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A guide to more than three thousand non-prescription medications furnishes a comprehensive, easy-to-use resource that takes the confusion out of selecting safe, effective, over-the-counter drugs. Original.
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Dr. Michael B. Brodin is in private practice and is on the faculty of the New York University School of Medicine. He is also Associate Attending at Tisch Hospital (NYU). Dr. Brodin is a past president of the New York County Medical Society. He also wrote The Encyclopedia of Medical Tests, available from Pocket Books.Excerpt. © Reprinted by permission. All rights reserved.:
Chapter 1: Allergies
What exactly is an allergy?
Although a complete explanation of allergies would require a complete explanation of the immune system itself, something that is outside the scope of this book, a simple way to think of an allergic reaction is as something your body does to get rid of a substance that is foreign to it and that it perceives as harmful.
For example, the swelling that commonly occurs in poison ivy is an attempt to dilute and weaken the offending substance with body fluids. The itching is an attempt to get you to scratch the stuff off your skin. The redness is an attempt to increase the blood flow so as bring more of the body's defenses to fight off the chemical invader, and so forth.
Allergies are good when they recognize and get rid of things like germs, but they are more of a nuisance when they launch an all-out attack on something as innocuous as grass pollen.
Although there are many different kinds of allergies, when someone talks about being allergic what he usually means is that he gets a runny, congested, and itchy nose and tearing, puffy, and itchy eyes at various times during the year. Well call these symptoms hay fever.
Hay fever symptoms may appear like clockwork every spring, summer, or winter, but at times they are more erratic. In all cases, however, the essential problem is caused by inhaling particles in the air. Most often these particles include pollens, molds, and house dust. You may be allergic to any or all these things to different degrees. Hay fever is not triggered by foods. Pollens and molds create allergy seasons, whereas house dust is a constant (perennial) problem. Seasonal hay fever tends to be more severe than the perennial variety.
The symptoms are similar to those of a common cold, and it can be hard to distinguish between the two, although certain medical tests can help. See Table 4 in Chapter 6 for distinguishing features. Individuals with hay fever may also suffer from hives, asthma, and eczema.
Allergy testing to find out what inhalants are responsible is controversial. If you do have testing, either with skin or blood tests, you will probably be presented with a large sheet of paper listing the various substances to which you are allergic, such Alternaria or Cladosporium molds, or ragweed, tree, and grass pollens. It is also possible to be allergic to pets, cigarette smoke, and a host of other substances. Once you know the substances the problem is what to do about them. There are two choices, avoidance or desensitization.
Avoidance sounds fine in theory, but unless you live in a bubble, you will find it very difficult. Desensitization (allergy shots) does work, especially with pollens, but it is time consuming and expensive. That's why people most often take pills or tough it out.
There are four classes of OTC medications that are used to treat the symptoms that go along with hay fever type allergies. Strictly speaking, you should choose the product based upon the symptoms you are having, as detailed in Table 1.
As you can see, technically speaking, a stuffy (congested) nose is different from a runny, itchy nose. This is because of the way the body chemicals involved in the allergic reaction work.
Although there are many combination allergy relief products, it is generally better to treat your symptoms with separate medications. You will understand their effects better and will have more control over them. If you find a combination of drugs that works particularly well, you might then select a product with the same ingredients for ease of use.
The mainstay of treatments for hay fever and allergic symptoms in general is the large and useful group of drugs called antihistamines. To understand how they work it is good to understand a little about the powerful chemical called histamine.
Histamine is found in many animals and plants and has a number of effects on the body, such as widening (dilating) blood vessels; allowing blood vessels to leak fluid; stimulating the nerves that cause itching; and constricting the bronchial tubes in the lungs. Histamine also promotes the formation of stomach acid by stimulating what are termed histamine2 receptors in the stomach lining (as opposed to histamine1 receptors in allergies).
Antihistamines are drugs that block the effects of histamine. It is important to understand that they block histamine rather than decrease the production of it. This means that if the histamine has already been produced and has already started to make your nose itch, it is too late for the antihistamine to work. You have to have it in your system before the allergic reaction takes place. This is why a regular, steady dose of medicine is the best way to take any antihistamine. Take it to prevent symptoms, not to treat them. If you play catch-up, you're losing the game.
Histamine is responsible for roughly half of the symptoms of hay fever allergies; thus, you can expect about a fifty-percent reduction in your symptoms.
The following are the currently approved and available OTC antihistamines for allergy relief.
As a group, antihistamines are among the most widely used and versatile in medicine and they constitute a good portion of the OTC market in all categories. They are used not only for allergy relief but also to aid sleep, suppress coughs, and prevent motion sickness. In topical form they act as anesthetics. They also tend to be safe when used as directed. There are more antihistamines than those listed above and new ones are constantly hitting the market, most of them having been designed to reduce side effects.
For the most part, the most troublesome of these side effects is drowsiness, and much research has gone into finding non-sedating antihistamines. At present these are available only by prescription and include drugs such as Allegra (fexofenadine), Hismanal (astemizole), and Claritin (Ioratadine). All, however, are much more expensive and have additional drug interaction problems. By the way, there is no benefit to going to the doctor for a shot of antihistamine; the oral forms are actually preferable.
Although all OTC antihistamines carry the drowsiness warning, brompheniramine, chlorpheniramine, dexbrompheniramine, and pheniramine are the least sedating, whereas clemastine, diphenhydramine, and doxylamine are the most sedating.
One way around the drowsiness issue, but only for allergic eye symptoms, is to use antihistamines by way of eye drops. There are two OTC topical eye antihistamines, pheniramine and antazoline, which are similar but not exactly the same. Both are combined with the decongestant naphazoline for added effectiveness.
The drowsiness from antihistamines can be felt as weakness or fatigue and the effect is considerably worsened by alcohol or other sedatives. It's rather easy to forget this if you happen to be at a party, and you have to be very careful when driving. Sometimes, however, particularly in children or the elderly, antihistamines produce an odd and exactly opposite effect -- agitation and insomnia. If this occurs there is nothing to do but discontinue the medication.
Other possible side effects include excessively dry mouth and nose, blurry vision, difficulty urinating, upset stomach, palpitations (rapid or irregular heartbeat), itching, rash, abnormal sensitivity to sunlight (photosensitivity), sweating, chills, thickening of lung secretions, and wheezing.
Antihistamines should not be taken if you have glaucoma, heart disease, thyroid disease, an enlarged prostate, diabetes, or high blood pressure. They should also not be taken with other sleeping pills, tranquilizers, or antidepressants such as monoamine oxidase inhibitors (MAOIs). You should check with your doctor if you have a lung disease such as asthma, emphysema, or chronic bronchitis.
Remember that, although antihistamines will dry out your nose, they will not unplug it. For that you need a decongestant.
Decongestants do not directly interfere with histamine or the allergic reaction but work indirectly: whereas histamine widens blood vessels, decongestants narrow or constrict them. When the blood vessels narrow, circulation decreases and with it the leakage of fluid that causes swelling of the mucous membranes.
Table 2 lists available decongestants and how they can be taken.
Copyright © 1998 by Michael B. Brodin, M.D.
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