Unfortunately, there is no cure for allergies—you can only manage the symptoms. The best allergy management is to avoid the allergen entirely, but that can sometimes be impossible. Allergy expert Dr. Gretchen Oakley explains how sprays, pills, and eye drops can be a part of your allergy management plan, and when you need to call in an expert.
Hear Dr. Oakley’s whole interview at healthcare.utah.edu or read the transcript below.
There is no cure for allergies. Really the best you can do is manage the symptoms. The first step to doing that is to avoid the things that give you allergy symptoms, but that can be hard. You can’t always do that. So then the next step is sprays, pills, and eye drops.
Dr. Gretchen May Oakley is a Nose and science expert at U of U Health, and is also an allergy expert. She is going to take us through the process of trying to figure out how to manage those symptoms, and then maybe understand when you need to get professional help. Dr. Oakley, let’s first start with allergy spray.
Dr. Oakley: There are a couple main nasal sprays that work really well and have great evidence behind them for the treatment of allergies. Our first line of treatment, based on the literature, and just how well it works in patients is nasal steroid sprays. And fortunately, they’re all [sold] over-the-counter. Some sprays would be, if I were to name some, would be Fluticasone nasal spray, Mometasone, Budesonide are the most common. There are a couple others in that similar family and they work really well. You can use them up to twice a day. More than that is not going to help any more. But one or twice a day use.
They’re very reliant on regular, consistent use, and they have a slower ramping up effect. So you really want to use for at least a few weeks on daily basis very regularly to get their full effect. Rather than here-and-there when there’s something bothering you.
The Scope: If the over-the-counter stuff doesn’t work, are their prescription ones that are very different? Or are most of them over-the-counter nowadays?
Oakley: There is an antihistamine spray that is a prescription that can work great for a lot of patients, too. Either as their primary treatment or as a secondary, an additional treatment if the corticosteroid sprays alone don’t work enough for them. That antihistamine spray is called Azelastine, and it works particularly well for those, let’s call them the “wet” allergy symptoms. More of those sneezing, runny nose, itchy, watery eyes, that kind of tickle sensation that we get with allergies. They work okay for the nasal congestion symptom, but the steroid sprays work better for that.
The Scope: What is it that makes it so different from person to person that perhaps a steroid spray would work for another? Is it just a difference in us as humans?
Oakley: We don’t always know exactly why some patients respond better to some sprays and not others. It may just be the severity of their symptoms. They might get 75% better with the steroid sprays but it might be not quite enough. Where someone else whose symptoms might be moderate and do great and that might be all they need. Some patients might be more bothered by the runny nose and the sneezing, whereas in those cases the antihistamine sprays would work better for them. So you know, you just get a different presentation of our allergies, different symptoms. But you’re right, the other factor is that we’re all just a little bit different and we respond just a little bit differently to certain treatments.
The Scope: It can be a little frustrating as an allergy sufferer sometimes because as patients we think “well, I’m going to go in and the doctor is going to give me the cure.” But will allergies, it sounds like sometimes you have to do some experimenting on what’s going to work for that person.
Oakley: Exactly. There’s definitely some trial and error there to try to get it just right for that patient. The third thing in terms of nasal treatments I’d be remiss if I didn’t mention is very straightforward. It’s saline in the nose, saline irrigation. Those can work really well as an adjunct treatment. It’s not going to, in and of itself, fix your allergies, but it can help with some of the symptoms, along with these other treatments by mechanically washing those allergens, those irritants, those pollens out of the nose so they’re not just sitting on the lining of the nose and inflaming it.
The Scope: So do you normally go nasal spray and then oral medications. Is that how that usually goes?
Oakley: In general, yes. I would like to give people topical treatments over the oral treatments if possible just because the side effects tend to be lower. The other thought I’ll talk with patients about, certain oral treatments, certain oral antihistamines, tend to work similarly to a nasal steroid spray and have similar effectiveness. But sometimes patients will have symptoms that are not just in the nose. They’ll have some dermatitis that they’ll get with their allergies that bother them. Or symptoms like that which are elsewhere. And sometimes the systemic therapies, or oral therapy, in that case, can be a little bit more helpful than a localized therapy.
The Scope: So oral medications… let’s talk about over-the-counter first. What are the choices there?
Oakley: I would say the main one would be those oral antihistamines, so the newer versions tend to work better for patients with fewer side effects are Loratadine (Alavert, Claritin), and Cetirizine (Zyrtec) and Fexofenadine (Allegra). Those are the main newer generation of oral antihistamines. The older generation antihistamines include what we’d know as Benadryl. Which can work, too but tends to have higher side effects and going to be more sedating to patients. So we generally recommend the newer generation meds, non-sedating meds. They have great evidence behind them that they work well.
The Scope: Itchy eyes is another symptom a lot of people have with allergies. I used to suffer terribly and then I was prescribed eyedrops. Now I can get them over the counter, think they’re the same thing, which makes all the difference. Can you talk about some of the eye drops you might want to look for if itchy eyes are part of your allergy symptoms?
Oakley: Eye drops can help a lot. It’s an antihistamine eye drop. There are a couple of different ones. One that is popping to mind is Olopatadine. That can actually help patients significantly because a constantly itchy eye will drive you crazy.
The Scope: And just like all the other things, I had to try a couple of different antihistamine eye drops before I found the one that worked for me. You know what, I started out thinking ‘let’s see if we can give people some things they can try on their own,’ but then you start talking about how this combination isn’t proven to work as well as that combination, and it can get really complicated really fast. I’m starting to think maybe if the first nasal spray doesn’t work, maybe go see a doctor to try to figure out what combinations of stuff will work. It gets complicated pretty fast, doesn’t it?
Oakley: It does get complicated. But it is certainly reasonable to try a couple over-the-counter meds on your own. If I were in my patients’ shoes, I would start a nasal spray and give that a few weeks. If that didn’t work, then I’d maybe try an oral antihistamine for a couple of weeks, just to see how I do. After that, I don’t see a lot of benefit in just suffering. I think it’s worth going in and talking to your doctor about some alternative options that may help quite a bit rather than being miserable.
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