School may be out for summer, but so are the outdoor allergy triggers. The good news is many allergy medications are now available without need for a prescription from your doctor. But unfortunately the over-the-counter (OTC) antihistamines and antihistamine-decongestant combinations are very expensive and sold in less than 30-day packets in many cases. Besides the cost and quantity issues brought on by OTC allergy medications, there are other concerns shared by allergists.
For many years patients were forced to make a follow-up appointment in order to get prescription refills for their antihistamines. Many times I spent several minutes explaining to parents and patients why regular follow-up appointments are an important component of good allergy management.
Follow-up appointments allow the allergist an opportunity to provide a review of how allergy medication should be taken, what benefit to expect from the medication, possible associated side-effects, drug interactions, and effective allergy medication combinations. Furthermore, the appointment gives your allergy provider a chance to assess your current status, review environmental controls and make adjustments in your medications if needed. Let me go into a little more detail about this.
How allergy medication should be taken
Initial allergy appointments are usually lengthy in time (because of all the questions and answers, the physical exam and testing) and loaded with information concerning prescribed medications and things to do in your home. Many times, the next appointment focuses on the response to treatment. Any misunderstandings about the medication can be addressed, and longer term prescriptions are usually given. Future follow-up appointments, which may be 3-6months apart, allow for further fine tuning and adjustments of the treatment plan. Seasonal triggers (for example tree, grass and ragweed pollen) are reviewed with respect to when they are prevalent in the air. For example, this time of the year I remind my patients who are allergic to grass, not to let up on taking their allergy medications because grass season, in the Midwest, continues through June into July. I remind my patients who are ragweed allergic to resume their allergy medications the first week of August and not to stop until the first sustained frost (usually October).
Benefit to expect from allergy medication
It is important to review what to expect from your allergy medication. Antihistamines (for example Claritin, Allegra and Zyrtec) target symptoms of runny nose, itching and sneezing, but generally do not decongest (reduce stuffiness) the nasal passages. On the other hand, pseudoephedrine (Sudafed) is a decongestant and can be taken alone or with antihistamine in order to reduce nasal stuffiness. If you only take a decongestant to treat your nasal allergies, you may continue to sneeze, itch and have a nose that drips like a faucet.
Possible associated side-effects of allergy medication
The potential side-effects of a medication are always included on the package insert, but how many people fully read them? Prescription medication provides the pharmacist as well as the prescribing doctor an opportunity to address possible side effects. Some people with glaucoma are advised to avoid antihistamines and decongestants. Antihistamines may also affect bladder tone and cause constipation in elderly people or people with underlying bladder, prostate or intestinal disorders. The OTC status of commonly used antihistamines reduces the opportunities for this exchange of information between the patient and doctor.
Although many allergy medications have rare side effects, drug interactions can occur when multiple medications are taken. The decongestant component of allergy medications (pseudoephedrine) may speed up the heart rate and raise the blood pressure more severely if other medications (for example some medications for Attention Deficit Disorder) that have similar side-effects are taken at the same time.
Helpful drug Combinations for allergy relief
Allergists are skilled in formulating a multiple drug regimen that may help reduce allergy symptoms in a way that minimizes side-effects yet targets specific symptoms in a complimentary way. Many patients are referred to me by their primary care doctors after several attempts to conquer bothersome nasal-sinus symptoms with a variety of pills and nasal sprays. After getting a feel for what the prevailing symptoms are, and what has been effective in the past, I can formulate a drug combination that more directly addresses the allergy problems. This would be very difficult for a patient to figure out on their own, with OTC medications.
People who have mild and infrequent allergic nasal symptoms may greatly benefit from OTC medications taken as needed. Those who have more moderate to severe, seasonal or perennial (year-round) allergy symptoms should have allergy testing and periodic follow-up with their allergist. Good quality of life can be better maintained by visits 2 or more times annually in order to prepare for allergy problems and avoid complications which include sinusitis, ear infections, worsening asthma control, persistent cough and headache.
Do you only seek allergy care when you are sick?
Have I convinced you to consider more periodic follow-ups with your doctor?
Published On: July 06, 2011