We are almost through ragweed season but some of my patients are wondering what made this year's season so bad. Actually, a certain number of allergy sufferers experience a peak in their nasal symptoms every spring and/or fall season which may be worse than previous years. But the most common mid-season question I encounter is: "Why have my medicines stopped working?"
Research on allergy and asthma patients has yielded some interesting information on the use of prescribed allergy medications and "control" of these disorders.[i] A major factor in the successful management of allergic airway problems is "adherence".
Adherence is a term that expresses the degree to which a patient consistently follows an agreed upon treatment plan under the doctor's supervision.
How often do you forget to take your medication?** Have you recently had to miss or reschedule your follow-up allergy appointment?**** Recent allergy research questionnaires and surveys highlight several more reasons for non-adherence:******
- Concerns about side effects (short and long term)
- Lack of immediate improvement
-Convinced that medication is not working or no longer needed
-Belief that medication should be used for a shorter period of time or as needed
-Difficulty in taking the medication (for example, swallowing a large pill or using a nasal spray)
-Medication is too expensive
-Fear of becoming dependent on the medication
Have you ever had any of these concerns?
One of my greatest challenges is getting my patients to a level of understanding about their allergy problems which allows them to overcome many of the fears and concerns mentioned above.
Good allergy management requires effective passage of information between the doctor and patient.
Your doctor can provide better care for your allergy problems if he/she is aware of your specific concerns.
Here are some tips on how to get more from your next doctor visit:
-Express your desired goals each time you have an appointment (for example, reduce nasal congestion, headache or postnasal drip). It is important to be specific and emphasize your most important concerns.
-If you forget to take your medication, share this with your doctor. You may get some advice on how to become more consistent in taking medication. I've had my patients take their nasal sprays right after a bath or shower, in order to make it more routine (and get the sprays in the nose when the passages are more open and clear of mucus).
-Ask about side effects and how severe and how common they occur. What should you do if you have side effects? Are there reports of long term side effects or dependency?
-Share any concerns you have about medication cost. If possible have your formulary list with
you. Your doctor is likely on several different insurance plans all of which have different formulary preferences. There are often multiple brands of medications that serve the same purpose yet may be considerably less costly to you. Many insurance companies will provide you with a formulary list or allow you to download a list from the Internet.
-Ask your doctor to demonstrate how to use a nasal spray (if you are on one). Have your nasal spray technique checked almost every visit. I
flaws in nasal spray technique with my
patients almost every office visit. Prescribed nasal sprays are not easy to use. Many people don't realize they are using them improperly.
-Discuss any concerns you have about the need for taking medication after symptoms are gone.
Ask whether the medication can at times be taken as needed (and how many days or weeks it should be taken before stopping when used as needed).
-Ask about possible drug interactions (when you are on medications prescribed by other doctors) or use of your allergy medication while taking herbal remedies or over the counter meds. Women, if appropriate, should ask about medication use in the setting of pregnancy or breast feeding.
-Try not to miss your follow-up appointments. Schedule appointments a month or two ahead of
your peak season so that you can plan ahead. Ask for a written action plan.
-Make a list of all the above concerns and issues that you identify with and take them with you
to your next appointment.
Good allergic rhinitis control means your sleep state, work or school routine and social and sports/exercise activities are not impacted by allergy symptoms. It means that all your allergy symptoms have been eliminated or satisfactorily minimized. Good control also means you are at reduced risk for sinus and ear infections, worsening control asthma, cough, and sleep apnea.
Does your allergy medication stop working? Not usually, but many factors can reduce its effectiveness, and sometimes, it just isn't enough.
Partnering with your allergy care provider, getting educational materials, establishing an action plan, communicating your concerns and adequate follow-up are major ingredients for success.
The majority of my article came from data and recommendations made in the article below.
[i] Symposium Allergic Rhinitis: The reality of adherence to rhinitis treatment: Identifying and overcoming barriers
D. Buckstein, MD., A. Luskin, MD, J. Farrar, Ph.D. Allergy and Asthma Proceedings July-Aug 2011, Vol 32, No 4 p 265-271