combination of loratadine plus montelukast sodium and fluticasone propionate in total symptom scores and quality of life.
When the total symptom scores are examined, the median score of patients in the fluticasone group is numerically lower than that of patients in the loratadine and montelukast group at every measurement time, although the magnitude of the difference did not reach statistical significance. In quality-of-life scores, it is interesting that both treatments demonstrated a similar improvement in the eye domain of the RQLQ, which is consistent with other clinical trials and suggests that antihistamines have no clinical advantage over intranasal steroids in the control of eye symptoms.
All the individual and overall domain scores of the RQLQ were reduced by both treatments in a clinically and statistically significant manner. However, fluticasone demonstrated a statistical superiority in the reduction of nasal symptoms. We suspect that we underestimated the effect of the combination in our initial power analysis for this study.
A larger number of subjects would probably have added statistical significance to the impression of superiority of fluticasone. In contrast, in a nasal biopsy study of patients with seasonal allergic rhinitis, 18 the leukotriene receptor antagonist zafirlukast did not lead to a statistically significant reduction in the number of eosinophils compared with preseason numbers.
The combination of loratadine and montelukast did not reduce eosinophil counts or ECP levels in nasal lavages in the present study. Perhaps this is because the treatment was not administered for a long enough period to affect eosinophil influx or because the mechanism of eosinophil chemotaxis is different in asthma than in seasonal allergic rhinitis.
However, the major reason behind our observation is related to the lower median eosinophil count at study entry in the loratadine and montelukast group than in the fluticasone group, even though the patients were randomized to the different study treatments.
Thus, it is hard to draw any conclusions about reduction of eosinophils by the loratadine and montelukast combination when a very small signal was present at baseline.
In our study design, with rolling enrollment, some subjects were enrolled later in the season than others. One would expect these subjects to have more eosinophils and a higher inflammatory response because they have been primed by prior exposure to the allergen. Thus, one would also expect that the effect of fluticasone the anti-inflammatory agent would be more marked in these subjects.
Indeed, when the patients were divided into those enrolled in the first half of the season and those enrolled in the second half of the season, and their total symptom scores compared, there was more separation of the symptoms, with lower symptom scores in the fluticasone group than in the combination group in the patients enrolled during the second half of the season.
In fact, total symptom scores were statistically different between treatments in favor of the fluticasone group at several points despite the presence of fewer subjects in these subgroups. Perhaps a longer seasonal study or one in perennial allergic rhinitis would show larger differences between the treatment arms.
Relieves itchy nose, runny nose, and sneezing. Available without a prescription. Applied directly at the source, in the nose. Sources: AAFA. Rhinitis and Sinusitis. Accessed August 1, Follow Us.
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