Allergy Treatments and Medications FAQ
National Jewish is a world leader in allergy research and treatment. Learn how our doctors, Henry Milgrom, MD, Lanny J. Rosenwasser, MD, and Richard Weber, MD, answer frequently asked questions concerning the following treatments and medications for allergic conditions:
Avoidance (Environmental Control)
Allergy Medications (Antihistamines, Steroids ,Other Medications for Allergies)
Allergy Drug Interactions and Other Concurrent Respiratory and Sinus Diseases
Allergy Medications, Pediatrics, and Pregnancy
Allergy Shots (Immunotherapy)
Avoidance (Environmental Control)
Question: I am allergic to oak trees, and of course I live in the woods with only oak trees around. What is the best thing to take besides moving away? I already take Allegra D.
Dr. Rosenwasser's Answer: Allergra D is a good non-sedating antihistamine and decongestant, but you might want to try a different medicine such as Zyrtec D or Clarinex D or Claritin D. Outdoor pollens get indoors so it is important to keep the doors and windows shut. You may also want to consider using an air conditioner that filters out pollens and airborne pollutants. When conditions are dry and windy, the pollen counts are usually highest in the afternoon, so morning and evening may be the best times to work in the yard. When you come in from outside, take a shower to wash off pollen that may be sticking to your skin or hair, and leave your outdoor clothes in the laundry room, away from your bedroom. Unfortunately, if these measures don’t work, there is no way to completely avoid all oak pollen other than moving away from oaks.
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Frequently Asked Questions About Allergy Medications
Antihistamines
Question: Is there a major difference between Claritin and Clarinex?
Dr. Rosenwasser's Answer: Clarinex is a bit more pure, so a lower dose causes the same effect. Other than that, it is very similar to Claritin.
Question: I take Claritin and it works. Should I switch to Clarinex? Are there any advantages?
Dr. Rosenwasser's Answer: They are very similar. If Claritin works well for you, it is fine to stay with it.
Question: Why do I get sleepy from Clarinex? I never got sleepy on Claritin. I tried immunotherapy, but had to quit because I had severe reactions. Is there something else that I can try or look forward to?
Dr. Rosenwasser's Answer: At certain doses, both Claritin and Clarinex can cause sleepiness. If Claritin worked well without sleepiness, you should go back to it. Allegra is an alternative since sleepiness is not a side effect.
Question: Are any over-the-counter allergy medications effective at reducing mild allergy/hay fever symptoms...in my experience, I haven't found one that helps at all.
Dr. Milgrom's Answer: Over-the-counter antihistamines are effective. Benadryl works well but can make you drowsy. Claritin is a non-sedating antihistamine and is now sold over the counter. Antihistamine/decongestant combinations are also effective. Their effectiveness can be increased by not using a single preparation for longer than a couple of weeks. Cromolyn is available over the counter with the name Nasalcrom, and it is highly effective but must be used four times a day or more.
Steroids
Question: What are the long-term effects of nasal steroid use?
Dr. Rosenwasser's Answer: Nasal steroids - in the usual doses - can be tolerated for long periods of time by most people. Some of the side effects of steroids, in general, are higher in people who use nasal steroids than people who don't take any steroids. These effects may range from cracking and minor bleeding in the nose to a very small but measurable increased risk of diabetes, osteoporosis and cataracts.
Question: Can nasal steroids cause thrush?
Dr. Rosenwasser's Answer: Yes, if the medicine reaches your throat and is swallowed. This is rare with a nasal steroid but the treatment is the same as with an inhaled steroid. Rinse your mouth after use of the nasal steroid. If you use an inhaled steroid, make sure you use a spacer.
Question: If someone is using a nasal steroid spray, such as Nasonex or Flonase, is it okay or even desirable to also use an oral antihistamine such as Zyrtec or Claritin?
Dr. Rosenwasser's Answer: Yes, both antihistamines and nasal steroids can be used, depending on the clinical symptoms and the response to treatment. Many patients use both.
Question: I used to live in Denver, but now I live in Lima, Peru. Since moving, my allergies have gotten really bad . It seems weird, but they seem to be related to the weather – it’s very humid here. Maybe it’s the pollution too. I take Clarinex but it makes me sleepy. When I take Zyrtec D it makes me shake and nervous. What do you recommend I take?
