Medications for Allergy

Sprays Work, But Overuse Can Cause Dependence

Nasal sprays are just one type of over-the-counter medicine people will reach for this year as they wrestle with congestion caused by colds and allergies.

Used carefully, the sprays can temporarily alleviate symptoms of sneezing and stuffy nose. But they will not cure the allergy or cold or shorten its duration. And if used improperly, doctors warn, the sprays can cause harmful side effects.

They work by constricting the blood vessels in the nose, temporarily shrinking the mucous membrane, a thin lining that keeps the respiratory tract clean and moist.

Once the medication wears off, blood flows to the vessels again and the membrane tissue swells beyond the point it was before the spray was used, said Dr. Jeffrey Hausfeld, an ear, nose and throat specialist.

Often, people become congested again and use more of the medicine. If this cycle continues for more than three days, irreversible changes can occur in the nasal passages. Experts call this effect “the rebound phenomenon.”

“The mucous membranes start getting bigger, so a person always feels congested,” said Hausfeld, an assistant professor of surgery at George Washington University Medical Center. “The tissue can degenerate into polyps causing chronic infection, and people can get addicted to the nasal spray.”

Because the ingredients in the nose sprays constrict blood vessels, an elevation in blood pressure can occur. People who have hypertension should talk to their doctor before using this type of medication, Hausfeld said.

Warning labels on nasal sprays tell consumers not to use the product for more than three days and to consult a physician if the symptoms persist. But they don’t say a rebound effect can happen if people use the medicine beyond the recommended time.

Hausfeld sees 12 new patients a week who are addicted to over-the-counter nasal sprays.

“Most of the time, people don’t tell me they are using nasal sprays,” Hausfeld said. “They don’t consider it medicine.”

Last year, Americans spent $20 million on nasal sprays, according to estimates by Chain Drug Review, a trade publication. The five best-selling nasal sprays for 1986 were Afrin, Neo-Synephrine, Dristan, Sinex and 4-Way.

Advertising of nasal sprays depicts them as safe and effective ways to treat colds and allergies. They can be useful in treating unpleasant symptoms if used properly and may have advantages over pills or liquid medicines.

“I would argue that the risks of taking what amounts to unnecessarily large doses to your whole body of a decongestant are much greater than something going wrong with nose drops or nose sprays,” said Dr. Sidney Wolfe, director of the Public Citizen Health Research Group. “It is also significantly less expensive to use nose sprays than these combination drugs.”

People have a tendency to think of nonprescription medication as innocuous, said Dr. Edwin Webb, clinical affairs associate at the American Pharmaceutical Association.

It is the person who keeps a bottle beside the bed, in the car’s glove compartment and in the desk drawer at work who is in danger of using the medicine too much, Hausfeld said.

People with constant congestion may suffer from allergies or have a structural problem with their nose such as a deviated septum. The septum, made up of bone and cartilage, separates the nose into two spaces. Chronic congestion is a condition that should be checked by a doctor, said Hausfeld.

If the cause of the congestion is unknown, Hausfeld recommends use of over-the-counter saline sprays. These salt solutions can help keep nasal passages warm and moist.

Nasal sprays were approved by the Food and Drug Administration (FDA) for over-the-counter sales in September 1976.

“They have been in the marketplace for a length of time and have a relatively good record of low instances of side effects,” said Dr. Peter H. Rheinstein, director of the Office of Drug Standards for the FDA.

What’s more, pharmacists can respond to questions and concerns about any nonprescription product should any confusion or problems arise.

Right now, the FDA has two categories for medications, prescription and over-the-counter. The pharmaceutical association believes a third classification may be necessary, in which the medicine would be dispensed under the guidelines of a pharmacist.

“There is ongoing dialogue in the profession about the need for this,” Webb said. “Afrin is an example of a prescription drug going to a nonprescription category, and that movement has sparked discussion of the need for an intermediary category in the process.”

Other concerns center on where people can buy over-the-counter medicine. If it is bought in supermarkets, which captured 23 percent of the $20 million in nasal spray sales last year, people may be less likely to ask questions or seek advice from a pharmacist.

More Information

The American Pharmaceutical Association publishes a “Handbook of Non-Prescription Drugs,” which provides technical and nontechnical information on over-the-counter medicines.
The Washington Post

Halloween arrives this weekend, and many kids are looking forward to restocking their candy supply. But for kids with food allergies, Halloween isn’t so simple.

Living with food allergies can be complicated–especially at Halloween! While other kids stuff their bags with goodies, kids with allergies have to be careful not to collect foods that could make them sick.

People with food allergies have abnormal responses to items such as nuts, milk, eggs, soy, fish, shellfish and wheat. When someone with a food allergy eats what experts call a “trigger” food, the symptoms can include hives, vomiting, diarrhea and even breathing problems.

Food allergies are no joke: In some cases, just one bite of food can bring on anaphylaxis, a severe allergic reaction that can cause body systems to shut down. In extreme cases, anaphylaxis can cause death.

Unfortunately for people who have them, the only way to manage food allergies is to strictly avoid the foods to which they’re allergic. They have to learn how to read food labels carefully and how to spot high-risk foods that might contain hidden allergy triggers.

At Halloween, being on guard against trigger foods can be a real challenge. Like other children, trick-or-treaters with food allergies want to collect as much candy as possible. However, many candies don’t have ingredient labels. Those candies just have to be shared with someone who doesn’t have allergies or thrown away.

That doesn’t mean that kids with food allergies have to avoid the holiday entirely. But they do need to be extra careful, and to ask for some adult help to celebrate safely.

Of course, if you don’t have food allergies, you still need to be careful about what you eat on Halloween. It’s really hard to resist the temptation to start gobbling while you’re still out going from house to house–but you have to do it! To be safe, wait until you get home and can see exactly what you’ve collected. Ask your parents to help you go through your goodies in the light. Throw away anything that might not be safe, including loose or unwrapped candy, apples and other fruit.

Halloween’s almost here. Following these tips from the American Red Cross will help you and your ghoulish friends stay safe while you’re scaring the living daylights out of the little kids on your block:

* Walk, slither and sneak on sidewalks, not in the street.

* Look both ways before crossing the street to check for cars, trucks and low-flying brooms.

* Cross the street only at corners.

* Don’t hide between parked cars.

* Wear light-colored or reflective clothing so you are more visible. (And remember to put reflective tape on bikes and brooms, too!)

* Plan your route and share it with your family. If possible, have an adult go with you.

* Carry a flashlight to light your way.

