FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

ADVICE TO READER: TRY OTHER REMEDIES BEFORE COSTLY ALLERGY SHOTS

Question: I'm having trouble with my allergies again this year. I have all the symptoms the ads on TV talk about the itching eyes, running nose and congestion. I've tried most of the brands of non-prescription allergy medications with unsatisfactory results. Some didn't help very much, while others worked but put me to sleep. Is there anything new for allergies?

Answer: Allergies one of the most common human maladies beset up to 30 percent of Americans. Wow! If this causes each sufferer to be absent from work or school for only four days a year, the country loses at least 100 million person-days of productivity. Additionally, we spend more than $500 million for allergy related doctors' visits and medications.

"Allergies," are called "allergic rhinitis" in medical jargon. Plant pollen, the most likely causes for your current symptoms, as well as animal dander, molds, house dust and other substances produce watery eyes, a runny nose, a scratchy throat, puffy dark bags under the eyes (allergic shiners) as well as coughing and "wheezing" from the lungs. It sounds like you've just about had them all!

As a general rule, it's safe to try the non-prescription allergy medications first, just as you have done. They are relatively inexpensive and safe if taken using the label directions. Most contain an antihistamine such as chlorpheniramine which works by blocking the release of histamine the natural body chemical which produces the allergy symptoms. Unfortunately, most of these drugs also cause drowsiness as well as the desired antihistamine effect.

Antihistamines work better when taken before you are exposed to the substance that produces the allergy symptoms. For most of us this means that they should be taken regularly during the allergy season instead of waiting until the symptoms are severe. Once the symptoms are established, it takes a longer time for the antihistamine to "catch up" and make you feel better.

Many allergy medications add a decongestant such as pseudoephedrine or phenylpropanolamine. These medications reduce the swelling in the nose and sinus areas. They are used with antihistamines to give more rapid relief of the allergic symptoms. The decongestant opens up the nose now, and the antihistamine blocks the allergic reaction which would have resulted in a stuffy nose in a few hours. As a group, antihistamines tend to produce drowsiness, and decongestants tend to produce nervousness. Taken together, each one often cancels out the other's undesirable effects, but as you know from experience, this doesn't always work out.

We doctors have a wide assortment of available antihistamines and decongestant combinations, nasal steroids, cromolyn sodium, and other treatments that are more effective and or have fewer side effects than the non-prescription treatments you have tried. These medications usually provide safe and affordable relief for most allergy suffers. There are new products within each of these drug categories, but none of them offer dramatic advantages over their older counterparts.

Question: Should I have allergy testing before my doctor gives me one of the stronger allergy medications?

Answer: Allergy testing and allergy shots are important treatment tools. For most people, though, I think that it makes more sense to try one of the stronger allergy medications first. For those individuals whose symptoms are not controlled with the available medications or who cannot tolerate them, I'd recommend allergy testing followed by allergy shots (sometimes called desensitization or immunotherapy).

Allergy shots do bring significant improvement or total elimination of symptoms within one year for 80 percent of those who try them. Unfortunately, 20 percent get little or no relief but are still faced with these shots' considerable cost and inconvenience as well as their minor discomfort. Your doctor can advise you if allergy shots would worth trying.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.