NEWSPAPER ARTICLE
Dreading spring
April, 2003

While her friends are excitedly looking forward to the arrival of spring, Rachel dreads the springtime. Spring brings her misery during which she suffers from annoying fits of sneezing. Nasal congestion, which worsens at nighttime, does not allow restful sleep. She is miserable from itching in the nose, roof of the mouth, and throat. Her eyes itch and water. No wonder she is not looking forward to springtime.

Rachel is suffering from hayfever. Hayfever is a misnomer because patients do not develop fever. The medical name for hayfever is allergic rhinitis. Typically, Rachel’s symptoms start in March. In some years, her symptoms start in late February.

Frustrated, Rachel asked, “What is in the air?” During spring, pollens of trees cause allergic symptoms. In our region pollens of Rocky Mountain Juniper, Cottonwood, American and Chinese Elm, Ash, etc., are the culprits. Chopping them down is not the solution as their pollens float into the air and can get carried away by wind for miles.

“Dr. Patel, what time of day should I not venture outdoors?” Rachel inquired. Besides closing the windows and turning an air conditioning on in the house and car, I do not recommended drastic lifestyle altering measures because they are not practical and most are minimally effective. With modern treatment programs, doctors can relieve the suffering.

“Initially, for the first few days, Claritin, which I purchased over the counter, seemed to help somewhat; but, it doesn’t work anymore,” Rachel reported. Now Claritin, an antihistamine, has become over the counter; of course, it is fairly expensive. Antihistamines, as a group, have been around for many years; names such as Benadryl, Chlor-Trimeton, Tavist-1 and many others are very familiar

Oral antihistamines may reduce sneezing, itching, and runny nose in addition to watery, itchy eyes. Typically, antihistamines do not help nasal congestion. So, pharmaceutical companies combined antihistamines with oral decongestants such as pseudoephedrine -- Sudafed being the popular brand name.

Older antihistamines such as Benadryl and Tavist are sedating and may affect cognitive and motor function, even without obvious sedation. Newer antihistamines such as Claritin, Clarinex, and Allegra are non-sedating.

Antihistamines may cause bladder retention in persons with enlarged prostate.

With the availability of Claritin over the counter, some insurance companies are asking patients to try Claritin first before approving other antihistamines such as Allegra, Clarinex, or Zyrtec. Some insurance companies are asking patients to pay substantially high co-pays for prescription antihistamines.

“Dr. Patel, should I try something else over the counter? I cannot decide what to choose, as a plethora of products are available over the counter for treatment of nasal and sinus symptoms,” Rachel inquired.

Grouping the available over-the-counter medications as follows will help in the selection of appropriate medication:

Pure antihistamine
a. Over-the-counter: Benadryl, Tavist-1, Claritin and many others.
b. Prescription: Allegra, Clarinex, Zyrtec and others.

Pure oral decongestants such as pseudoephedrine, Sudafed, and phenylephrine. Patients with high blood pressure should check with their doctors before using oral decongestants.

Combination of oral antihistamine and decongestant such as Allegra-D, Claritin-D, Zyrtec-D and others.

Addition of acetaminophen, Tylenol, to antihistamine and decongestant. For example, Dimetapp Cold and Allergy Tablets contain acetaminophen, a pain reliever, chlorophenamine, an antihistamine, and phenylephrine, a decongestant.

Guaifenesin is supposed to help with mucous, and drug companies combine it with antihistamines and/or decongestants. For example, Dimetapp Cold and Congestion Caplets contain dextromethorphan, a supposed cough suppressant, guaifenesin, supposedly an expectorant, and pseudoephedrine, a nasal decongestant.

Dextromethorphan: Companies add it to combination products to reduce the cough. I am not sure how much dextromethorphan helps the cough.

As I am discussing, antihistamines let me mention an intranasal antihistamine, Astelin, which is available only by prescription. It can cause sedation in some and has an unpleasant taste.

Of course, many more options are available for treatment of hayfever. In future columns, I will address cortisone nasal sprays and the role of a leukotrine modifier, Singulair, which has been recently approved for treatment of allergic rhinitis.

By the way, cromolyn, NasalCrom, is available over the counter. NasalCrom may help mild hayfever symptoms, but a patient has to use it 4-6 times per day for it to be effective. I, myself, would have difficulty in using a medication 4-6 times a day, every day.

I advise my patients not to use nasal decongestant sprays such as Afrin, which when stopped can cause rebound nasal congestion and eventually are habit-forming.

Ashok Patel, MD, Allergist, Academy Allergy, Asthma, Sinus & Immunology Center