Allergy
Medication
Medications
to relieve allergy symptoms seem as numerous
as there are stars in the sky and grains of
sand at the sea.
They are
classified in one of two families:
antihistamines and inhaled corticosteroids.
The
antihistamines work in two manners. They
help block the start of symptoms and relieve
symptoms once started.
Respiratory
allergies are conspicuous with runny nose,
sneezing, tearing, and itching nose and
eyes.
Antihistamines work by blocking the allergic
reaction. They compete with the allergen
(pollen, mold, housedust, animal dander,
roach) attaching to the cell receptor. If
antihistamines cover the receptor sites, few
remain for the allergen. Consequently, the
allergic reaction with the release of
chemical mediators (histamine) is blocked
and symptoms are minimized or prevented.
The best
way to use antihistamines is as prophylaxis:
prevention maintenance. When exposure is
inevitable, taking antihistamines around the
clock is protective.
Antihistamines also prove helpful in
dampening symptoms already present.
The inhaled
corticosteroids are the key medications to
manage allergies. Cortisone is without a
peer as an anti-inflammatory agent. Since
allergies are in fact, inflammations, the
inhaled steroids are the unquestioned
medications of choice.
Unfortunately, there is considerable steroid
phobia which diminishes the appreciation of
the value of these nasal inhalers. Suffice
it to write, the effectiveness of these
products is considerable, with an excellent
safety margin. Multiple studies have clearly
demonstrated minimal likelihood of
significant side effects. (The commonest
complaint being nasal irritation)
Most
products come in two forms, a metered dose
spray and aqueous drops; both are
equivalent, leaving the choice to personal
preference.
They are
used on a daily basis - some taken once a
day, others more often. What is paramount is
these inhaled steroids are not so
therapeutic and not recommended for an
attack of allergy. They are protective
rather than used for treatment.
“All
intranasal corticosteroids are safe and
effective, with differences among them
limited to patient preference, dosing
regimens, and the delivery device and
vehicle. However, Nasonex and Flonase have
characteristics that could classify them as
preferred. (Each is more topically potent
than the other agents. They have a higher
degree of lipophilicity, therefore producing
a faster rate of absorption, longer retention
time in the nasal tissues, and minimal
absorption in the gastrointestinal tract.
The systemic bioavailability of these two
drugs is minimal, which reduces systemic
adverse effects. The drugs are equal to each
other and superior to placebo in reducing
total nasal symptoms, therefore leading to
greater numbers of symptom-free days. When
considering patient adherence and special
patient populations, Nasonex and Flovent are
dosed once/day and can be used by adults and
children above 3 and 4 years of age,
respectively.
Amy L.
Whitaker, Pharm.D., P.O. Box 980533, 410
North 12th Street, Smith Building 335,
Richmond, VA 23298-0533; e-mail: alwhitak@vcu.edu.
Most
commentaries reveal little differences among
the nasal steroids; effectiveness in
managing allergies is more a function of
compliance. Take any of the medications, as
directed, and one will do well. Studies do
suggest Nasarel causes more local burning.
Nasocort may be the most patient friendly,
but again, no product rises to a clear
advantage.
Bill Ziering
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