May 18, 2001

By TARA PARKER-POPE
Staff Reporter of THE WALL STREET JOURNAL

AMERICANS SPENT nearly $4.7 billion on the prescription allergy drugs Claritin, Allegra and Zyrtec last year. But many of those people -- one study suggests as many as two-thirds -- may not even have allergies.

The problem, say doctors, is that people who suffer from a chronic runny nose, congestion or sinus problems often think they have allergies when their symptoms are actually triggered by foods, medication, bacteria or some other reason. Rather than be tested, many patients simply get their doctor to prescribe one of the popular allergy drugs they've seen advertised on television.

While the FDA mulls whether the group of "second generation" allergy drugs known as nonsedating antihistamines should be sold over the counter, some doctors worry the debate is misplaced.

The issue is not so much how to give consumers access to the medicines, they say, but whether many of them should be taking the drugs at all. "Many more people think they have allergies than really do," says Lanny Rosenwasser, head of allergy and immunology at the National Jewish Medical and Research Center in Denver.

An estimated 35 million people, for example, suffer from chronic sinusitis, which occurs when a cold, polyps or some other problem obstructs the sinuses. Symptoms include congestion, dull pain around the eyes and cheeks, postnasal drip and other problems. Allergy is often the culprit, but about 40% of sufferers don't have allergies.

AN OHIO STATE UNIVERSITY study tested 246 North Carolina patients taking Claritin, Allegra or Zyrtec. The study, presented in March at the American College of Osteopathic Family Physicians, found that 65% of those taking the drugs didn't have allergies.

 

"If they're not truly allergic, why should they spend all that money on the nonsedating antihistamines?" says the study's author Sheryl Szeinbach, OSU professor of pharmacy administration.

All of the patients had been prescribed allergy drugs by a general practitioner rather than an allergist. For the study, the patients were screened for a wide range of allergens, including pollens, molds, grasses, dust and animals.

The study has its limits. It was funded by Pharmacia Diagnostics, which makes the ImmunoCAP allergy blood test and wants more family doctors to use the test. Some allergists don't believe the blood test is reliable. In addition, it's possible that some of the patients simply weren't tested for the right allergens.

But the study is bolstered by other research and doctors' own anecdotal evidence. Steven D. Schaefer, chairman of the department of otolaryngology at the New York Eye and Ear Infirmary, says that in his experience, more than half of the patients who think they have allergies don't test positive for them. "It's hard to separate those people who have sinusitis from those who have allergic disease," says Dr. Schaefer.

Phil Lieberman, clinical professor of medicine and pediatrics at the University of Tennessee College of Medicine says that as many as one-third of the patients who come to see him with chronic allergy symptoms don't actually have allergies.

Schering-Plough, the maker of Claritin, declined to comment. Spokeswomen for Allegra maker Aventis and Zyrtec maker Pfizer both said their companies were committed to the appropriate diagnosis and treatment of allergies.

The issue of misdiagnosis was raised last week during the FDA panel discussion on whether it's safe to sell the drugs without a prescription. Mark Dykewicz, director of allergy and immunology training at St. Louis University School of Medicine, voted in favor of the safety proposal but voiced concern that patients often misdiagnose year-round nasal symptoms as allergies. "People's perceptions of their health patterns are not always accurate," says Dr. Dykewicz.

BECAUSE THE DRUGS are considered safe, in most cases the only downside to using them for nonallergic problems is that they don't work and are expensive. A 30-pill Claritin prescription costs about $80.

Most allergy medications work by blocking the histamines that cause a runny nose and other symptoms. Some nonallergic patients feel better when they take allergy pills not because of the antihistamine but because they take a type that also has a decongestant. Last year, consumers spent $1 billion on Claritin-D and Allegra-D, according to IMS Health. Far less expensive decongestants, however, are sold over the counter.

About 17 million people suffer from chronic nonallergic rhinitis, which causes a runny nose, sneezing and sinus congestion. Sheldon Spector, a UCLA clinical professor of medicine, says he recently treated a 24-year-old man who thought allergies caused his drippy nose. The problem was gustatory rhinitis, a nonallergic reaction to certain foods, and a nose spray was prescribed.

Others suffer from chronic runny nose and congestion triggered by regular use of aspirin or anti-inflammatory drugs like ibuprofen. "It's not uncommon," says Dr. Spector. "It's just not recognized."

Treatment for nonallergic nasal and sinus conditions usually consists of prescription nasal steroid sprays such as Flonase or Nasocort, or the antihistamine spray Astelin.