Over-the-Counter Allergy Medications 101

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Lets talk for a bit about common allergy medications.  In the interest of time, I’ll focus on meds used to treat nasal symptoms, what doctors call rhinitis.

The most common medications used for rhinitis are antihistamines.  Antihistamines work, as their name suggests, by blocking the effects of the chemical histamine.  They are particularly good for controlling symptoms of nasal itching, sneezing, runny nose, and itchy eyes.  They are not very good at controlling nasal congestion and drainage.  Older antihistamines like diphenhydramine (benadryl), chlorpheniramine (chlor-trimeton) , and hydroxyzine (atarax, vistaril)  are very potent, but they are also very sedating.  Newer antihistamines such as cetirizine (zyrtec), fexofenadine (allegra), and loratidine (claritin) are classified as low- or non-sedating and still have adequate potency.  I generally recommend one of the newer medications.  Cetirizine and loratidine are available over-the-counter and store brands run only about $10 a month.

Decongestants also do what their name suggests: help control nasal congestion.  Some people find they help with symptoms of pressure and pain as well.  They work by constricting the blood vessels in the nose which, in turn, shrinks the lining of the nasal passage.  Since they are oral medications, they will also constrict the blood vessels in the rest of the body, which can worsen blood pressure,  In guys, they can also worsen prostate problems.  They cause insomnia in a number of people as well.  Because of all these side effects, I avoid decongestants as much as possible and limit their use to short periods of time.

Over-the-counter nasal sprays are a double-edged sword.  They are sold under a variety of names, but most contain the drug oxymetazoline.   They will open your nose like nothing else, but if used improperly can lead to dependence so be very careful with them and always follow the instructions.  Never use them for more than 3 days in a row or more than twice a day.  If you do, when you try to stop, your nose will be worse than when it started- a phenomenon called rebound.  I see patients every week who have become dependent on these medications to breathe through their nose.  Don’t become one of them.

Finally, I’ll talk about saline rinse.  This is a great treatment for most nasal symptoms, including drainage. It’s essentially free and devoid of side effects.  I’m not referring to “ocean spray” that simply moistens the nose, but rather forcing a large volume of saline through the nose.  This can be done with gravity-a neti pot- or with force- a plastic squeeze bottle. Either way, make sure you don’t use plain tap water- it’s too dilute and will irritate the lining of the nose.  A simple mix involves using a teaspoon of salt in 8 ounces of water.  Some companies try to sell you their mix, claiming that they have “pharmaceutical grade NaCl”.  This is ridiculous.  Plain table salt is fine and could never make the nose a dirtier place than it already is.

Hope this is helpful.

Dr. O

One Comment

  1. just wanted to say thanks for your blog. i just found it, and am local also. just wanted to let you know that i’m reading & appreciate your thoughts.

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