* Keep away from open fires and candles. (Costumes can be extremely flammable.)

* Only visit homes that have the porch light on.

* Accept your treats at the door and never go into a stranger’s house.

* Use face paint rather than masks or things that will cover your eyes.

* Don’t eat candy if the package has already been opened.

Happy haunting!

TIPS FOR PARENTS

The Food Allergy Network offer these tips to help children with food allergies safely enjoy trick or treating:

* Early in the day, deliver raisins, pretzels, stickers or other special treats for your child to your neighbors’ homes. (It is important for children to feel “normal,” so be discreet.)

* Tell your neighbors what character your child will be dressed as so they can hand out your treats to your child.

* Explain to your child that if the candy does not have an ingredient statement, it will have to be traded for one that does.

* Plan to trade the “forbidden” candies for others when your child gets home.

* Nonfood treats can include stickers, wash-off tattoos, small toys, stamps or other inexpensive trinkets.

* Accompany your child to be sure that he or she does not eat any candies before you read the ingredient label.

For more information on food allergies, contact the Food Allergy Network, 10400 Eaton Place, Suite 107, Fairfax, VA 22030-2208, or call 1-800-929-4040.

For you to do

If you have a food allergy, then you know how tough it can be to do ordinary things like trick-or-treat or go to birthday parties. The Food Allergy Network is working on a book about what it’s like for young people to live with food allergies. Your story might help them. Your essay doesn’t have to be long; a few paragraphs will do. You can submit it by e-mail to webmaster@foodallergy.org. Tell a little about yourself, too–such as your name, age, what foods you are allergic to, your hobbies and what advice you would give to other kids with food allergies. If you can’t use e-mail, you can send your essay to the Food Allergy Network at the address listed above.

The Washington Post



Hay Fever Victims Suffer as Area Pollen Count Soars

Debbie Adams knows when it’s spring. She can’t smell it.

The 36-year-old nurse has a pollen-sensitive nose that sort of shuts down at this time of year, which is something of an occupational handicap: Adams works in an allergy clinic in the District, and it’s her job to collect pollen grains each morning-and count them.

“When the count is under 100, you feel like you want to sneeze 12 hours a day,” she said. “When it’s over 100, you want to rip your face off.”

Adams is not alone. In Washington, often called the allergy capital of the world, she and at least 150,000 to 200,000 area asthma or hay fever sufferers are having an especially miserable time of it.

The pollen count hit 256 on Friday, a high so far this year, and the folks who keep track of such things say pollen levels are worse than usual, even for this town.

The region’s pollen-plagued patients are filling up doctors’ offices as fast as smelling the roses fills up their sinuses. Some allergy clinics are treating 60 to 80 people a day for this seasonal malady, which can stretch from March through October, depending upon the sufferer’s sensitivity to tree, grass or weed pollen.

“A lot of people call this the allergy capital of the world,” said Dr. William F. Thompson, an allergist. “It’s bad because we have a lot of different types of pollen and a fairly long pollen season, but I’m not sure we can say we’re Number One or Number 10.”

So how bad is it? In Washington, at least, where high winds stir the pollen and spread its mischief, reports indicate that every little breeze whispers more than Louise.

“Overall, the pollen count is a lot higher this year,” said Bob Day, environmental health director at the National Capital Area Lung Associations.

The Friday count of 256, the most recent available, is a reassurance of sorts that the air is as pollen-heavy as one’s itchy eyes and stuffy nose might suggest. By way of comparison, doctors say a count of 10 or more is enough to cause symptoms in the majority of patients with pollen allergy. And when it starts pushing 60 or 70, those with allergies are supposed to stay off the golf course and forgo mowing the lawn.

While the high last year was a mere 239, sufferers can take comfort perhaps in knowing that it has been worse. The record pollen peak in recent years occurred on May 2, 1986, when the count shot up to a head-splitting 280.

For Mae B. Staton, 44, that much pollen is life-threatening.

“It’s something killing me like a slow death,” said Staton, a District resident whose multiple allergies often send her to the hospital emergency room.

She receives two to three allergy-fighting injections a week and wears a mask over her nose and mouth whenever she goes outside. Still, her allergic reaction to pollen produces fluids that build up in her eyes and nose, cause pounding headaches and drain down her throat.

“I have to stay in because when I go out, it makes me sick,” said Staton, who keeps the air conditioning or humidifier turned on in her home virtually nonstop.

Nurse Adams, on the other hand, braves the elements . . . and suffers the consequences. Each weekday morning between 7 and 8 a.m., she heads for the roof of the downtown medical building that houses Thompson and Yuill Black’s allergy clinic.

There, she collects the gel-coated slide put out the day before to catch pollen particles in the air. Back at the office, she puts the slide under a microscope and, in the true sense of the word, painstakingly counts the number of pollen grains-a count immediately relayed to the Air Quality Information Service telephone tape (682-0677).

When the count is high, Adams can feel the pressure in her sinuses even before she puts the slide under the microscope. When it’s really high, her eyes water while she is counting.

“My nose can swell up to the point where I can’t breathe,” she said. “It’s like a head cold with no cold.”

The high count has kept allergy physicians busy, too busy in some instances to discuss the finer points of pollen with anyone but their patients. And more than a few doctors, some for the first time, have had to put themselves on the allergy sick list.

“I’ve really felt it this year, and I’m going to take shots,” said Robert Pumphrey, a physician with the Ear, Nose and Throat Medical Group in the District. “Washington has more than its share of airborne substances.”

But it’s obviously not the only place with a problem. An estimated 24 million Americans suffer from asthma or hay fever, conditions caused or aggravated by an allergy to airborne pollens.

Pollen is the fine, powder-like material produced by flowering plants, and it functions as the male element in fertilization. In pollination, insects or the wind carry the pollen to its female counterpart. But the wind also spreads it to people.

“If there was no wind, the pollen would just drop off and fall to the ground,” said Pumphrey, who paints a rather pathetic portrait of the Washington environment and its impact on allergy sufferers.

North America in general and the region in particular, according to Pumphrey, have temperate climates and a lot of trees that reproduce by windborne pollination. In addition, an urbanized area such as this, where land has been cleared for development, is a breeding ground for weeds, especially ragweed.

And, as if that’s not enough, the District also has to contend with mold, a souvenir of its birth atop reclaimed swampland, and air pollution.

“This area has something to bother people all year round,” Pumphrey said. “The tree pollen starts arriving in late February, then the grass pollens in April and May and then the weeds into July and August. The ragweed season lasts till the first frost, then all the leaves drop off and you get mold, and the wind blows that around.”

