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Risks From Some Common Allergy Medications
By: Joram S. Seggev, MD, FACP

This is a summary of peer-reviewed guidelines for diagnosis and management of rhinitis that were developed by the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology, representing the American College of Allergy, Asthma and Immunology (ACAAI); the American Academy of Allergy, Asthma and Immunology (AAAAI); and the Joint Council on Allergy, Asthma and Immunology.

Many older, but still widely-used allergy, sinus and cold remedies have potentially dangerous side effects that can cause physical and mental impairment, according to a report issued by a national task force of experts in allergy and immunology. Patients taking these over-the-counter and prescription medications are legally considered "under the influence" of drugs in the majority of states, including California.

There is disturbing evidence that many so-called first-generation antihistamines have been a factor in some fatal automobile accidents and occupational injuries. These medications also can affect learning and school performance in children. In fact, the risk from these drugs may be greater than that from narcotics and prescription sedatives.

First-generation antihistamines include brompheniramine (Dimetane DC, Dimetapp), chlorpheniramine (Chlor-Trimeton, Deconamine, Rynatan), diphenhydramine (Benadryl), hydroxyzine (Atarax) and triprolidine (Actifed). Some patients experience side effects similar to those of alcohol, including delayed reaction times, problems focusing on tasks and decreased memory. It is estimated that as many as 63 million people in the U.S. are taking one or more of these drugs.

Newer, second-generation antihistamines such as fexofenadine (Allegra), loratadine (Claritin), and cetirizine (Zyrtec) and the intranasal antihistamine, astelazine (Astelin), have a significantly lower risk of side effects, and usually should be prescribed in place of the older medications for allergic rhinitis. Rhinitis is a general term to describe conditions that cause upper respiratory inflammation and symptoms such as nasal congestion, sneezing and runny nose. Allergic rhinitis (hay fever) is the most common form, affecting from 20 million to 40 million Americans, including from 10 percent to 30 percent of adults and up to 40 percent of children. It is estimated to cost the U.S. nearly $3 billion annually.

Other findings of the task force:
Nasally inhaled corticosteroids (Flonase, Nasonex, Rhinocort, Vancenase, Beconase, Nasacort, and Nasrel) are the most effective medication class for controlling the symptoms of allergic rhinitis, particularly in severe cases.

Antihistamines, oral decongestants and some nose sprays can benefit asthma sufferers who also have rhinitis. Some antihistamines still have warning labels about their use with asthma, yet recent studies demonstrate that these medications are not harmful to most individuals with asthma. Some second-generation antihistamines may even have mild anti- asthma effects, and can reduce asthma symptoms and improve lung function in some patients.

The use of cortisone steroid injections for seasonal hay fever, which are prescribed by many physicians, should be discouraged. Although these injections can provide relief, the potential for hormonal and other side effects is much greater than with the safer alternatives. Safe alternatives to steroid injections include nasal cortisone sprays or, for severe symptoms, a 3- to 7-day course of oral cortisone (prednisone, methyl-prednisolone) medications. Other hay fever treatments recommended by the study include cromolyn nasal spray, oral decongestant tablets and, in some cases, allergy vaccination (immunotherapy).

The task force also provided guidelines on when patients with rhinitis may benefit from referral to an allergy specialist, such as when: The patient needs help identifying and learning to avoid the substances that trigger his or her allergies; The patient's quality of life is significantly affected; Multiple allergic diseases, such as chronic sinus or ear inflammation, are present; Allergy vaccination is indicated; or symptoms last longer than three months.

Joram S. Seggev, MD, FACP
Joram S. Seggev, MD, FACP is a Fellow with the American Academy of Allergy, Asthma & Immunology and Certified with the American Board of Allergy/Immunology.