Dr. Rosenwasser's Answer: It’s difficult to tell what is causing your allergies without taking a complete history and allergy tests. However, weather can cause hay fever symptoms in some people. Nasal steroids are probably the best treatment for allergies caused by climate or pollution (vasomotor rhinitis), but I'm not sure of that diagnosis based on your question. Talk to your doctor in Lima about trying a nasal steroid.
Question: I have always had normal nasal (rhinitis) symptoms, but this year I have also developed asthma and food allergies. Now, in the last three weeks, as trees are budding, I have developed severe skin "itchiness." I am very sensitive to various fabrics - cotton seems to be the only thing I can tolerate. My questions: Is this a typical allergic response? What can I do to stop the itching?
Dr. Rosenwasser's Answer: Many people with nasal allergy (allergic rhinitis) and springtime allergies develop significant symptoms such as itchy skin, as you are experiencing. Another phenomenon known as oral allergy syndrome occurs when cross-reactions between allergy pollen and food allergens cause itchiness and swelling in the mouth and throat after eating the food allergen. Antihistamines are a good treatment for this. If you develop hives (urticaria), topical steroids (used on the skin) could be used to help control the itching. However, you should see an allergist and use all prescription medications in conjunction with a physician’s consultation and proper monitoring.
Question: My allergy goes to my eyes and the doctor here in Lima, Peru told me not to use drops with steroids. What do you recommend for me to use?
Dr. Rosenwasser's Answer: Patanol eye drops are not steroids and may help.
Other Medications for Allergies
Question: How does Singulair help with allergies ? Why is it suggested to take in the evening?
Dr. Rosenwasser's Answer: Singulair is a prescription medicine approved to help control asthma in adults and children as young as 12 months and to help relieve the symptoms of seasonal allergies in adults and children as young as 2 years. The reason why it works with both conditions is because the mediators present in asthma are also present in allergic rhinitis. In all of its studies, Singulair has only been tested with a single dose in the evening, so that is how it has been approved for use (it was originally formulated for relief of nighttime asthma symptoms). However, it is a once-a-day medication so its effects should last twenty-four hours. Singulair has no side effects such as drowsiness or dryness, like antihistamines. Singulair is a leukotriene antagonist, different than antihistamines.
Question: My respiratory allergies result in recurrent development of polyps in my nose and sinuses. I've recently had a fifth operation on my sinuses, just to remove the polyps this time. My ENT physician has suggested that I use Singulair to inhibit the growth of polyps. (I regularly take either Allegra or Claritin, and I also have asthma that is fully controlled by four inhalations of Vanceril and four inhalations of Intal each day.) Do you think that Singulair or other medications might reduce the recurrence of Polyps?
Dr. Rosenwasser's Answer: Yes, it is not published yet but Singulair and Accolate can help sinusitis and polyps.
Question: I've heard that work is in progress on a new drug that will inhibit the action of IL-4, specifically an IL-4 receptor blocker. Do you know the status of such a drug?
Dr. Rosenwasser's Answer: The IL-4 work with the receptor antagonist by Immunex is on hold because of equivocal results in helping asthma. Other companies are going ahead with trials of an anti-IL4 humanized monoclonal antibody. The results are too preliminary to comment on at this point.
Question: I would appreciate some information on the upcoming IgE medication and the effects on spring allergies . How does it relate to allergy? When will it be available? Who would benefit from it? How would it benefit a person who has asthma-like myself? Where can I read more about it?
Dr. Rosenwasser's Answer: The new anti-IgE medication is called Xolair. It is indicated for the treatment of moderate to severe allergic asthma and has not been approved for nasal allergy (allergic rhinitis). However, it has been shown in studies that it can relieve hay fever and/or nasal (rhinitis) symptoms, but it must be injected and is far too expensive to justify its use for nasal symptoms only. Most people can treat their hay fever with much cheaper medication that doesn't require injections.
Question: What is the cause and how get I get relief for watery eyes? I am a 70 yr old male with asthma. My eyes water constantly, so much so that tears run down my face. THis occurs when I go outside (e.g. grocery shopping, walking, etc).