In 1966, Kimishige Ishizaka, now at Johns Hopkins University, isolated and identified the antibody, immunoglobulin E, or IgE, that causes the allergic reaction to pollen. Since then, scientists have developed more accurate techniques for desensitizing the body and turning off this reaction.

At the same time, antihistamine pills, particularly a brand advertised as Seldane, and steroid nose sprays bring some relief from swelling and inflammation, according to several physicians.

The injections, pills and doctors visits add up, however. Allergy and asthma sufferers in this country may spend as much as $1 billion a year on allergy treatment, according to the National Institute of Allergy and Infectious Diseases.

Adams said weekly shots “during my bad times” help her function. “Otherwise I would walk around with Kleenex stuffed up each nostril and be absolutely useless.”

Tim Logue, 34, another pollen sufferer, also takes weekly injections during the allergy season-and fights with his car pool members to keep the windows of the vehicle closed.

“The drive home used to be, and still is, a point of dread during high pollen days if it’s not warm enough to put on the air conditioning,” Logue said.

Martha Ellis, a maintenance supervisor with the U.S. Park Service, finds that a lot of the available medication leaves her drowsy.

Her job keeps her outdoors no matter what the pollen count, so she takes an antihistamine pill in the morning, when she feels most alert.

For coworkers who need more protection, the Park Service provides paper dust masks and plastic air filters.

Allergists recommend that pollen sufferers stay in air-conditioned rooms as much as possible, sleep with their bedroom windows closed and drive in air-conditioned cars, even on comfortable days.

If all else fails, consider moving.

Pollen dust hits the Midwest the hardest, according to allergists, with the East a close second. The southern tip of Florida and the northern tip of Maine are more pollen free, while the Western states supposedly offer the most relief.

But be careful, lest you head west and expose yourself to a whole new set of allergies. Arizona, for instance, has tumbleweed and sagebrush. It also has grass, much of it planted by pollen sufferers who relocated.

“I have a couple of patients who went to Tucson and wrote back, `I’m not better here,’ ” Thompson said. “We have problems pretty much all over.”

The pollen invasion

As the pollen season starts up, allergy sufferers are feeling the effects. Microscopic grains of pollen released by budding plants and trees drift through the air. When the pollen is inhaled it binds to the moist walls of the nasal passages. The immune systems of allergy sufferers overreact to the pollen invasion, releasing chemicals that cause the sneezing, congestion and itching of hay fever.

Trees: Oak, maple, birch, elm, box elder, cedar and junipers, hickory, mulberry, ash, cottonwood, poplar, hackberry, beech, local pines

Grass: Timothy grass, Bermuda grass, redtop, vernal grass, orchard grass, rye grass, bluegrass, June grass, Johnson grass

Weeds: Ragweed, pigweed, lamb’s quarters, Mexican firebrush, cocklebur, plantain, dock, sorrel

National Geographic Society

When mainstream physicians talk about food allergies, they usually refer to responses in which the immune system, in reaction to a food, produces an antibody called immunoglobulin E (IgE). This in turn can trigger a range of symptoms, from a rash and wheezing to potentially fatal episodes of anaphylactic shock.

Symptoms Shortly after a food is eaten, symptoms can include itchy mouth, vomiting, diarrhea and abdominal pain. After entering the bloodstream, which can take a few minutes or a few hours, the allergens may produce a drop in blood pressure, hives, eczema or asthma. Very rarely, food allergies can cause anaphylactic shock, an extreme allergic reaction which can begin with itching, tingling or a metallic taste in the mouth within minutes and progress to loss of consciousness and death.

Common Reaction-Causing Foods Milk, eggs, peanuts, tree nuts (walnuts, cashews, pecans), fish, shellfish, soy, wheat.

Diagnosis and Testing Typically, a doctor will begin by asking questions to assess whether reactions to foods are consistent with food allergies rather than another problem. Not all allergies can be identified this way.

The next steps are for the patient to keep a food diary for one to two weeks and to gauge symptom relief after eliminating suspect foods. Both steps will help to narrow the list of possible allergies before a doctor uses diagnostic tests.

Lab tests include a scratch/prick skin test, a blood test, RAST (radioallergosorbent test) and ELISA (Enzyme-Linked Immunosorbent Assay). A positive test result does not always identify an allergen, however.

Double-blind food challenges are the gold standard test for linking food consumption and allergic reaction. But they are expensive and time-consuming and rarely used. A patient swallows opaque capsules filled with potential reaction-causing foods, and the doctor watches for a response. Both doctor and patient are “blind” to the contents of the capsules. A reaction will confirm the food allergy.

Management IgE allergies are considered permanent. Management involves avoiding reactoin-causing foods and treating symptoms. Antihistamines are commonly used to relieve gastrointestinal symptoms, hives and sneezing, but they are not effective at preventing the allergic reaction from happening. Some people with food allergies carry an Epi-pen, a prescription device that can dispense epinephrine in case of a serious allergic reaction.

FOOD INTOLERANCES Symptoms of food intolerances often resemble those of food allergies; the key difference is that intolerances do not involve the immune system. In lactose intolerance, often misidentified as a food allergy, a deficiency in the enzyme lactase leaves some lactose undigested and allows it to enter the intestines. Bacteria there processes the sugar, releasing gas, which leads to the bloating, abdominal pain and diarrhea characteristic of the food intolerance.

IgG ALLERGIES The immune system can produce a number of antibodies in response to foods, one of which is immunoglobulin G (IgG). The question of whether an elevated level of IgG constitutes an allergic response — and whether it can be responsible for the vast range of symptoms some practitioners of IgG testing and treatment claim — remains unanswered and highly controversial.

Practitioners of IgG allergy testing and treatment believe elevated levels of these antibodies ultimately affect a broad range of tissues and organs. Common symptoms of IgG-related allergies include recurring respiratory infection, ear infection in children, eczema, migraines, achy joints and gastrointestinal irritations, according to Noel Peterson, a naturopathic doctor based in Lake Oswego, Ore., who uses IgG testing in his practice to identify food allergies. These symptoms can occur hours or days after the food is eaten. IgG trigger foods may include dairy products, eggs, wheat, pineapple, yeast, corn, gluten and soy.

Critics say the IgG mechanism has not been proven by solid research, that the body makes IgG in response to many foods and that tests can’t accurately measure IgG levels anyway. Under this view, patients of practitioners who use IgG tests are “cured” of their diverse symptoms not by exotic dietary restrictions but by the placebo effect or other factors. Without an understanding of the IgG allergic mechanism, interpreting elevated IgG antibody levels is impossible, these critics say.

