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Allergy Medications

The following survey of allergy medications is intended as a guide for patients who suffer from allergy and asthma, but is not intended as a substitute for consultation and instruction from a qualified allergist.

Antihistamines: Anithistomines are medications often prescribed in the treatment of allergic rhinitis (sometimes called hay fever), hives and other allergic conditions.  Antihistomines prevent the effects of a substance called histamine-a, which is released by mast cells during an allergic reaction, causing allergic symptoms. Antihistamines, which are available in liquid, capsule or spray form, are generally divided into two main categories:  sedating and non-sedating (those that cause drowsiness and those that do not).  Other potential side effects of antihistamines include, dry mouth, constipation, difficulty urinating (especially in men with diseases of the prostate), sleep disturbance or nightmares (especially in children), restlessness and irritability.  Most side effects are more common with non-sedating antihistamines.  You should consult your allergist to determine which antihistamine is best for you. 

Decongestants generally work by constricting the blood vessels that often become “leaky” during an allergic reaction.  This prevents the flow of fluids (congestion), especially in nasal passages.  Like antihistamines, decongestants are available in liquid, capsule and spray form.   Most are available over the counter, but some stronger decongestants may require prescription by your allergist.  Potential side effects of decongestants usually include: sleep disturbance, agitation, increased blood pressure and heart palpitations.  Patients with hay fever (allergic rhinitis) may experience a “rebound” effect, causing the nasal congestion to become worse, which can lead to decongestant dependance in such patients. 

"Controller" or anti-inflammatory medications:
 Allergic symptoms are often the result of the swelling and mucous production around the lining of the nasal passages and airways of patients with allergic diseases.  Substances which control inflammation can be tremendously effective in reducing symptoms in allergic patients.  The three classes of medications  specifically designed to reduce inflammation in allergic patients:

• Mast Cell Stabilizers:
These are non-steroidal medications which prevent the release of inflammatory chemicals, such as histamine. These include cromolyn and nedocromil, which are used to treat rhinitis and asthma. 

• Corticosteroids:  When taken properly, corticosteroids may be very effective in the treatment of asthma and allergies. Corticosteriods used in the treatment of allergies and asthma are very different from and should not be confused with the anabolic steroids misused by athletes.  Corticoseriods for use in allergy treatment are available in topical form (creams and ointments), as nasal sprays, inhalers and capsule form.  If your symptoms are severe and require immediate relief, your allergist may choose to administer corticosteriods in an injectable solution.  Under all conditions, corticosteroid may have serious side effects and requires careful supervision by an allergist. 

Oral corticosteroids:  Oral corticosteroids are usually used as short-term treatment for acute asthma, severe congestion, skin conditions such as poison ivy or severe, debilitating eczema.  Side effects may include bloating, weight gain, heartburn and stomach upset, which generally subside when the steriod is stopped.  More long term effects, when steroids are used over months or years, may include stomach ulcers, cataracts, osteoporosis, and diabetes.  In children, corticosteroids may effect growth and development.

Inhaled corticosteroids:  Because inhaled corticosteroids have minimal systemic effects (effects on the entire body) and are highly effective, inhaled corticosteroids are often used for long-term control of persisten asthma. Minor side effects may include hoarsness or thrush (a minor infection of the mouth and throat).  In children, inhaled corticosteriods may cause a trasient reduced growth velocity.  However, this tens to be limited and generally occurs only in the first year of use.

Anti-Leukotrienes:  leukotrienes (lu-ko-try-eens), like histamines are responsible for increasing inflammation causing contraction of the airway muscle, swelling of the lining of the airways and the increased secretion of mucus.  Anti-Leukotrienes are generally used in patients with mild persistent asthma, in combination with inhaled corticosteroids in more severe cases of asthma and in the treatment of patients with allergic rhinites.

Bronchodilators: These medications relax the smooth muscle surrounding the  Bronchial tubes (the respiratory airways or lungs), which can be constricted in people with asthma, resulting in difficulty breathing.  There are three main types of bronchodilaters:  Beta-agonist, Theophylline, and Anti-cholinergic agents:

Beta-agonist bronchodilators 
are use d as quick-relief medications. They are available in inhaled and liquid forms as well as in tablet form.  Examples include albuterol and levalbutrol. These are “short-acting” beta-agonists.  Their effect begins almost immediately and persists for up to 4 t 6 hours.  Longer acting beta-agonists include medications like salmeterol and formoterol.  These medications may remain effective for up to 12 hours.  Side effects of these medications iclude restlessness and insomnia.  They may also cause headaches.  The FDA has issued an advisory warning that long-acting beta-agonists may increase the risk of severe asthma flares in some patients.  Your allergist will be able to guide you in assessing the relative risk of using beta-agonists to control your asthma. 

has been used for over 30 years to treat asthma. It is may be administered orally or intravenously.  Blood levels should be monitored closely.  Side effects include headaches, increase in heart rate and stomach upset.  Elevated levels of theophylline in the blood have also been known to induce seizures. 
Anticholinergic agents are only available in inhaled form.  They may be used alone, or in combination with other medications.  Ipratropium (an anticholinergic drug) has been used in the treatment of asthma, although it is mainly indicated in treatment of patients with chronic obstructive pulmonary disease.  Side effects of anticholinergic drugs include cough and headaches. 

Anti-IgE antibody:
IgE, an antibody that we all produce, is responsible for causing symptoms of allergic diseases, including allergic rhinitis ("hay fever") and asthma in some people. Anti-IgE may reduce allergic reactions by binding free IgE so that the bound IgE cannot produce the allergic reaction. Omalizumab (Anti-IgE antibody in its medication form) was approved in 2003 as a new class of therapy for patients, but is limited in its use only to those  with moderate to severe persistent allergic asthma. Your allergist will determine if Omalizumab is right for you.  Omalizumab needs to be administered every two to four weeks by injection based on body weight and total serum IgE levels.

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