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Mr. Allergy Bike Doc.

 
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the toninator
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PostPosted: Thu Oct 20, 2011 11:17 am GMT +0000    Post subject: Mr. Allergy Bike Doc. Reply with quote

I've been taking Actifed or more recently Walgreens version (with the Crank Drug in it) forever. After reading the previous thread and reading some of the side effects, I think it's time to switch away from pseudoephedrine hydrochloride but donít know of a good alternative. I think I have pretty typical symptoms like stuffy, runny nose and watery itchy eyes.
There a bunch of newish products on the market like Zyrtec, Claritin, Allegra etc but Iím not sure which one is best for my symptoms.
Any advice you can provide will be appreciated.
Tony
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The Bike Doc
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Joined: 08 May 2003
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Location: Corpus Christi and Warda, Texas

PostPosted: Sat Oct 22, 2011 9:48 am GMT +0000    Post subject: Reply with quote

toninator:

The selection of an over the counter allergy medication would be predicated by your predominant allergy symptoms.

Persistent, watery nasal drainage, you should use an antihistamine that provides some drying characteristics: Cetirizine (Zyrtec) 10 mg daily, Clemastine (Tavist) 1.34mg twice daily are very effective in this area and they both help control the itching and indirectly decrease congestion by blocking the vasodilating effects of histamine. The side effects are mouth dryness, nasal dryness, in men with prostate problems difficulty with urination, and slight sleepiness in some individuals (the sleepiness effect wears off within 2-3 days of daily dosing).

If however, excess nasal dryness and nose bleeds are a problem for you or you do not tolerate the other above side effects, then you would want to use a non-drying, non-sedating antihistamine such as Loratadine (Claritin) 10mg daily or Fexofenadine (Allegra).

You don't have to pay the higher brand name prices. I happen to use generic Clemastine for when my allergies flare and are not adequately controlled by the topical nasal steroids and hypertonic nasal irrigation that I use. The generic Clemastin works quite well for me.

If you have problems with nasal congestion as the predominant symptom, then a non-sedating antihistamine combined with irrigating your nasal passages with hypertonic saline (1.8% sodium chloride solution) instead of normal saline (0.9% sodium chloride solution). I recommend the NeilMed Sinus Rinse bottle 16 ounce size. http://www.neilmed.com/usa/sinusrinse.php You can use the enclosed packets but add two to the bottle to get the hypertonic saline concentration. When you have used up the packets you can make this very inexpensively by mixing 1 tsp plain table salt to 2 cups warm water. I recommend the sinus rinse bottle over the Nettie pot because with the gentle pressure you apply while squeezing the bottle, you can more effectively rinse the nasal passage clear.

Even if you do not have predominant nasal congestion but have mostly nasal itching and drainage, the hypertonic nasal saline irrigation can help tremendously by daily rinsing out the excess mucous that acts like glue to hold all the inhaled allergens in your nose where the allergens chronically inflame the nasal passages and trigger allergy symptoms. With the daily rinsing the mucous and the allergens are flushed from the nasal passages and there is significant reduction in nasal allergy symptoms.(1-4)

Topical nasal steroids require a prescription. They are also very effective in reducing nasal allergy symptoms. These medications include Budesonide (Rhinocort), Ciclesonide (Omnaris), Fluticasone (Flonase) and Mometasone (Nasonex). When using these medications remember the ditty ďHead down and away from the side you spray.Ē

Steer clear of over the counter nasal decongestants due to "rhinitis medicamentosaĒ or more commonly called rebound congestion. This is problem caused by chronic usage (more than three days) of nasal spray decongestants such as Afrin, Dristan, Neo-Synephrine and others. These medications work in a completely different way than the topical nasal steroids which work by suppressing local inflammation. The nasal spray decongestants work by constricting blood vessels that leads to decreased fluid getting into the surround mucous membranes. The problem is the body can tolerate constricted blood vessels so long and will compensate by releasing substances that make the blood vessels open back up. This can occur in as little as three days of routine use of the nasal decongestants, thus the warning they carry in the tiny print on the bottle or package that states if your symptoms last more than three days seek medical attention. So if you are using a nasal decongestant spray it is time to stop using it.

As you alluded to, I do not recommend chronic oral decongestants, such as pseudoephedrine (Sudafed), as they not only constrict the blood vessels not only in the nose, but elsewhere in the body causing elevated blood pressure, elevated heart rate and in rare case strokes.

References
1. Li H, Sha Q, Zuo K, et al. Nasal saline irrigation facilitates control of allergic rhinitis by topical steroid in children. ORL J Otorhinolaryngol Relat Spec. 2009;71(1):50-5. Epub 2008 Dec 1.
2. Garavello W, Di Berardino F, Romagnoli M, et al. Nasal rinsing with hypertonic solution: an adjunctive treatment for pediatric seasonal allergic rhinoconjunctivitis. Int Arch Allergy Immunol. 2005 Aug;137(4):310-4. Epub 2005 Jun 20.
3. Garavello W, Romagnoli M, Sordo L, et al. Hyper-Saline nasal irrigation in children with symptomatic seasonal allergic rhinitis: a randomized study. Pediatr Allergy Immunol. 2003 Apr;14(2):140-3.
4. Rabago D, Zgierska A, Mundt M, et al. Efficacy of daily hypertonic saline nasal irrigation among patients with sinusisits: a randomized control trial. J Fam Pract. 2002 Dec;51(12):1049-55

Thanks,
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Paul K. Nolan, MD
AKA: The Bike Doc
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the toninator
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PostPosted: Sun Oct 23, 2011 3:36 pm GMT +0000    Post subject: Reply with quote

Thanks for all the great info Doc!
Tony
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the toninator
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Location: Hights

PostPosted: Mon Oct 24, 2011 8:46 am GMT +0000    Post subject: Reply with quote

Made the switch to generic Zyrtec this morning. Hope the withdraws from the crank med isnít too bad. Also going to watch the allergy report and see if I can skip days.
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the toninator
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Location: Hights

PostPosted: Wed Nov 16, 2011 1:06 pm GMT +0000    Post subject: Reply with quote

The transition has been very easy and I can tell Iím not suffering that pseudoephedrine grogginess anymore. I get the watery nose a little more often but its not bad.
Thanks doc!
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The Bike Doc
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Joined: 08 May 2003
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Location: Corpus Christi and Warda, Texas

PostPosted: Fri Nov 18, 2011 11:15 am GMT +0000    Post subject: Reply with quote

Toninator:

Try Tavist or the generic equvalent Clemastine. The over the counter strength is 1.34mg, take one twice a day to help decrease the nasal drainage. You can bump it to two tablets 2.68mg, which is the prescription strength of Tavist (Clemasinte), twice daily if you are having significant break through nasal drainage or itching.

Thanks,
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AKA: The Bike Doc
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