Generics Blog|Medical-Care News

It’s spring, the season of birth and hope, and so once again you perform your vernal ritual. You sneeze. You blow your nose. You rub your eyes. You sneeze. Then you dig out your tried-and true allergy medication, always good for a little relief–but only a little. So for the next few months you sneeze and blow and itch, and your voice sounds like the frogs croaking in the warm spring night.

But it doesn’t have to be that way. Ritual may be good for the soul, but when it comes to the nose, there’s nothing like a solid medical advance. Fortunately, the past few years have brought big improvements in hay fever remedies. A slew of new drugs, of both the prescription and over-the-counter varieties, have become available. On the other hand, some old favorites have been discredited. So if your current regimen leaves you snuffling and snorting, it’s time to sniff out what’s new.

One recent change should make it easier to head off many of your seasonal miseries without so much as a trip to the doctor. Last January the Food and Drug Administration decided to allow the over-the-counter sale of a nasal spray containing cromolyn sodium. Available by prescription for 14 years, Nasalcrom has a spotless safety record; its most serious side effect is that it can make your nose sting. Small potatoes when you consider that in return the drug keeps that organ from becoming itchy, drippy, and sneezy.

When cromolyn sodium hit drugstore aisles in April, it became the first nonprescription allergy preventive. Still, for many people, it won’t solve everything. One problem is inconvenience: You have to-spritz each nostril three or four times a day. “It works best in people who are a little bit obsessive compulsive,” says William Dolen, an allergist at the Medical College of Georgia. And you may have to follow that daily routine for more than a week before you notice any effect. More important, cromolyn doesn’t ease nasal stuffiness or do a thing for allergy-irritated eyes.

To unplug their noses, many allergy-sufferers make heavy use of decongestant; whether nasal spray or pill, they reduce swelling by constricting blood vessels. Big mistake, says allergist James Baraniuk of Georgetown University Medical Center. Use a spray more than a few days and you’ll get a rebound effect. “You’ll end up with congestion worse than when you started,” Baraniuk says. As for oral decongestants, they rev up the nervous system, bringing on jitters or even nightmares.

If you walk on by the decongestants, should you linger at the shelf reserved for antihistamines? They won’t do much more than cromolyn to unclog you–but in other ways these drugs are the foot soldiers of allergy treatment. They can give your smeller a break from sneezing and dripping, your eyes a rest from itching and tearing. And all you have to do is down one or two pills a day.

Just don’t choose this fix too often. Over-thecounter antihistamines have such serious drawbacks that if they were to come under FDA consideration today (rather than having been sanctioned years ago, when guidelines were less rigid), the agency probably wouldn’t approve them for nonprescription use. As anyone with allergies knows, they’re likely to make you sleepy. Even if you don’t feel drowsy, says pharmacologist dames O’Hanlon of Maastricht University in the Netherlands, these medications can leave you dangerously dopey.

O’Hanlon gave nonprescription antihistamines to volunteers, then tested their driving skills. He found that a single dose impaired the motorists as much as a blood alcohol level of .08, which in a number of states can get you slapped in jail for drunk driving. Drivers reacted slowly and tended to drift. “Personally,” says O’Hanlon, “I would never take an over-the-counter antihistamine and do anything that my safety or my family’s safety depended on.”

You can minimize the problem if you take a 24-hour antihistamine at bedtime; that way, the drug should combat allergy symptoms through the next day, but its soporific effect will have waned. If your allergies are so bad that you need antihistamines for months at a time, though, it’s worth seeing a doctor for a prescription antihistamine that doesn’t cause sleepiness. These kinds of drugs have been available for a number of years–but they, too, have improved.

A recent newspaper ad shows how big the changes are. In it, Hoechst Marion Roussel, maker of the well-known antihistamine Seldane, told its millions of satisfied customers to . . . switch to another drug. Granted, the other drug, Allegra, is also a Hoechst product. Still, it’s not the kind of ad one sees every day.

Seldane, of course, was the first nonsedating antihistamine. When it hit the market in 1985, allergy sufferers everywhere, eager for drowse-free relief, rushed to demand a prescription from their doctors. Seldane became the pharmaceutical equivalent of a record gone platinum. But in 1991 researchers discovered that when combined with the common antibiotic erythromycin or one of several other drugs–or when simply washed down with grapefruit juice–Seldane can trigger abnormal heart rhythms. In rare cases such arrhythmia is fatal. The problem received widespread attention, but not everyone got the message. In a study last year, researchers at the Georgetown University Medical Center reported that when presented sham prescriptions for both erythromycin and Seldane, one-third of pharmacists in the Washington, D.C., area provided the drugs without mentioning the danger.