“Whether [IgG antibodies] cause allergies or are just one of many players is not clear,” said Suzanne Teuber, an allergy specialist at UC Davis Medical Center in Davis, Calif. “Labs will say that every symptom under the sun is related to a food allergy and they can test for IgG, but those diagnostic tests are unproven.”

Commercial labs offer blood tests that check for both IgE and IgG antibodies.

The Washington Post

Diagnosing and treating allergies

When a physician is evaluating a person for allergies, there are several steps involved. First, the patient’s history is taken. Then, the patient is examined. Depending on the patient’s symptoms, several tests might be done. Since some medications (especially antihistamines) can affect test results, a person should ask the health care provider which medications should be stopped days before the testing is to take place.

Skin (scratch or puncture) testing

In this test, a variety of substances that are common to the region in which the person lives are evaluated. Tiny amounts of fluids containing allergens such as pollen, animal dander, dust mites, and molds are placed just under the surface of the skin. Within 15-20 minutes, swelling occurs at the site of any substance to which the person has an allergy. The severity of the reaction can indicate the person’s level of sensitivity.

Virtually painless, this form of testing offers immediate results and almost no risk of serious allergic reaction. This test is usually used to assess reactions to respiratory allergens.

Intradermal testing

These tests are similar to scratch or puncture tests, but are slightly more involved. Tiny amounts of allergens are injected under the skin. Intradermal tests are often done if the scratch or puncture test results are not complete or useful.

Blood (RAST) testing

In these tests, a person’s blood is combined with an allergen to determine whether any IgE antibodies react. If there is a reaction, there is likely an allergy to the tested substance. Although slightly more expensive than skin tests, this test is relatively painless, offers fast results, and provides almost no risk of serious allergic reaction. Blood testing is often used to evaluate reactions to insects and medications in people for whom skin testing is not an option.

Patch testing

For this type of test, allergen-specific adhesive patches are placed on a person’s skin and left for 72 hours. The sites that show swelling or redness indicate an allergic response. This form of testing is commonly used to assess reactions to metals and cosmetic additives.

Provocative testing

This type of testing is also called challenge testing. Usually, the substance in question is administered in an effort to provoke symptoms gradually. A trace amount of the allergen might be administered in an aerosol spray. The person’s reaction to the allergen indicates to the physician both the nature of and the severity of the symptoms. Provocative testing can be uncomfortable. Severe allergic reactions can occur.

An infant’s sensitivity to a food or even a food allergy might be diagnosed at home first. If a parent knows that there is a family history of food allergies, there is a way to avoid having an infant experience full-blown symptoms. By gradually introducing small amounts of new foods — one at a time — parents can isolate a reaction. If a few foods are grouped together in a single meal, it is far more difficult to figure out which one is causing the reaction. If, however, a parent already suspects that a child has a food allergy, it is best not to test this suspicion any further at home. Safer testing can be done in an allergist’s office.

A person can be treated for allergies, but not cured. The range of treatment options provides some relief for most people. As mentioned earlier, one common form of treatment involves ongoing allergen immunotherapy (also called allergy desensitization injections). Those who suffer from reactions to airborne allergens and insect stings find this form of treatment quite beneficial. Over time, a series of injections containing the offending allergens is given in an effort to build the immune system‘s defenses against them.

When a person first begins allergen immunotherapy, a very diluted form of the allergen compound is given. Gradually, more of the substance is added to the injection. Eventually, the allergist determines that the optimal dose has been reached. The allergist could also determine that the person is at risk of developing an allergic reaction if the injections continue. Whatever the determination is, at this point the therapy ends.

The entire process of allergen immunotherapy can last for years. There is some evidence that this type of therapy works by tricking the immune system. As increased amounts of the allergen are injected, the immune system starts to produce a blocking antibody (IgG). The IgG antibody competes with the allergy antibodies (IgE) for the allergen, takes it over, and then does two things that halt an allergic reaction: It prevents the mast cells from activating and it stops the release of histamines.

Most of the oral medications that are used to treat allergies fall into two categories: antihistamines and decongestants. Antihistamines prevent a histamine — a chemical that the body produces during an allergic reaction — from taking effect. Antihistamines are available over-the-counter in tablet and liquid form; they are also available as tablets, liquids, and injections with a prescription. Decongestants work by shrinking blood vessels and decreasing fluid leakage so that nasal congestion is reduced. Both liquid and tablet forms are available as over-the-counter and prescribed medications. Often, antihistamines and decongestants are combined in a single medication to address a greater number of symptoms.

For an acute allergic reaction that involves a great deal of congestion, a physician might recommend a decongestant in the form of drops or a nose spray. The over-the-counter form of medication should not be used for more than three or four consecutive days. Otherwise, it can actually increase nasal congestion. A prescription form of this medication can be used for a longer period without producing this side effect.

Nasal steroid inhalers or sprays can offer fast relief by reducing inflammation and swelling, as well as by slowing the rate at which histamines are released. These sprays deliver a very fine mist directly into the lining of the nose. They temporarily constrict the blood vessels in the swollen tissues within the nose. They also temporarily open a larger passage to allow for the free flow of air. When the effects of the spray wear off, the swelling returns. Sometimes, the swelling has grown worse. When this happens, most people just reuse the spray. Unfortunately, a series of brief periods of relief can lead to longer bouts of congestion. It is important to note that decongestant nasal sprays can be overused. If a person does overuse these sprays, his or her heart rate can increase and blood pressure can rise.

The good news is that most allergy symptoms can be treated easily and safely. The bad news is that, on rare occasions, an allergic reaction can be deadly. As we discussed earlier, anaphylaxis is a severe, sometimes fatal, allergic reaction. It is usually treated with an injection of epinephrine, and antihistamines and steroids are also given. The sooner the allergic person gets treatment, the less severe the symptoms will be. Epinephrine can stop the progression of anaphylaxis; antihistamines and steroids cannot. Antihistamines and steroids should never be given instead of epinephrine, because, while they can help recovery, they cannot reverse the symptoms of anaphylaxis.

Often, a person who has a severe food allergy learns about it only after exposure to the trigger. Such exposure can happen as a result of breathing in or eating the substance. After the symptoms are treated, contact an allergist for follow-up care. The allergist can help determine what trigger caused the reaction. This is very important in preventing anaphylaxis from happening again.

