New Allergy Medicines Offer Relief & Confusion

Decades ago, treating allergies was hard. First, you had to go to the doctor, since most allergy medicine was only available by prescription.
Antihistamines such as Benadryl and Chlortrimeton were reasonably effective for relieving sneezing and sniffling, but they could be sedating. Some allergy sufferers had to choose between a drippy nose and serious drowsiness, a feeling akin to walking under water.
If a patient complained that a simple antihistamine wasn’t enough, the doctor often prescribed a decongestant. Sudafed (pseudoephedrine) was popular, although it could cause problems for people with high blood pressure, glaucoma, prostate enlargement or heart disease. Its stimulant properties could also cause insomnia if it was taken in the evening.
These days, antihistamines like Benadryl can be purchased without a prescription. Sudafed is also available over the counter, and other prescription products have made the switch as well.
One is Nasalcrom, a unique nasal spray that can be used to stop allergy symptoms before they start. The active ingredient, cromolyn, stabilizes the mast cells that produce histamine and cause sniffles and sneezes. It works best if used preventively, before the nose starts to run and throughout allergy season.
This spring, there’s a brand new allergy medicine on drugstore shelves. Claritin, which was available only by prescription last year, has joined the OTC crowd.
For years, non-sedating Claritin was the most frequently prescribed allergy medicine. Now anyone can take it without a doctor’s visit. But not everyone is pleased.
Some patients have found that Claritin costs them more when they buy it over the counter than it did last year as a prescription product. At around a dollar a pill, a month’s supply can run more than $30. Insurance doesn’t cover nonprescription pills, so people have to pay the entire price themselves.
Insurance plans often charge a modest $10 or $15 co-pay. But with Claritin now available off-the-shelf, many insurance companies have raised the co-pay for other antihistamines. Drugs that still require a prescription, such as Allegra or Zyrtec, may carry a co-payment as high as $35 or even $50.
Antihistamines are not the only approach to allergy. Steroid nasal sprays have become extremely popular. These prescription products calm inflammation and go to work right in the nose where they are needed. Side effects associated with oral steroids like prednisone are much less common.
The big challenge is selecting the appropriate product. There are so many to choose from it gets complicated. There’s Flonase, Nasacort, Nasalide, Nasarel, Nasonex, Rhinocort and Vancenase.
A completely different kind of prescription spray called Atrovent works by drying up nasal secretions. And Astelin is a prescription antihistamine nose spray.
The newest player in the allergy sweepstakes is the prescription pill Singulair. Instead of blocking histamine receptors, it targets leukotrienes, other substances that are linked to allergic symptoms like sneezing and runny nose. Originally developed for asthma, Singulair is now being used for allergies.
With so many options, getting the right treatment requires close collaboration with a knowledgeable physician.