Tag Archives: claritin

When Benadryl is Dangerous (Insert scary movie music here)

benadryl funny pic

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


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.


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

Be sure to subscribe to receive updates by email (scroll up and hit the “Follow” button on the right)? Please “like” my facebook page at www.facebook.com/drdamin, follow me on Twitter and share this page 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.

Nasacort AQ May Become Available Without a Prescription

nose sprayOn Wednesday an FDA advisory panel voted 10-6 in favor of allowing Nasacort AQ to become available over the counter. This is great news for allergy sufferers. The active ingredient of Nasacort AQ is triamcinalone acetonide–a steroid. This will be the first in the nasal steroid category to become available without a prescription.

Great for congestion sufferers: I am always asked about remedies to treat nasal congestion, especially in children. The availability of Nasacort will provide another treatment option without calling the doctor for a prescription or having to use pseudofedrine or Afrin-like products.

The safety conundrum: For years allergists have been asked about the safety of prescription nasal steroids when in reality, more complications are seen from OTC topical decongestants like Afrin and other oxymetazoline containing products. In my mind, it would make more sense for nasal steroids to be available OTC and Afrin to require a prescription.

Others will follow: Watch for many others to follow suit.  As you may recall, a similar trend happened with antihistamines; we saw Claritin, Zyrtec and Allegra become available OTC.  I would expect to see Flonase, Nasonex and others rush to be next in line for placement beside Nasacort AQ on the grocery store shelves.

Be sure to subscribe to receive updates by email (scroll up and hit the “Follow” button on the right)? Please “like” my facebook page at www.facebook.com/drdamin, follow me on Twitter and share this page 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.

Nasal Congestion? Medicine not helping?

Are you or a family member struggling with one of allergy’s most aggravating symptoms? Sometimes our noses work too well. If it doesn’t like what you’re breathing, it does its best to protect you. A congested, runny nose is a body’s way of trying to block out or rinse out the particle/offender. The following is a list of treatments that help with the aggravating symptom of congestion:

  1. Nasal steroids-Nasal steroids are one of the most effective treatments when it comes to congestion. They all require a prescription, and their peak effect comes with several weeks of use. The safety profile is excellent with appropriate use. There can be side effects, though. Nose bleeds and nasal irritation can occur. On rare occasion, someone can develop a perforated septum which is a hole in the tissue dividing the two sides. They can also affect the pressure inside the eye which can be an issue for someone with glaucoma. Remember, they are steroids but  are delivered in microgram quantities and are not likely to cause long term issues the way milligram doses of oral steroids can.
  2. Nasal antihistamines-Nasal antihistamines also are effective for nasal congestion. Most nasal antihistamine studies show a noticeable benefit in congestion in as little as 30 minutes. They can also have an additional benefit when added to nasal steroids.  Like nasal steroids, these are also available only by prescription. They are not as likely to cause nose bleeds compared with nasal steroids and do not affect the pressures inside the eye.
  3. Oral decongestants-Oral decongestants like pseudoephedrine and phenylephrine are effective in treating nasal congestion. Pseudoephedrine is available behind the pharmacy counter without a prescription. For adults, it comes in short-acting 30mg pills as well as longer acting formulations that have up to 240mg in them. They can be found in a tablet by themselves or in combination with antihistamines or guaifenesin. The main issue with oral decongestants is their side effects, as they are stimulants that can raise blood pressure, increase heart rate and cause insomnia.
  4. Nasal spray decongestants-Nasal decongestants are the payday lender of nasal sprays. You can get quick relief but you’ll pay for it later with continued use. They constrict blood vessels in the nose and can provide a rapid improvement in congestion. If used more than three days, rebound congestion develops when the medicine wears off that can be worse than the initial congestion. These sprays can be addictive and lead to damage to your nasal tissue. It’s called rhinitis medicamentosa and occasionally needs steroids to help break the cycle. I have a bottle in my medicine cabinet. When I have a cold and wake up congested in the middle of the night, I’ll go for the rapid relief so I can get right back to sleep.
  5. Hypertonic nasal saline-Hypertonic nasal saline has a greater salt concentration than isotonic saline. It can have a very mild effect on nasal congestion.
  6. Surgery-If you’ve exhausted all the options above or have medical issues that narrow your choices, you may want to consider looking into an anatomical issue. For some a deviated septum or severely swollen nasal turbinates despite medicines will require an evaluation with an ENT. A septoplasty or a turbinectomy may be the answer rather than medicine. For kids, the blockage may not be the front portion of the nose but swollen adenoid tissue in the back of the nose.

You may ask, “What about oral antihistamines?” They are not on this list. By themselves, oral antihistamines do not treat congestion. That is why most are sold in combination with pseudoephedrine as a “D” option.

Spring is here. Talk with your doctor about what you should take to keep congestion from slowing you down.

Be sure to “like” my facebook page at www.facebook.com/drdamin, follow me on Twitter and share this page 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.

Tips to Save Money on Your Allergy Medications

If you think you are paying too much for your allergy medications, you probably are.

This week, I’m focusing on generic medications and how buying generic allergy medications can save you hundreds of dollars each year.

What is a generic drug? A pharmaceutical company manufactures a drug that is usually under a patent that, until the patent expires, may not be produced by another company. Once it expires, a generic can be made. The FDA deems a generic drug as identical (or bioequivalent) to a brand name drug in:

  • dosage form,
  • safety,
  • strength,
  • route of administration (how a drug gets into your body and travels to the area it is meant to target),
  • quality,
  • performance characteristics, and
  • intended use.

We are lucky to have a myriad of generic options to treat common afflictions. As insurance plans move to higher and higher deductibles, patients need to become smart shoppers when it comes to their medical care. Here are some tips that can save you money on your allergy medications.

Last year, the patents for Singulair (generic: montelukast), Astepro Nasal Spray (generic: azelastine 0.15%) and Allegra syrup (generic: fexofenadine) expired. Many generic options already exist for oral antihistamines and nasal sprays. The best way to find the generic is to shop for the active ingredient. Below I have charted three of the most common brand name allergy medications at today’s prices, the active ingredients and the cost to buy the generics at your local warehouse club.

Generic Medication Savings

What about your nasal spray prescriptions, which can be highly effective for many allergy sufferers? Find the generic Flonase by looking for the active ingredient fluticasone. There are also generics for Astelin (generic: azelastine 0.10%) and Nasacort AQ (generic: triamcinalone). How about steroid creams? I am a big fan of generic triamcinalone acetonide cream. You can even buy it in a one-pound container, and this is helpful if you were going through a 30 gram tube every few days. Do you use eye drops to help with your allergies? Check out your local pharmacy eye care aisle and look for ketotifen eye drops instead of Zaditor or Alaway.

Seeking out generic forms of medication can save you a lot of money. Several years ago, brand name Flonase and Zyrtec cost roughly $2,000 per year! Generic options have cut treatment costs over 90% for these users. Some people swear by a brand name medication for their needs, but most people cannot tell a difference. And remember, generic drugs undergo FDA approval to ensure they meet regulations for safety and efficacy. Talk to your doctor to figure out what’s best for you.

So the next time you are ready to purchase your brand name medication, turn over the package and check the shelf for a generic equivalent. Your wallet will thank you for it!

Be sure to “like” my facebook page at www.facebook.com/drdamin and share this page 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.