Although triggers that are foods may be easy to avoid, it might be trickier when the allergen is a food additive. This is why it is crucial to be under a doctor’s care. If anaphylaxis happens again, the person might already have an injection of epinephrine handy. Using this medicine will keep symptoms under control until the person can be taken to a hospital. An allergist can even offer treatments that can help build immunity to some triggers. For example, if anaphylaxis is triggered by insect stings, ongoing allergy shots can help build tolerance to the venom.

Here are some suggestions for what can be done to assist someone who is experiencing anaphylaxis:

1. Ahead of time, learn enough about the symptoms to recognize when the reaction is occurring.

2. Get medical help as soon as possible.

3. Do not allow a person who is undergoing this type of reaction to drive.

4. Even if the person receives treatment at the location where the reaction occurred, it is vital that he or she go to an emergency room, where the condition can be monitored.

5. Make a note of what could have caused the reaction and what amount of time elapsed between exposure and reaction. Having this information could help to prevent a future reaction.

Preventing and controlling allergies

For most allergies, preventing or controlling symptoms requires a few simple steps. Depending on the severity and frequency of the reaction, almost all symptoms can be minimized by changes in environment and the person’s behavior. Once the triggers are known, they should be avoided. Changes to the home, school, and work environments can significantly reduce the person’s exposure to a variety of allergens.

The most important behavioral change that a person can make to help prevent and control allergies is to use all available methods of treatment. Allergen immunotherapy can help build tolerance against specific allergens. Other medications can help prevent or control symptoms that do recur. A person who suffers from allergies can also improve his or her general health by eating nutritious foods, exercising regularly, and getting enough rest.

At the very beginning of life and during early childhood, measures can be taken to help prevent some allergies. Researchers have known for some time that breast milk is far more nutritious for infants than formula, cow’s milk, or soy milk. Studies show that infants who are breast-fed are less likely to develop allergies to a variety of substances. The lower incidence of allergy in children who were breastfed might result from the mother’s immunities being transferred to the child through the breast milk.

Asthma and Allergies: The Science Inside

Another way to help lower the risk of allergy — specifically, peanut or nut allergy — involves not exposing children under the age of three to peanut products. Allergists believe that one reason that there are so many children in the United States with peanut allergies might be the extensive early exposure they have to peanuts. Many young American children regularly eat foods that contain peanuts or peanut products.

In the case of life-threatening allergic reactions, prevention is possible only if the trigger can be completely avoided. This is difficult to do, so additional measures must be taken to control symptoms. If a person has had an anaphylactic allergic reaction in the past, a physician might suggest carrying a supply of epinephrine at all times.

Regardless of whether the trigger is or is not known, the symptoms certainly are. Having a supply of a medication that can offer immediate relief will help get the symptoms under control until the person can be taken to a hospital. Since this medication is given in the form of an injection, the person who carries it must know how to administer it. However, because there is a possibility that the person having the reaction might be incapable of completing the injection, a companion should also know how to administer it. Another measure that can help save the life of a person known to have anaphylactic reactions is even easier to do: Have the person wear a medical bracelet that indicates to medical personnel and others the nature of the person’s allergic condition and any possible triggers.

In the United States, allergies are the sixth-leading cause of all chronic diseases. Allergies can develop at any age, even in the elderly. There are 50 million children and adults affected by allergies in this country alone, approximately 35 million of whom suffer from hay fever. The financial impact of hay fever in the United States in 1996 totaled $6 billion by itself. And, in 1998, increased absenteeism and reduced productivity due to allergies cost U.S. companies more than $250 million.

With tens of millions of sufferers in this country alone, allergies are now considered a serious disorder. Up to 10% of the population may be at risk of allergic reaction to medications. Food-induced anaphylaxis results in 30,000 visits to the emergency room each year. Approximately

10-17% of people working in health care have an allergy to latex. Up to 4% of the population has experienced anaphylaxis that was caused by an insect sting.

Asthma also has serious consequences. If asthma is not managed properly, the cost of treating the condition increases. According to the Asthma and Allergy Foundation of America, over the last 10 years the costs that resulted from adults missing work because of their own asthma quadrupled. The number of adults who stayed home to care for children with asthma increased lost work time costs in 1998 by $3.8 billion. That same year, overall costs for visits to physicians, hospitalizations, and medications that resulted from asthma symptoms totaled $7.5 billion. Of this total, the greatest portion was spent on hospitalizations. Asthma symptoms result in 1.8 million emergency room visits, 10 million visits to a physician’s office, and half a million hospitalizations each year. Among children aged 5 to 17, asthma symptoms are the leading cause of absence from school — a loss of more than 10-14 million school days each year.

Asthma can also have a serious financial impact on a family. When a child has to stay home from school because of asthma symptoms, a parent often has to miss a day of work. Repeated trips to a physician’s office or emergency room or multiple stays in a hospital can be costly even when a family is insured. When a family is uninsured, these expenses can be devastating.

The best way to avoid the high costs of asthma and allergies is to have the conditions diagnosed and treated as early and as consistently as possible.

Besides AIDS and tuberculosis, asthma is the only chronic disease that has an increasing death rate. Between 1978 and 1992, the death rate from asthma increased 58%. Between 1980 and 1993, the death rate for children under 19 increased 78%. More females die of asthma than males, as do more African Americans and Hispanics than whites. Higher rates of asthma-related symptoms, hospitalizations, and death among African Americans and Hispanics seem in part to be due to poverty, poor urban air quality, indoor allergens, inadequate information, and a lack of medical care. While African Americans make up 12.8% of the population of the United States, they account for 23.7% of the total number of deaths due to asthma.

Among Hispanics, Puerto Ricans seem to have higher death rates from asthma than any other group. Unfortunately, scientists do not yet know why this is so. Recently, in the American Journal of Respiratory and Critical Care Medicine, a study revealed that Puerto Ricans had an annual death rate of 40.9 per million due to asthma. Cuban Americans had a rate of 15.8, and Mexican Americans a rate of 9.2, per million. If asthma is properly managed, however, the death rates due to the condition could decline.

When adequate medical treatment is not available to help prevent the symptoms of asthma from becoming severe, hospitalizations and emergency room visits become necessary. In general, more than four times the number of African Americans are taken to emergency rooms because of asthma attacks than those of other races. African-American children are three times more likely to be hospitalized for asthma than white children.

