Pharmacy Q&A

Q: Who gets allergies?
A: More than 50 million Americans have some form of allergy. Allergic rhinitis, the most common type of allergy, affects approximately 40 million Americans each year. Sensitivity often starts in childhood or young adulthood.
Although experts do not fully understand why some people develop allergies and others don’t, allergies do tend to run in families. If both parents have allergies, a child’s chances of developing allergies are 66%. If only one parent has allergies, a child’s chances of developing them are about 50%.
Q: Do allergies run in the family?
A: The tendency to develop allergies does tend to run in families, but other factors may come into play. A child’s chances of developing allergies are about 50% if one parent has allergies. The chances increase to about 66% if both parents have allergies. Some individuals develop allergies even though neither parent has had a diagnosis of allergy. Many experts also believe that early exposure to a potential allergen may make a person more likely to develop an allergy to it later in life.
Q: What types of plants produce the most allergy-causing pollen?

A: The type of pollen that most commonly causes allergy symptoms comes from plants (trees, grasses, and weeds) that typically do not bear fruit or flowers. These plants produce small, light, dry pollen granules in large quantities that can be carried through the air for miles. Common plant allergens include:

>> Weeds, such as ragweed, sagebrush, redroot pigweed, lamb’s quarters, goosefoot, tumbleweed (Russian thistle), and English plantain.

>> Grasses, such as timothy grass, Kentucky blue grass, Johnson grass, Bermuda grass, redtop grass, orchard grass, sweet vernal grass, perennial rye, salt grass, velvet grass, and fescue.

>> Hardwood deciduous trees, such as oak, ash, elm, birch, maple, alder and hazel as well as hickory, pecan, box and mountain cedar. Juniper, cedar, cypress, and sequoia trees are also likely to cause allergies.

Q: What does a pollen count mean?

A: A pollen count is the measure of the amount of pollen in the air. Pollen counts are commonly included in local weather reports and are usually reported for mold spores and three types of pollen: grasses, trees, and weeds. The count is reported as grains of pollen per square meter of air collected over 24 hours. This number represents the concentration of all the pollen in the air in a certain area at a specific time. The pollen count is translated into a corresponding level: absent, low, medium, or high.

In general, a “low” pollen count means that only people extremely sensitive to pollen will experience symptoms. A “medium” count means many people who are relatively sensitive to pollen will experience symptoms and a “high” count means most people with any sensitivity to pollen will experience symptoms.

Q: How can I tell if my child has allergies or a common cold?

A: Symptoms of allergies and colds can be similar, but here’s how to tell the difference:

Occurrence of symptoms:
Both allergies and colds cause symptoms of sneezing, congestion, runny nose, watery eyes, fatigue, and headaches. However, colds often cause symptoms one at a time: first sneezing, then a runny nose, and then congestion. Allergies cause symptoms that occur all at once.

Duration of symptoms:
Cold symptoms generally last from 7 to 10 days, whereas allergy symptoms continue as long as a person is exposed to whatever triggered them. Allergy symptoms may subside soon after elimination of allergen exposure.

Mucus discharge:
Colds may cause yellowish nasal discharge, suggesting an infectious cause. Allergies generally cause clear, thin, watery mucus discharge.

Sneezing:
Sneezing is a more common symptom of allergies, especially when sneezing occurs two or three times in a row.

Time of year:
Colds are more common during the winter months, whereas allergies are more common in the spring through the fall, when plants are pollinating.

Presence of a fever:
Colds may be accompanied by a fever, but allergies are not usually associated with a fever.

Although the pollen count is an approximate value and fluctuates, it is useful as a general guide when you are trying to determine whether or not you should stay indoors to avoid pollen contact.

Q: How are allergy symptoms treated and controlled?

A: When avoidance measures fail or are not possible, many people will require medications to treat their allergic rhinitis symptoms. The choice of medication depends on numerous questions to be answered by the person or person’s physician:

  1. How severe are the symptoms?
  2. What are the symptoms?
  3. What medication can the person get (over the counter, prescription)?
  4. What medication will the person take?
  5. Is the medication needed daily or intermittently?
  6. What side effects might the person experience from the medications?