Dr. Rosenwasser's Answer: Watery, itchy eyes are usually related to allergic conjunctivitis, although other eye conditions can cause these same symptoms. Patanol eye drops can relieve the symptoms of itchy, watery eyes that you describe. Patanol uses a combination of antihistamines and mast-cell stabilizers. Check with your doctor about trying this.
Question: I have hay fever really bad in the spring and the fall; how soon before my bad season starts should I take my allergy meds?
Dr. Milgrom's Answer: Most medications are effective within a matter of days. Cromolyn takes a full month to be completely effective. Allergy shots may take as long as two years.
Question: What is the best precaution to take knowing that I have severe reactions to insect bites (like swelling, blisters)? Are there certain over-the-counter medications that I should always carry?
Dr. Milgrom's Answer: Patients who have had systemic reactions to stings by vespids (honey bee, wasp, hornet, yellow jacket) or ants are at risk for allergic reactions that may be life threatening. Systemic reactions are those that cause low blood pressure, shortness of breath, gastrointestinal symptoms or swelling or rash distant from the site of the sting. Individuals who have experienced such reactions should carry injectable adrenaline that comes in pre-loaded syringes under the names Ana-Kit or Epi-Pen. These preparations are available by prescription only but can be life saving and should be carried by all patients with a history of systemic responses to these insects. It is especially important to carry one of these preparations if one is going to be participating in activities in remote areas. Antihistamines can be helpful but are not adequate for a life-threatening situation. Some hikers have found that applying Adolph's Meat Tenderizer, a preparation that contains the enzyme papain, can make their stings less painful.
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Allergy Drug Interactions and Other Concurrent Respiratory and Sinus Diseases
Question: Can people with COPD take Allegra? I know Sudafed and others are not recommended for COPD patients.
Dr. Rosenwasser's Answer: People who have allergies as well as COPD can take antihistamines for their allergies. Sudafed is a decongestant and a different type of medicine.
Question: I have COPD and problems with my sinuses. I currently use Claritin-D. Is there another medicine that will work better to clear up the drainage? I am also on Serevent, Atrovent, Proventil and Uniphyl. I rarely take Proventil.
Dr. Rosenwasser's Answer: Claritin-D can help sinus drainage for people with allergy and sinus drainage problems. Other antihistamines and decongestants can work including Allegra-D and Zyrtec. There are also over-the-counter antihistamine and decongestant combinations that help with sinus drainage. These medicines, however, would have no direct effect on COPD – the medicines you are already taking are treatment for COPD.
Question: Are there new medications for allergy out that are safe for those with COPD ?
Dr. Rosenwasser's Answer: New treatments are being tested all the time for COPD. It would be best to check with your pulmonary specialist.
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Allergy Medications, Pediatrics, and Pregnancy
Question: Is Claritin dangerous if I am pregnant ? I heard something about Claritin and Hypospadias last week in the news.
Dr. Rosenwasser's Answer: All medications should be used cautiously in pregnancy. Older antihistamines, such as pyribenzamine and benadryl, are probably the safest to use in pregnancy.
Question: Can you suggest a safe medicine for a nursing mother with nasal allergy (allergic rhinitis) and itchy eyes and skin?
Dr. Rosenwasser's Answer: First of all, every pregnant or nursing mother and her doctor must carefully weigh the benefits to the woman against the risks to her fetus or infant when using any medication. Always inform your doctor if you are pregnant, planning a pregnancy or breastfeeding before using any medicine. That being said, nasal steroids are generally well tolerated during pregnancy and by nursing mothers. Benadryl is probably the safest antihistamine to use because it’s been around the longest, although it can cause drowsiness. Many of the newer antihistamines have either not been tested, or they have been found to be present in breast milk. Great caution should be used with all of these medications and certainly not before a thorough consultation with your doctor.
Question: I have a six-month old baby with eczema, and he sneezes all the time. His eyes are not red or watery, but at night he has trouble breathing from congestion. His nose is not runny, though. Do you have treatment suggestions? Is he too young for seasonal allergies? We are getting ready to try Triaminic based on our pediatrician's suggestion.