A study published in the Journal of Asthma (July 1999) revealed that hospitalization rates for asthma in New York City were 21 times higher among those who lived in low-income neighborhoods and minority neighborhoods. Physicians at the New York Academy of Medicine studied 107 children with severe or chronic asthma, most of whom were Puerto Rican or African American. Only 39% of these children were using anti-inflammatory medications daily.

There appears to be some evidence that certain aspects of community life among Hispanics and African Americans account for their higher rates of asthma.

Every form of air pollution — ozone, sulfur dioxide, acidic air particles — is more common in urban, minority neighborhoods. High crime rates create stress for those who live in these areas. In 2000, Harvard researchers said that in a study of children under the age of 26 months, children were twice as likely to have physician-diagnosed asthma if they lived in areas with higher rates of violent crime and vacant housing. Researchers found that in these same areas, children over the age of two had a 40% increased risk of being diagnosed with asthma.

Residents of high-crime areas cannot control the gun violence and the stress caused by it.

However, there is another asthma trigger that can be reduced, which is found inside many households in these areas. The National Inner-City Asthma Study found a relationship between inner-city residents and asthma resulting from exposure to cockroach droppings. If measures are taken to reduce the number of cockroaches in a home, this will decrease the number of droppings that an asthmatic is exposed to in bed-sheets, food, bathroom towels, and carpeting.

A similar program in Seattle for low-income children with asthma used community-based lay health workers who focused on multiple triggers, including dust mites, house dust, mold, moisture, environmental tobacco smoke, roaches, and rodents. This one-year Seattle Healthy Homes intervention showed a reduction in both the number of days with symptoms and emergency clinic visits, as well as a significantly improved quality of life for caregivers.

It is estimated that, out of the 17 million Americans who suffer from asthma, 5 million of them are children. Childhood asthma is so common that it results in nearly 3 million visits to a physician and 200,000 hospitalizations each year. Asthma often begins in early childhood. Up to 80% of children with asthma show symptoms of the condition before the age of five. The first signs of asthma in infants and children are often a cough, a fast or noisy breathing pattern, and chest congestion. These asthma symptoms can be so subtle that the children might not even be aware of them. For example, a child might grow so accustomed to chest tightness that it seems normal. This is why it is crucial for parents to take note of these subtle changes. A parent’s observations could be the basis for a physician to diagnose the condition sooner.

Some children will outgrow the disease, but others will not. It is just as unclear why asthma starts as why it goes away. Severe childhood asthma often goes away, but mild asthma often does not. If asthma occasionally occurs in childhood, especially as a result of viral respiratory infections, there is a greater chance that the symptoms will ease with age. In fact, about half of all children who have chronic asthma will have fewer symptoms or none at all by adolescence. Since older children tend to get fewer viral respiratory infections, this alone might account for fewer asthma attacks.

It is also possible that the asthma symptoms will remain, but that the triggers will change. An older child who once suffered from asthma due to viral infections could begin to experience attacks triggered by allergens or environmental factors.

Childhood asthma can lead to many absences from school. The symptoms of asthma can make participation in a variety of activities difficult for children. As a result, a child can feel left out. In addition, the symptoms of asthma — especially difficulty breathing — can leave a child feeling scared. Although having asthma at a young age can lead to restricting activities initially, every effort should be made to help asthmatics live normal lives. With proper treatment and management, many young asthmatics can excel in sports. In fact, a great number of accomplished athletes around the world have been asthmatic. Some have even competed in the Olympics and for professional sports teams.

As for allergies, some of the most serious allergy symptoms that a child can experience are triggered by foods. Food allergies were reported in Europe as early as the beginning of the 1900s. Physicians around the world have been treating food allergies since the 1940s. Children account for the majority of those affected by food allergies. In the United States, 6-8% of children and 2% of adults have food allergies, and about 100 people die each year from food-related anaphylaxis. According to a recent study, teens who have a food allergy as well as asthma are more likely to experience anaphylaxis for several reasons: They often dine away from home; they do not always carry medications with them; they might not recognize symptoms; and even if they do, they might ignore the symptoms.

For both asthma and allergies, mild and severe forms of the conditions occur in children and should be treated at the first signs of symptoms. Early, consistent treatment is important for several reasons. First, it could prevent the condition from getting worse. In fact, there is some evidence that allergen immunotherapy can actually help a child outgrow allergies. Second, if symptoms are left untreated, learning and development can be affected. Third, it is always important to give a child whatever he or she needs to experience life in the fullest, healthiest way possible. If a child is always coughing or struggling to get a full breath, he or she is less likely to attend school, socialize, or play. Even a child with severe symptoms should feel as normal as possible.

To help a child manage asthma and allergies, it is important for parents, physicians, and school administrators to work together and keep certain goals in mind:

• Reduce or avoid triggers. This means establish a smoke-free, clean environment in which animal dander and dust mite and cockroach droppings are minimized. Also, reduce the overall amounts of dust, mold, and mildew in the home.

• Foster an overall healthy lifestyle. Make sure that the child has a good diet, proper rest, and exercise. Also, make sure that all medications are available and are used correctly. An asthma care plan should be clearly communicated by the child’s health provider and given to the parent for posting at home.

• Help the child achieve emotional health. Inspire confidence in the child. Give the child opportunities to achieve and succeed. Encourage the child to see herself or himself as a healthy person, not a sickly person.

• Prevent symptoms from threatening normal living. If the child is constantly struggling to breathe, it will make concentration on schoolwork, friends, and exercise more difficult. With proper management of symptoms, exercise should be encouraged not just for the child’s overall well-being, but also to strengthen his or her upper respiratory system.

• Foster communication to create a supportive environment. Make sure that the principal, teachers, coaches, and school nurse are all aware of the child’s condition and the specifics of treatment. Make sure that the child is allowed to take medications on schedule and follow other directions of his or her asthma care plan. Every effort should be made to treat the child normally. However, all school personnel should be prepared to assist the child in case of an allergic reaction or an asthma attack.

Lichtenstein: I haven’t seen those recent data, but when you went from one to eight injections, you were getting closer to the regular preseasonal schedule which involves 16 injections.

Creticos: That’s exactly the point that we’ve made. The question is: with peptide injection therapy are you going to be able to “get away with” just a couple of injections and accomplish the same therapeutic benefit that otherwise would require many injections over several years with traditional therapy? The first question that must be asked is: how does this stack up against its natural counterpart co-seasonal, pre-seasonal therapy? In those early studies it took 20 injections to reach “maintenance” and then you went into the ragweed season. Certainly the observations here are that injections times four are not as good as injections times we should really characterize this carefully in terms of dose frequency. I think one of the most useful studies would be a dose frequency study evaluating 250 µg times four versus 250 µg times eight versus 250 µg times 16 injections.

