Tag Archives: antihistamines

When Benadryl is Dangerous (Insert scary movie music here)

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The A,B,Cs and Zs of Antihistamines

A is for Allegra or fexofenadine, B is for Benadryl or diphenhydramine, C is for Claritin or loratadine and Z is for Zyrtec or cetirizine.

First and foremost, Benadryl can be dangerous. Everyone knows it causes sedation in most people but some of you still contend, “It doesn’t bother me!” Here is some data to the contrary. A well known study on antihistamines was written by an author named Weiler and published in 2000 in the Annals of Internal Medicine. Using a driving simulator, he compared the effects of Benadryl, Allegra, alcohol and placebo. He measured how well subjects could follow another vehicle at a set distance, how many times they got out of their lane and reaction times when responding to an obstacle put in their path. The subjects taking Benadryl had the worst performance—worse than alcohol! They also divided up the Benadryl takers inquiring which ones felt subjectively unaffected by the drug. The study found that those people still objectively had slower reaction times. So even if you think your immune to the effects of Benadryl, studies show that to be false.  The Allegra arm of the study showed no effect on cognition. A lot of UPS pilots reside here in Louisville, and this study is often cited to allow UPS pilots to take Allegra while in the air.

Benadryl can also be an issue for our children. Michael Blaiss, past president of the American College of Allergy, Asthma and Immunology, wrote a review in Clinical Therapeutics in 2004 about antihistamine prescribing strategies in school age children. He cites the detrimental effects of older sedating antihistamines on their “physical, social, and psychological well-being and academic performance.”

The take-home message is Benadryl should not be used routinely during the day. Newer agents such as Allegra, Zyrtec and Claritin have much better side effect profiles. Even Zyrtec cannot be called “non-sedating.” It’s also associated with sedation in some people and is therefore called “less sedating.” This becomes an issue if you operate heavy machinery or fly an airplane.

Hopefully you are still awake. Stay tuned for a blog on the ever-changing OTC nasal steroid market. Be sure to “like” my facebook page www.facebook.com/drdamin and share with other allergy sufferers.

 

Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.

Courier-Journal: Dr. Damin Addresses Fall Allergies and Finding Relief

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Sneezy and miserable this fall? Here’s why.

Ragweed is rearing its devilish head in the Louisville area, bringing on sneezing, itchy eyes and other irritating symptoms for those who are allergic to it.

The season, which typically begins in August, will last for the next several weeks, said Dr. Wes Sublett, an allergy and immunology specialist with Family Allergy & Asthma.

“All the way through September, you’re going to have high, high ragweed concentrations,” Sublett said. And “ragweed persists all the way until the end of October when we get a couple of hard freezes.”

If you’re miserable, you also could be reacting to other fall weeds, mold or Kentucky’s state flower, goldenrod, said Dr. Derek Damin of Allergy Partners of Louisville.

The allergies can overlap and lead to the same kinds of symptoms, such as itchy nose, runny nose, sneezing, postnasal drip, itchy and teary eyes and even asthma flares, said Damin, an allergist. Some people also complain of headaches and ear issues.

“Without skin testing, it’s hard to say specifically” which allergy the person has, he said.

While some people may get adequate relief from taking a generic Zyrtec (cetirizine) on an “as-needed basis,” others may need multiple categories of medications year-round to get the best results, Damin said. “It depends on the individual.”

Getting a jump on the season by, for example, starting sublingual tablets (Ragwitek under the tongue) three months in advance, can be helpful, Damin said.

But if you didn’t do that, there is hope. “A lot of your antihistamines can kick in, in as little as an hour,” he said. “It’s never too late to start.”

Many, including Allegra (fexofenadine), are available without a prescription, he said.

Other medications that might be helpful include nasal steroids such as Flonase (fluticasone) and Nasacort (triamcinolone), antihistamines such as Claritin (loratadine), and eye soothers, such as Zaditor (ophthalmic ketotifen) and prescription Pazeo (olopatadine hydrochloride), Sublett said.

Some nose sprays may take a couple of weeks to provide a noticeable benefit, but “even starting them now will help you well into September and October,” Damin said.

Nasal sprays and oral decongestants may help people who get allergy-related headaches, Damin said, but patients with severe symptoms may need to see a headache specialist or a neurologist.

When choosing a medication, be sure to familiarize yourself with the side effects. For example, drowsiness can be a significant issue with some drugs, such as Chlor-Trimeton (chlorpheniramine) and Benadryl (diphenhydramine), Damin said.

“Kids who go to school on sedating antihistamines may have a 10 percent decrease in their academic performance,” Damin said.

Consider seeking the advice of a qualified medical professional for guidance.

“If you know that you’re having problems during August and September and you suspect that it’s ragweed, the best thing to do is to see a board-certified allergist to confirm your ragweed allergy and then talk about therapy options, which may include medications or immunotherapy,” Sublett said.

Allergy shots are a type of immunotherapy. The American Academy of Allergy, Asthma and Immunology describes them this way: “Allergy shots work like a vaccine. Your body responds to injected amounts of a particular allergen, given in gradually increasing doses, by developing immunity or tolerance to the allergen.”

In other words, immunotherapy can help to “change your immune system to get rid of the problem,” Sublett said.

However, the shots don’t work right away. There’s a build-up phase that may include getting shots once or twice a week for say three to six months, then taking maintenance shots (with a longer period between shots) once the effective dose has been reached, according to the academy.

Damin noted that “oftentimes, when patients first start allergy shots, until those shots become therapeutic, (patients) will still have to rely pretty heavily on their medications to suppress their symptoms.”

A small percentage of people don’t benefit from allergy shots, but patients should give their shots “at least a good six months at maintenance levels before they deem themselves a non-responder,” Damin said.

If your shots don’t seem to be working, there’s also a chance that you were misdiagnosed or that the dose isn’t high enough, he said.

Beyond shots and medications, allergy sufferers may get some relief from avoidance measures, such as keeping windows closed, wearing a mask (preferably the NIOSH 95 type) for yard work, taking a shower afterward and using a high-efficiency air filter on their heating and air-conditioning systems, Sublett said.

Some asthmatics benefit from avoidance as well as various treatment strategies, from steroid inhalers to short-acting medications that ease bronchospasms and wheezing, Damin said.

“We’ve seen numerous patients where the fall allergy season is causing significant respiratory symptoms and asthma symptoms, leading to loss of workdays and a diminished quality of life in terms of being able to breathe on a normal basis,” he said.

Reporter Darla Carter can be reached at (502) 582-7068, dcarter@courier-journal.com or on Facebook at DarlaCarterCJ.

ALLERGY TIPS

See a board-certified allergist for advice.

Try over-the-counter or prescription drugs.

For longer-term benefit, consider allergy shots.

Ask about taking sublingual tablets before your allergy season starts.

Use avoidance measures, such as keeping your windows closed and wearing a mask during yardwork.

Consider using a nasal rinse. If you don’t have a sterilized solution, use boiled water or distilled water to reduce risk of infection.

Sources: Louisville allergists Derek Damin and Wes Sublett


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Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.