Dr. Rosenwasser's Answer: Your baby is too young for seasonal allergies. However, food allergy may play a role, especially with eczema and the sneeziness. Pediatric Triaminic as a decongestant is OK.
Question: What would you recommend for treating a severe allergy to Timothy grass for a child under the age of 12?
Dr. Rosenwasser's Answer: The standard treatments for a child under the age of 12 would be in place, including Allegra, Claritin, Zyrtec and allergy shots (immunotherapy). The antihistamines are approved at least to age 6 and above and some forms of antihistamine medication, such as Claritin Redi-Tab and Zyrtec syrup can be given to children as young as 2. Allegra, at a dose of 30mg, is approved for children age 6 and older.
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Allergy Shots (Immunotherapy)
Question: I have been reading about a six-week program for allergic rhinitis. Will allergists soon be able to offer this to their patients?
Dr. Rosenwasser's Answer: Immunotherapy can be given in a rush pattern that is completed in six weeks. Other, more experimental treatments can be given within a season, but they are not yet approved. If you experience only one allergy season, then standard treatment with antihistamines and nasal steroids can work well.
Question: If you have allergies to oak, grass, weeds, mold, etc. would you recommend taking Claritin all year? This is what has been recommended to me and I wanted your thought on this.
Dr. Rosenwasser's Answer: Alergy shots (immunotherapy) is an alternative to antihistamine therapy in patients with multiple allergies and nasal symptoms (rhinitis). Otherwise, use of antihistamines – like Claritin - and nasal steroids may be required for both year round and seasonal nasal symptoms.
Question: I am extremely allergic to grass, tree, weed pollen, mold, and mites, dogs and cats. I avoid the latter animals but this season is so intense with pollen nothing I take lasts for more than 4 or 5 hours. I can't even go outside of my house without a mask - and that doesn't help much - within minutes my eyes, nose and asthma kick up. I’ve tried taking lots of different antihistamines in high doses, but they tend to make me very drowsy. Also, I don’t like having to take so much medicine all of the time. Any ideas ?
Dr. Rosenwasser's Answer: Allergy shots (immunotherapy) may help with such numerous and severe allergies. It may help you avoid some of the side effects that you describe from the medicines.
Question: I am 30 years old and have been suffering from allergies for 10 years. All the medicines I have tried over the years have failed to control it. Are there any alternatives?
Dr. Rosenwasser's Answer: Besides medication, hay fever and nasal symptoms can also be effectively treated with allergy shots (allergy immunotherapy). This kind of treatment is very often effective and it initially requires weekly shots followed by a shot given monthly. However, this mode of treatment is the only one available that potentially could cure allergies.
Question: I am considering allergy shots for my daughter and was wondering if this will lead to her taking less medicine (Advair, Clarinex, Flonase, Singular).
Dr. Rosenwasser's Answer: If the allergy shots are used properly, use of less asthma medicines should be a result. This works especially well in children and young adults.
Question: Are allergy shots (immunotherapy) relatively safe? This is one of the reasons I have held off giving them to my daughter, who is 14. Her doctor has recommended them but the anaphylactic risk scares me.
Dr. Rosenwasser's Answer: There is some risk to allergy shots when done with proper dosing of allergens. These risks are minimized by proper observation after injections (in the doctor's office). If this type of treatment is indicated for a 14 year old, adolescents usually respond well.
Question: I have numerous allergies: outdoor pollens and other air borne particulates, as well as indoor exposure to dust, mildews, etc and particularly animal dander. I am forced to take antihistamines year-round in the form of pills (currently over-the counter Tavist), eye drops (Visine A), and nose spray (Nasalchrom) daily. My symptoms include itchy, swollen eyes; itchy, runny nose; sneezing; and also asthmatic shortness of breath. This combination of antihistamines, as well as my daily asthma prescriptions, do keep my symptoms under control. However, I worry about long-term use of all of these products. Allergy shots, with the extent and nature of my allergies are not a viable option.
Dr. Rosenwasser's Answer: The extent of your allergies and nature of your symptoms are not necessarily contraindications to allergy shots (immunotherapy). Immunotherapy may be difficult to give if you are so sensitive, but it may significantly reduce requirements for the medicines you worry about taking so frequently.
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