Metzger: In terms of your cat allergen studies, have you ever exposed these people to chronic exposure as opposed to intermittent challenges on immunotherapy? What do you think the value of the immunotherapy is going to be? My impression is that with intermittent exposure it works quite well, but with chronic it doesn’t.

Creticos: I think that’s a very good question. These studies have all been done with live cat room exposure and patients who do not have pets at home. We surely do know that cat allergen is ubiquitous. True, you can bring the allergen home on your clothes, but you won’t be exposed to as much allergen on a “prn” basis as opposed to having a cat in the bedroom. Those studies have not been done, but they’ve not been done with conventional therapy either. My NIH grant right now is studying cat-allergic asthmatics with cats in the house; we’re going to look at the effect of immunotherapy in that group of patients.

Gelfand: You started by saying that you have to give immunotherapy for a long period of time and you chose five years, and you also talked about concentration. A number of studies are suggesting that with the more rapid administration, for example under rush immunotherapy protocols, you can achieve tolerance much more quickly. Any thoughts about that, particularly in terms of the design of some of these studies as opposed to dragging them out?

Creticos: Hal Nelson is looking at rush immunotherapy and I think the relation here is looking at ways to immunize patients more effectively and more efficiently, which really gets to convenience and compliance. Getting patients injected serially over months and years is very difficult and not very user-friendly. The question is: can we alter this process with either oral immunization, for example, which is user-friendly, or with the rush regimen, where you do have to balance this out in terms of the reaction rates that would occur? But a rush regimen, where you might be able over a matter of three visits or two or three weeks could accomplish the same effect. We have studied rushe and cluster regimens with Dr. Thomas Van Metre and Dr. Frank Adkinson and the kinetic responses are very similar to conventional therapy.

Gelfand: In a recent study that we just published (J. Allergy Clin. Immunol. 99:530-538, 1997), the changes in IgE were not the issue, but you can achieve tolerance on provocation by skin testing and also change other T cell responsiveness within a two-week period with a rush protocol.

Creticos: This paper certainly raises the issue that the allergic diathesis is on the one hand a T-cell driven process. Immunotherapy appears to alter effectively this mechanistic component.

Platts-Mills: Do you have any vision of where all these peptides go? On a molar basis you’re giving a dose about four orders of magnitude higher than that of normal immunotherapy? Do you think that 99% is just metabolized straight?

Creticos: That’s a good question. I don’t know. With conventional therapy we give 6-12 µg of the major protein per injection; over the course of the year you’re going to give about 125-150 µg. And with peptide therapy we’re giving 750 µg or 250 µg of peptides. I don’t know how the lymphoreticular (endothelial) system handles this.

Rihoux: In Europe an increasing number of patients are treated with acupuncture for allergy and when we see your results with placebo injections maybe it’s not astonishing. It could be interesting to introduce a group of acupuncture-treated patients. Do you observe objective improvement in the T cells in vitro after treatment?

Creticos: That’s a very good question. In the previous study I mentioned with Phil Korma and David Proud, we showed that biofeedback and behavioural modification did influence mediator release upon nasal challenge. This suggests that “placebo” effects may have distinct neurosensory or neurovascular components.

Hogg: I’m not an allergist and this may be a very naive question. How critical is the size of the peptides?

Creticos: We were discussing this yesterday in the break and there are two schools of thought: one that it’s very critical and the other that it’s not. There is no confirmatory evidence one way or the other. Many researchers suggest that 8-15 amino acids fit best into the “groove”. With this product we are looking at overlapping peptides — multiple epitopes of 21-26 amino acids each. Barry Kay says that perhaps they are too large and that’s why you see the ability to induce an IgE response, and hence reactions. But I think some of the animal data would suggest that that’s not the case and that these are still quite small peptides and should not be inducing any effects. That leads us to the next question: what is the basis for the reactions that are seen, are they IgE-mediated? Larry pointed out yesterday that we very carefully examined patients during their reactions — trying to measure tryptase, histamine and urinary prostaglandins. We’ve not been able to identify any consistent markers that suggest these were mast cell driven processes.

Although some of the symptoms of these two conditions are similar, first-line treatment differs, making distinction important.

Occasionally, minor medical conditions for which patients seek advice for self-treatment resemble each other. One of the most common conditions presented to pharmacists is the common cold. However, allergic rhinitis, which affects 20% of the U.S. population, mimics the common cold in many respects.

The patient may not be able to distinguish one from the other, but the pharmacist can facilitate patient self-treatment and/or triage. Treatment goals are different for each condition.

Etiologies

Etiologies of the common cold and allergic rhinitis are markedly different. Viruses cause the common cold.

At least half of cold episodes are produced by the the rhinovirus family. Other cold pathogens include coronavirus, influenza A or B virus, parainfluenza virus, respiratory syncytial virus, adenovirus, and enterovirus.

Unlike the common cold, allergic rhinitis is neither infectious nor communicable. This IgE-mediated condition may be caused by a wide variety of allergens. Allergists group the syndrome into two types: perennial or seasonal. Identifying whether symptoms exist year-round (perennial) or occur only at certain times of the year (seasonal), provide clues regarding the specific etiologic agents.

Perennial allergic rhinitis is is caused by an allergen that the patient may have contact with at virtually any time. Examples include automotive exhaust, cosmetics, hair spray components, pillows, cigarette smoke, household cleaning substances, toiletries, upholstery, and house pets. One of the most common perennial offenders is the house dust mite. This microscopic creature is found in incredibly high numbers throughout the house, especially where people spend a lot of time, such as the bedroom and livingroom. The mite ingests protein, including skin cells shed from humans or animals. Patients are usually not allergic to the mite itself, but to the feces it yields to the environment.

Seasonal allergic rhinitis is caused by an allergen present only during certain times of the year. Patients might experience the most severe symptoms when flowering plants are producing pollen, when ragweed is blooming, or when wheat is being harvested. Trees, grasses and all types of weeds may sensitize patients. During the rainy season, residual moisture causes rampant growth of molds and mildews, other common causes of seasonal allergic rhinitis.

Manifestations

Common cold symptoms vary somewhat depending on which viral invader is responsible. However, virtually all cold viruses produce some degree of nasal blockage, runny nose, cough, and sore throat. Patients may also experience headache or other body aches, occasional sneezing, weakness, dizziness, and postnasal drip. The patient may also note that one or more family members, coworkers
or playmates have the condition. Symptoms may occur 3–4 times yearly, each lasting for a period of 2–3 days (sneezing, sore throat) to as long as 2 weeks (cough, nasal discharge, postnasal drip, throat clearing).

