Over-the-Counter Allergy Medications
by Dr. Morris Nejat

Content

1. Introduction
2. Allergy Symptoms
3. Allergy Medication Table
4. Conclusion
    

Introduction

Sneezing, wheezing, coughing, and sniffling. So many allergy symptoms and so little time to get to the doctor to get a prescription to relieve you of these irritating and somewhat debilitating symptoms. Well, now you will have the information necessary to treat your symptoms with the appropriate over-the-counter (OTC) medications, which at one time, were prescription products that for one reason or another, were made into OTC medications. Furthermore, simply because a medication is available over the counter does not make it safer or less effective than its prescription equivalent.

We will concentrate on the generic rather than brand names because there are multiple brands available of the same generic products. There are also countless combination products available that combine some of the more popular generics to treat a wider variety of allergy and cold symptoms. Most brand-name, over-the-counter products have a generic equivalent. For the most part, brand names and their generics are comparable as far as efficacy and side effects go. By understanding what is in your favorite OTC products, you will be able to save 25 to 75 percent by buying the generic equivalent. This article will discuss various allergy symptoms along with the appropriate OTC products that would treat your symptoms.

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Allergy Symptoms

Sneezing, itchy nose, throat, and ears: These are the most common complaints of the allergy sufferer. These symptoms can be associated with seasonal triggers such as grass, tree, or ragweed pollen, or perennial triggers such as dust mites, roaches, or pets. The first-line treatment for these symptoms are antihistamines. When exposed to an allergen, the mast cell, which is found all over the body, especially in connective tissue such as the skin, releases histamine. Antihistamines block the action of histamine and prevent the allergic reaction from taking place. The most popular OTC antihistamines are diphenhydramine (Benadryl), clemastine (Tavist), and chlorpheniramine (Chlor-Trimetron).

Some of these products’ manufacturers have used the side effect of sleepiness to create a new product out of the same drug. Popular examples include Unisom, Nytol, and Sominex. In fact, diphenhydramine is almost as popular as a sleep aid as an allergy product.

Side effects
Be careful when driving. Over-the-counter allergy products may impair your judgment as much as alcohol, and when combined with alcohol, may affect you even more. Also, men with enlarged prostates may experience urinary retention while taking these products. For moderate to severe symptoms, or if the side effects of the treatment  are intolerable, a patient will benefit greatly from consulting an allergy specialist and gaining access to one of the second generation antihistamines that have a much improved side effect profile. Another class of products available to treat these products is mast cell stabilizers.

Nasalcrom nasal spray recently was made available over the counter for the treatment of allergic rhinitis. This product boasts an impressive safety profile, but is limited as far as usefulness. To achieve maximum benefit, one would need to use Nasalcrom (cromolyn sodium) three to four times per day and give the medicine up to one month to start to work. Some patients swear by it.

Congestion, sinus pain: These symptoms may or may not be associated with allergies. If you don’t have sneezing, an itchy nose, throat, or ears, you may want to avoid combination products that have antihistamines to minimize occurrences of dry mouth and sedation. The principal therapy for these symptoms is decongestants. Decongestants can be taken orally or topically. The most popular oral decongestants is pseudoephedrine (phenylpropanolamine was previously used but it has been discontinued by the FDA - See more information). These same products are also available in prescription strength. Decongestants work by shrinking the mucous membranes, thereby decreasing the surface area. Unfortunately, when the medication wears off, so does the symptom relief. Also, many patients get very jittery and shaky while taking these products. These patients don’t usually do well on coffee or other forms of concentrated caffeine, either. If these symptoms persist, it would be wise for the patient to consult with an allergist or other sinus specialists such as an otolaryngologist (ear, nose, and throat doctor) for further evaluation or treatment.

Remember though, if you don’t have allergy symptoms, you don’t need to take a combination product with antihistamines. Often times, decongestants may come with guaifensisin, an expectorant to loosen the phlegm or mucus and assist with drainage. Although in theory, this is a good idea, in most OTC products, it is given at such low dosages, it doesn’t do much. You usually need the much higher dosages of prescription products to do any good. If congestion is particularly bothersome, you may want to use an OTC decongestant spray for a few days to help relieve the symptoms and allow some of the more long-term prescription and OTC medications to kick in.

Side effects
Use of topical decongestants such as phenylephrine (Afrin, Neo-Synephrine, Vicks Sinex) or oxymetazoline (Afrin Original Nasal Spray, Neo-Synephrine 12 hour) for more than three to four days may lead to a mucosal dependence (or addiction), making it more difficult to wean off of these medications. Also, if a patient abuses these products, they may irreversibly damage the nasal mucous membranes.

Post-Nasal Drip: This symptom is very difficult to treat. The causes can be an allergy, infection, or a nasal structural abnormality. Antihistamine decongestant products are the OTC treatment of choice. I would recommend, however, seeing an allergy or sinus specialist for a more specific etiology so that treatment can be optimized.

Cough of two-week duration or less: This kind of cough in the absence of other underlying medical problems such as chronic bronchitis or emphysema, or without other associated symptoms such as a fever is probably due to a cold. I usually recommend a product with a cough suppressant such as dextromethorphan and a decongestant such a pseudoephedrine to dry the post-nasal drip. If the drip is particularly bad, one can add an OTC antihistamine to help dry the drip further. I would especially recommend this at night when being sleepy is not as big of an issue.

Cough of more than two weeks duration: Now we are approaching the category of “chronic cough.” The overwhelming majority of chronic coughs are related to three causes. These include:

Itchy, runny eyes: Most over-the-counter medications treat the systems of eye allergies using a topical decongestant (oxymetazoline, naphazoline) and an antihistamine (pheniramine).

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You can use the chart below as a handy reference for looking up the different products found in OTC allergy products and using them to treat the appropriate allergy symptoms.

Another factor to consider when deciding on what medicines to use is cost. Although prescription medications are generally more expensive, often times they are generally less expensive for the patient because they are covered by their prescription plan. Also, the time saved not going to the doctor and self-medicating, may be lost because of lost productivity and sick days away from work.

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