Health Topic: Focus on Allergies

by Dr. Wilbur Kuo, MD
March 10, 2016


How is allergic rhinitis treated?
Part 2: Medication Treatments

Nasal steroids
* First-line medication treatment
* Flonase and Nasacort are now available over the counter
* Prescription ones often not covered by insurance or require prior authorization
* All have similar efficacy
* Work best when used daily
* Often take a week or so of daily use before they become effective
* Patients with seasonal allergies should start their nasal steroids a week before the season starts
* How to use
- Before using, clean nose with nasal lavage
- Place head in upright position
- Spray upwards and away from midline
- Sniff gently to get the spray higher up the nose
- Don't sniff so hard that it drains on the back of the throat
- Stop if get nose bleeds

Antihistamines
* Benadryl pills: can be sedating
* Non-sedating pills: Claritin, Allegra, and Zyrtec are now over-the-counter
* Non-sedating Xyzal and Clarinex are no more effective, often not covered by insurance, or require prior authorizations
* Astelin and Patinase are non-sedating nasal sprays used once daily or as needed

Combination nasal steroid and antihistamine
* Dymista: combination of flonase and astelin

Decongestant pills
* Sudafed, Actifed, or Drixoral
* Often combined with antihistamines to make claritin-D, allegra-D, and zyrtec-D
* Can be used to make the illegal drug methamphetamine (crystal meth)
- Purchase in US requires driver's license
* Can raise blood pressure or cause heart problems; don't use if you have high blood pressure or heart condition
* Can make prostate symptoms worse

Decongestant Nasal sprays: Afrin, Neo-synephrine
* Do not use for more than 2-3 days!
* Causes rebound nasal congestion, worse than what you started with!!

Leukotriene inhibitors
* Singulair, a pill
* Often used with antihistamines
* Particularly helpful in people who also have asthma

Cromolyn sodium
* Nasalcrom, an over-the-counter nasal spray
* Need to use it 3-4 times a day
* Best if started a few days before allergy season

Ipratropium
* Nasal spray for severe runny nose
* Do not use if have glaucoma or enlarged prostate