Medical treatment for allergy
Bulent Mamikoglu, M.D. and Timothy C. Hain, M.D.
December 12, 2015
We are mainly discussing treatment allergic rhinitis, and we are not attempting to cover food allergy.
We also are attempting to use "common names", sometimes trade names, to make this page more useful to patients. There is an immense literature concerning allergy treatment -- we are not attempting to be comprehensive, but hoping to be practical. There are many excellent online resources for allergy treatment. You should ask your health care provider about safety of these medications -- and especially in high risk patients or pregnancy.
Treatment of allergy
Once allergies have been identified, most patients start with simple treatments such as avoidance, pharmacotherapy (usually sprays for the eye or nose, antihistamine or steroid pills) and move on to immunotherapy if symptoms are significant and the other two methods are not sufficient.
Avoidance of allergens is great if possible, but it may not always be practical to avoid breathing air containing allergins.
Medications for allergy include:
- Unselective (examples: benadryl) -- these are typically inexpensive, and do not require prescriptions. They can cause drowsiness, weight gain, dry eyes and mouth, urinary retention, constipation and rapid pulse. Generally these are not the best choice.
- Selective H1 blockers (examples: allegra, claratin, zyrtec). These over the counter medications are often a good choice for seasonal allergy.
- Nasal antihistamines (example: astelin). This is a rapidly working nasal spray, that has an unpleasant taste. It is prescription only.
- Corticosteroids (example: flonase; medrol dose-pack or "6-pack"). Steroid nasal sprays are often recommended as first-line treatment for persistent allergic rhinitis. They can be reasonably combined with a selective H1 blocker. Steroid pills (e.g. medrol, prednisone) are stronger, but have many more side effects. They are prescription only and are not used very often for fear of side effects.
- Decongestants (example: sudafed). These drugs are effective but have significant side effects including hypertension (if taken as a pill), or rebound (basically addiction) if used as a nasal spray for more than a few days.
- Anticholinergics (example: ipratropian). This drug just turns off the glands involved with nasal secretion. It mainly affects the nose, but can also affect other parts of the body such as the eyes and bladder. It is prescription.
- Mast cell stabilizers (example: cromolyn sodium). This drug is also available over the counter. It is mainly used prior to anticipated exposure to an allergy source -- such as a cat.
- Leukotriene inhibitors (example: singulair). This is a pill that reduces inflammation. Headache is a potential adverse effect.
- Nasal saline. This treatment involves salt water irrigation of the nasal passages, typically with a cup of warm salt water combined with a device that can deliver it "up one side and down the other". It can wash out allergens, it is a decongestant, and usually is well tolerated.
Antibiotics are not treatments for allergy. In other words a "z-pack" is treating infection, not allergy.
Other approaches to allergy treatment include allergy shots and sublingual drops. These have the advantage that they can "cure" the allergy, but take more up-front work.
August 3, 2016
, Timothy C. Hain, M.D.
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August 3, 2016