Over the Counter (OTC) Remedies – Featured in St. Pete Times

QUESTION: There are so many different allergy remedies being advertised. Pills, nose sprays, and air cleaners — how do I know which one might help me?
Many of you have felt the arrival of allergy season this year. You may be feeling the runny nose, sneezing, itchy/watery eyes, congestion, and cough or wheezing. For allergy suffers in the spring, pollen is usually the culprit. And with so many over the counter remedies, one can become easily confused.
When patients suffer from allergic rhinitis (the medical term for hay fever), the vast majority of symptoms are being mediated by release of chemicals like histamine, in our bodies. Anti-histamines are great for treating runny, sneezy, itchy symptoms. The older anti-histamines (like Benadryl & ChlorTrimeton) work very well but cause a lot of sedation. The newer anti-histamines like Claritin (loratadine) & Zyrtec (cetirizine) offer similar benefits without the sedation. Both now have generic equivalents available over the counter. Decongestants are added on to address nasal congestion and sinus pressure, but must be used cautiously in people with hypertension.
OTC Nasal sprays like Afrin offer rapid relief of nasal congestion or pressure. The risk with their use is that a level of dependence occurs and people find it harder & harder to breathe thru the nose without the medication. The medication may also cause elevation of blood pressure. People must use caution with these nasal sprays & limit their use to only 3 days.
Sometimes it’s just the itchy red eyes that seem to be the problem. Zaditor(ketotifen), an eye drop that used to be a prescription and now is OTC can offer great results. The drops apply an anti-histamine locally to the tissue of the eye. Contact lenses must removed during use of these allergy eye drops.
Air purifiers are often hyped as being a great addition to the environment of allergy sufferers. An air purifier is intended to remove allergens from the air so the sufferer is exposed to less allergen. The problem is that many allergens like dust mites and pollens are quite heavy particles, relatively, so they don’t float in the air, but drop down to the ground quickly. That being said, an air purifier will not be able to extract much of these allergens from the air. Animal danders are a different story. Those allergen particles are tiny ( <1micron) and can float around for hours in the air. And so they can be effectively extracted from the air with proper placement of an air purifier.
Sinus irrigation has received a lot of attention lately- probably because Oprah talked about the neti pot. The concept is sound. Flushing the nasal passages with saline can remove irritants and particles from the nasal mucosa. The saline also helps the cilia in the nose to properly handle secretions. There has been some controversy as to whether frequent and vigorous irrigation of the nose can cause sinus infections. The jury is still out, but it is best to make sure your irrigation device is kept clean and that you discuss this treatment option with your doctor if you suffer with chronic sinusitis.
Sometimes allergy symptoms are just too severe and none of these remedies help. That is when you should consider seeing an allergist. An allergist can identify if you truly are suffering with nasal symptoms caused by allergies or if you have non-allergic rhinitis. If you really don’t have allergies, allergy medications will likely not help your symptoms. Also, identifying what you are allergic to will help you to optimize your environment and minimize your exposure to allergens. For example, if you have a dust mite allergy, many environmental modifications can be done to the home that will decrease your exposure significantly. And if you have pollen allergies and want to exercise outside on a day with high pollen counts, you can avoid doing so prior to 10am. Earlier in the morning moisture causes pollen particles to aggregate and become more bothersome.
If OTC remedies have failed an allergy patient, they probably will require prescription treatments. Nasal steroid sprays are the best treatments we have for rhinitis symptoms but must be used in a preventive fashion. Finally, many patients require more aggressive treatment of their allergies- like immunotherapy. Allergen immunotherapy (aka allergy shots) is the only FDA approved treatment for allergies that can offer long-term benefits for your symptoms. This therapy changes the way a person’s immune system deals with allergens in a beneficial way, becoming less reactive to them over time.
So if Spring has got you in tears know that there is help.