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Your Step-by-Step Guide to Treating Allergies
STEP 1: ANTIHISTAMINES
Dr. Ownby's Tip: Start early, and keep it up.
“The problem I see with most people … is that they wait until their symptoms are very bad and then try to take an antihistamine,” says Dr. Ownby. Allergy symptoms are like a snowball that starts small but then gets bigger, faster and more destructive. “If you wait until it’s really going, it gets very difficult to stop.”
So start the antihistamines at the beginning of your allergy season, and don’t stop until it’s over. If you’re allergic to something that’s present all year, he says, “by and large, there doesn’t seem to be any major danger of taking antihistamines year-round.”
How Antihistamines Work
Some people’s bodies perceive threats where there are none. If yours thinks something like grass or cat dander is dangerous, it releases chemicals, including histamine, to get rid of the invader. Histamine can cause itching, sneezing, runny nose, watery eyes, congestion, swelling—in other words, an allergic reaction. Antihistamines prevent histamine from starting this reaction.
Antihistamine Side Effects
The main side effect is drowsiness, since histamine also helps your brain stay awake. The newer antihistamines, Allegra, Clarinex and Zyrtec, don’t get into your brain as much, so they’re less likely to make you sleepy. Over-the-counter loratadine (Claritin, Alavert) is also nonsedating, but, in Dr. Ownby’s opinion, “is not as effective.”
Older antihistamines, such as diphenhydramine (Benadryl), clemastine (Tavist) and chlorpheniramine (Chlor-Trimeton), are effective and may be less expensive than their newer counterparts.
How to Avoid Drowsiness With Antihistamines
Start slowly. For example, says Dr. Ownby, “for Benadryl, the normal dose for an adult is 25 to 50 milligrams three to four times per day.” Shocking your system with this much antihistamine all at once is bound to make you sleepy. Instead, allow your body to adjust gradually, beginning with 25 milligrams at bedtime. (“The drowsiness is usually worse as the blood levels increase in the first four to six hours.”) Then, increase the amount by 25 milligrams every three days until you’re at (not over) the maximum dosage.
Also, get enough sleep while you’re on antihistamines. “It doesn’t take much to cause some additional drowsiness.”
STEP 2: DECONGESTANTS
Dr. Ownby's tip: Don’t overdo it, or they won’t work as well.
How Decongestants Work
By shrinking blood vessels and reducing swelling, thus unstopping your nose.
Down Side of Decongestants
You can’t take them all the time. “If you take them regularly, you develop some tolerance,” Dr. Ownby says. So only use them as needed. Decongestants can also have side effects, like increasing your blood pressure, and can “cause some people to be jittery or shaky.”
In addition to the pills, decongestant nasal sprays are available, but the body builds up a tolerance to them more quickly, so you shouldn’t use them more than three days in a row.
STEP 3: PRESCRIPTION STEROID NASAL SPRAYS
How Steroid Nasal Sprays Work
By causing nasal blood vessels to shrink and inhibiting your immune system’s ability to attack the nose.
How to Use Steroid Nasal Sprays
Like antihistamines, you should use steroid nasal sprays continually throughout the season. And the point is not to inhale the med but to get it directly onto the lining of your nose. “Aim straight for the back of the head,” Dr. Ownby advises—not too straight up or too much to one side.
Also, he says, prime (pump) the bottle if it hasn’t been used for “at least several days or a week. To prime it every time you use it is just wasting medication, though.”
Two Side Effects of Steroid Nasal Sprays
Rarely, they can cause nasal septum perforation (a tiny hole in the nose). If your nose starts bleeding and this lasts for more than a few hours, stop using the spray, cautions Dr. Ownby. Steroid nasal sprays may also slightly increase your risk for cataracts.
By the way, these sprays are not addictive, and Dr. Ownby notes that only “a very tiny fraction” of the steroids in the spray get into your system.
STEP 4: ALLERGY SHOTS
Dr. Ownby's tip: Allergy shots are the only treatment designed to make you less allergic over time.
How Allergy Shots Work
Allergy shots increase your tolerance to allergens. They're “specific for each individual allergen,” says Dr. Ownby, “so you have to be tested to see what you’re allergic to,” usually through a skin test. Most people then get a shot once or twice a week, eventually reducing that frequency to once a month. “Typically, allergy shots are then continued over a period of three to five years. After that, most people can stop.”
Last updated and/or approved: August 2009. Bio current as of spring 2006.
Original article appeared in spring 2006 issue of My Family Doctor. Subscribe here. Buy back issues here.
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