Oral anti-histamines:
This is the most common class of medications used for allergic rhinitis. The first generation anti-histamines, which includes Benadryl®, are generally considered too sedating for routine use. These medications have been shown to affect work performance and alter a person’s ability to operate an automobile. Newer, second-generation anti-histamines have now become first-line therapy for people with allergic rhinitis. These prescription medication include cetirizine (Zyrtec®), fexofenadine (Allegra®), and desloratadine (Clarinex®). Loratadine (Claritin®, Alavert® and generic forms) is now available over the counter. These medications have the advantage of being relatively inexpensive, easy for people to take, start working within a few hours, and therefore can be given on as “as needed” basis. The medications are particularly good at treating sneezing, runny nose, and itching of the nose as a result of allergic rhinitis. Side effects are rare, and include a low-rate of sedation or sleepiness, but much less than the first-generation anti-histamines.

Topical nasal steroids:
This class of allergy medications is probably the most effective at treating nasal allergies, as well as non-allergic rhinitis. There are numerous topical nasal steroids on the market, and are all available by prescription. Some people note that one smells or tastes better than another, but they all work about the same. This group of medications includes fluticasone (Flonase®), mometasone (Nasonex®), budesonide (Rhinocort Aqua®), flunisolide (Nasarel®), triamcinolone (Nasacort AQ®) and beclomethasone (Beconase AQ®). Nasal steroids are excellent at controlling allergic rhinitis symptoms. However, the sprays need to be used daily for best effect and therefore don’t work well as needed. Side effects are mild and limited to nasal irritation and nose bleeds. The use of these nasal sprays should be stopped if irritation or bleeding is persistent or severe.

Other prescription nasal sprays:
There are two other prescription nasal sprays available, a nasal anti-histamine and a nasal anti-cholinergic. The anti-histamine, azelastine (Astelin®), is effective at treating allergic and non-allergic rhinitis. It treats all nasal symptoms similar to nasal steroids, and should be used routinely for best effect. Side effects are generally mild and include local nasal irritation and some reports of sleepiness, as it is a first-generation anti-histamine. Nasal ipratropium (Atrovent nasal®) works to dry up nasal secretions, and is indicated at treating allergic rhinitis, non-allergic rhinitis and symptoms of the common cold. It works great at treating a “drippy nose”, but will not treat nasal itching or nasal congestion symptoms. Side effects are mild and typically include local nasal irritation and dryness.

Over-the-counter nasal sprays:
This group includes cromolyn nasal spray (NasalCrom®) and topical decongestants such as oxymetazoline (Afrin®) and phenylephrine (Neo-Synephrine®). Cromolyn works by preventing allergic rhinitis symptoms only if used before exposure to allergic triggers. This medication therefore does not work on an as-needed basis. Topical decongestants are helpful in treating nasal congestion. These medications should be used for limited periods of 3 days every 2-4 weeks; otherwise there can be a rebound/worsening of nasal congestion called rhinitis medicamentosa. The side effects of the above are both generally mild and include local nasal irritation and bleeding, but topical decongestants should be used with caution in patients with heart or blood pressure problems.

Oral decongestants:
Oral decongestants, with or without oral anti-histamines, are useful medications in the treatment of nasal congestion in people with allergic rhinitis. This class of medications includes pseudoephrine (Sudafed®), phenylephrine, and numerous combination products. Decongestant/anti-histamine combination products (such as Allegra-D®, Zyrtec-D®, Clarinex-D® and Claritin-D® are indicated for treating allergic rhinitis in people 12 years of age and older. This class of medication works well for occasional and as-needed use, but side effects with long-term use can include insomnia, headaches, elevated blood pressure, rapid heart rate and nervousness.

Leukotriene blockers:
Montelukast (Singulair®), was originally developed for asthma approximately 10 years ago, and is now approved for the treatment of allergic rhinitis as well. Studies show that this medication is not as good at treating allergies as the oral anti-histamines, but may be better at treating nasal congestion. In addition, the combination of montelukast and an oral anti-histamine may be better at treating allergies than either medication alone. Montelukast may be of particular benefit for people with mild asthma and allergic rhinitis, since it is indicated for both medical conditions. The medication must be taken daily for best effects, and usually takes a few days before it starts working. Side effects are usually mild and include headaches, abdominal pains and fatigue.

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