In January the FDA proposed yanking Seldane from the market. Fortunately, newly approved Allegra is Seldane’s good twin. It turns out that Seldane mutes allergy symptoms only after the body has converted the somewhat risky drug into another chemical. Allegra supplies a straight shot of that workhorse compound–which tests show to be free of major side effects. And there are other options: Neither Claritin, introduced a couple of years ago, nor Zyrtec, which came out last year, has the potential for Seldane-style interactions. Of the three, Zyrtec is the strongest, but it makes a small proportion of users drowsy. (Hismanal, the other nonsedating antihistamine on the market, can have the same perilous side effect as Seldane when taken with erythromycin.)

You’ll need to do a little experimenting to find out which of these drugs works best for you. Although researchers don’t know why, one allergy-sufferer may find relief with Claritin but not Allegra, for instance, while another may have the opposite experience.

If your symptoms are really driving you crazy or bringing on problems such as sinus infections, even prescription antihistamines may not be enough. Then it’s time to call in the heavy artillery. Steroid nasal sprays outperform antihistamines in relieving congestion and sneezing. Like cromolyn, though, steroid sprays can take a week to start working and even then may not soothe itchy eyes.

An unlucky minority doesn’t respond to any of these allergy treatments. If you’re truly pollen-impaired, your last resort is to get allergy shots. This approach, known as immunotherapy, has been around for decades. You may remember the routine from childhood: The doctor does a series of skin tests to determine exactly what provokes your allergies, then injects you with small doses of those very irritants–called allergens–to desensitize your immune system. You have to get shots year-round, but over several years, as your body grows accustomed to higher doses of allergen, you need them less frequently. If all goes well, you can eventually end therapy without a return of symptoms.

It’s a regimen that rewards people with thick skin and plenty of patience. For people who lack the latter, allergist Jay Portnoy of Children’s Mercy Hospital in Kansas City, Missouri, recently reported on a technique he calls rush immunotherapy. Patients get their first eight shots in six hours, compressing a few months of treatments into a single day. In a recent trial with 22 allergy-sufferers, patients experienced more side effects- chest tightness, hives, runny noses–on that grueling day than they would have during any single session of standard immunotherapy. Still, Portnoy says the method proved safe.

Less extreme forms of this technique, such as getting four injections in a day, are also under investigation. But many allergists, squeamish about the potential side effects, are approaching the method cautiously. Much more research and doctor education will have to be done if these techniques are to catch on.

If the thought of year-round immunotherapy, whether rushed or leisurely, makes you cringe, keep an eye out for news on a vaccine for the allergy to ragweed, one of the biggest sneeze-drip-itch triggers in the United States. In a study by Immulogic Pharmaceutical Corporation, getting eight shots of the vaccine, called Allervax Ragweed, over about a two-week period before ragweed season left volunteers needing half as much allergy medication as the unfortunates who’d received dummy shots. The vaccine could be on the market in 1999.

But most people needn’t wait for relief. A trip to the drugstore or doctor and a little experimenting with the new remedies may be enough to get you ready for a new spring ritual. Forget the tissues; bury your nose in blossoms instead. And from now on, let the bullfrogs be the only ones who croak.
A Roster of Hay Fever Relievers

Do you buy tissues in bulk? You may not be getting all the allergy relief that’s out there. Here are the pros and cons of the prescription and ovet-the-counter drugs currently available.

Spray decongestants (e.g., AFRIN, 4-WAY, VICKS SINEX) PRO: immediately unclog stuffed nose.

CON: can actually cause stuffiness with prolonged use.

Oral decongestants (e.g., SINUTAB, SUDAFED, TYLENOL SINUS)

PRO: ease nasal stuffiness without producing rebound congestion.

CON: can cause nervousness and insomnia; can raise blood pressure.

Nonprescription antihistamines (e.g., BENADRYL, CHLOR-TRIMETON, TAVIST)

PRO: quickly relieve itchy eyes, runny nose, and sneezing.

CON: can cause drowsiness; don’t unclog nose.

Prescription antihistamines (ALLEGRA, CLARITIN, HISMANAL, ZYRTEC)

PRO: quell symptoms without inducing sleepiness.

CON: can take up to two weeks to bring relief. Hismanal can interact with the antibiotic erythromycin to produce heart-rhythm abnormalities.

Cromolyn nasal spray (NASALCROM)

PRO: prevents sneezing and runny, itchy nose; available over the counter.

CON: must be used four to six times daily; full effect takes up to two weeks; doesn’t lessen nasal stuffiness or soothe itchy, watery eyes.

Steroid nasal sprays (e.g., BECONASE, FLONASE, VANCENASE)

PRO: provide the most effective relief of congested or runny nose, sneezing, and watery, itchy eyes; can also help prevent these symptoms.

CON: bring some relief quickly but take up to a month for full effect.