In contrast to common cold symptoms, which exhibit a gradual onset and slow progression, onset of allergic rhinitis can be sudden. Some allergic rhinitis symptoms are distinctive and others nonspecific. Among the nonspecific symptoms are rhinorrhea and nasal congestion. These are considered two of the cardinal symptoms of allergic rhinitis, and they overlap with the common cold. Other signs and symptoms of allergic rhinitis can help differentiate it from the common cold. For instance, allergic rhinitis produces nasal pruritus, absent in the common cold. Itch often occurs in the posterior nose, where it cannot easily be alleviated. As a result, the patient may wrinkle the nose constantly (“bunny nose”), and may rub the nose upward with the heel of the hand in a gesture known as the “allergic salute.” Allergic rhinitis produces sneezes that are different in both quality and quantity from those of the common cold. Common cold sneezes are infrequent and deep, occurring as an attempt to relieve or clear bronchial or nasal congestion. In allergic rhinitis, implantation
of an allergen on the nasal mucosa causes a paroxysm of sneezes (as many as 10–20), which may be light and relatively quiet. The cold rarely causes ophthalmic problems, which are frequently a component of allergic rhinitis. Allergic patients may complain of a profuse, watery discharge or tearing. They may also exhibit a network of lines (Morgan’s or Dennie’s lines) that extend away from the inner
corner of the eye down-ward in a fan-like pattern. Finally, patients may have blue-black discolorations beneath both eyes. These “allergic shiners” occur when the venous network that drains the infraorbital area anastomoses with nasal vessels that are congested from allergen, causing a backup of venous blood. Allergic rhinitis is more likely than the common cold to affect the sense of smell, causing hyposmia or anosmia. The pharmacist may ask about the patient’s sense of taste, because inability to smell radically reduces the taste of foods.

Counseling Important with Common Cold and Allergic Rhinitis

Certain drugs and conditions contraindicate some self-treatments for allergic rhinitis and the common cold. Ingredients such as dextromethorphan and pseudoephedrine may produce a deadly interaction when taken with monoamine oxidase inhibitors. Phenylpropanolamine (the safety of which has been recently brought into question by the FDA) should never be taken with any other product containing phenylpropanolamine or pseudoephedrine. A sore throat accompanied by fever, headache, rash, inflammation, nausea or vomiting should not be self-treated. Similarly, cough accompanied by rash, fever or persistent headache and chronic cough as seen in smoking, asthma, or emphysema should not be self-treated. Patients with hypertension, diabetes mellitus, thyroid disease or
prostatic hypertrophy should avoid products containing decongestants. Self-treatments may be accompanied by numerous other warnings. Pharmacists should ensure patients understand these warnings and precautions.

Complications

The common cold is a self-limiting condition for most patients, although some develop complications, such as otitis media and sinus infections. Allergic rhinitis is more likely to produce complications because of its recurrence. Patients who have perennial allergic rhinitis may be affected virtually constantly. Thus, allergic rhinitis is now recognized as a risk factor for the development of conditions such as asthma, sinusitis, otitis media, and nasal polyps.

Prevention

With both conditions, prevention is the preferable treatment strategy. The primary method of transmission of the common cold virus is transfer of the virus to the nasal, oral or ophthalmic mucosa through contaminated hands. Seemingly innocuous activities such as wiping a tear from the eye can allow successful inoculation. Washing the hands frequently helps prevent infection.

Prevention of allergic rhinitis is achieved by avoidance of the allergen and control of the environment to eliminate or minimize the allergen (e.g., weekly laundering of bedding, carpet removal, using dust mite sprays, getting rid of pets, smoking cessation, installation of HEPA filters).

How to Treat A Cold and Hay Fever

Two common conditions are the cold and allergic rhinitis (hay fever). They may cause similar symptoms, but the cold is caused by a virus and hay fever is caused by an allergic reaction. Their treatments also differ, but both can be relieved with nonprescription products a pharmacist can help you select.

Treatment for the Common Cold: With the common cold, the nose alternates between being congested and running. Congestion may be treated with a topical decongestant (spray, inhalant, or drops) or an oral nasal decongestant. One example of a topical decongestant is the chemical oxymetazoline, which should be used no more often than every 12 hours. Never exceed the time of use on the label of any spray or drop (usually three days). The chemicals in the product can damage your nose. If you have already been using a drop or spray beyond three days, you must stop to allow the nasal tissues to return to nor-mal. If you choose an oral nasal decongestant, an ingredient such as pseudoephedrine is safe and effective.

The only antihistamines proven safe and effective for runny nose and sneezing of the common cold are clemastine, doxylamine and chlorpheniramine. Sore throat caused by a cold may be self-treated if the pain is minor. Do not treat it more than 2 days. If sore throat lasts more than 7 days, you should see a physician. Lozenges for sore throat contain ingredients such as benzocaine, menthol, dyclonine, phenol/sodium phenolate, hexylresorcinol and benzyl alcohol. Oral painkiller products such as acetaminophen, ibuprofen, ketoprofen or naproxen are also helpful and soothing.

Cough due to colds may be safely treated for as long as 7 days. If the cough is productive (brings up mucus), the ingredient guaifenesin can help break up the chest congestion (water intake is also important). If the cough is dry and hacking, a cough suppressant (dextromethorphan) can stop the cough.

Treatment for Hay Fever: When the problem is hay fever, antihistamines act against the process that causes the symptoms. Many different antihistamines are effective for this purpose and help relieve runny nose, sneezing, nasal itching, and watery, itchy eyes. Recently, eye drops have become available containing naphazoline plus an antihistamine (pheniramine or antazoline). They may help eye symptoms such as tearing, redness or itch. At times, hay fever causes nasal congestion, which is not well treated by antihistamines. You may want to try using decongestant pills containing pseudoephedrine, or adhesive breathing strips, which are placed over the bridge of the nostrils and open up the nasal passages.

Patients may also choose cromolyn sodium nasal solution, which may prevent allergies if used up to one week before contact with an allergen. It also relieves runny/itchy nose, sneezing, and stuffy nose.

Ask Your Pharmacist: Your pharmacist can help you choose products containing the ingredients recommended on this page to treat specific symptoms. Be sure to carefully read all warning and caution labels on products you select. The pharmacist also can tell you if a product should not be used if you take prescription medicine.