Treating Sneezes and Wheezes: Allergy and Asthma Medications

Adult taking pill from the bottle


Walk into any drugstore, and you are confronted by a seemingly endless array of over-the-counter preparations to treat allergies and asthma. More drugs are stocked out of sight, available only with a prescription. To make an informed choice you should understand the appropriate use, effects and side effects of each class of drugs.

Antihistamines

Antihistamines are the first line of treatment for allergy symptoms. Antihistamines do not prevent allergic reactions; they simply block some of the symptoms after the reaction has occurred. Most antihistamines will help prevent the itching of an allergic reaction, but may do little to relieve the associated congestion. Some antihistamines must be taken as frequently as every four hours, while others may last for more than a day. Some antihistamines may work in minutes, but others may require hours before any benefit can be noticed. Certain medications may need to be taken with food, while others must be taken on an empty stomach. Therefore it is very important to read the directions for any antihistamine and follow them carefully!

The best-known side effects of antihistamines are drowsiness and decreased reaction time. Fortunately, several new antihistamines cause little or no drowsiness. Other side effects that can occur are dryness of the eyes, blurry vision and, in some men, obstruction of urine flow. Be certain you understand what to expect and how to manage potential side effects.

During pregnancy, some antihistamines are preferred over others. As with other medications, talk with your doctor before taking an antihistamine.

Decongestants

Decongestants are used to treat nasal swelling brought on by an allergic reaction. Most of these medications work quickly, but may last only a few hours. However, some decongestants are available as time-released preparations.

Decongestants can stimulate the nervous system, muscles and cardiovascular system. As a result, patients may experience stimulation, shakiness, insomnia and irritability. They may notice a rapid pulse, and their blood pressure may increase. For these reasons, it is important not to exceed the prescribed dose or frequency of a decongestant medication and to report faithfully any possible side effects to your physician.

Combination Medications

Combinations of antihistamines and decongestant medications are available in a wide assortment of preparations. Some require a physician’s prescription, but many are available over-the-counter. Usually, antihistamine/decongestant combinations provide a more convenient way to take these medications, and in some formulations the action of one ingredient enhances the benefits of another. However, the appropriate amount of one medication may be combined with an excessive or inadequate dose of another. In addition, the stimulating effect of the decongestant is not necessarily offset by the sedating effects of the antihistamine component. For some patients, it may be advisable to adjust the dose of one ingredient while maintaining the dose of another. You should inform your physician of any side effects from a combination preparation so necessary changes can be made.

Beta-Agonist Bronchodilators

Although beta-agonist bronchodilators may not sound familiar, this group of medications is used by virtually all patients with asthma. They are available as tablets, liquids and in aerosol form. Over-the-counter, they are sold as metered inhalers or in oral form. According to M. Eric Gershwin, M.D., non­prescription bronchodilators such as Primatene Mist which contain epinephrine are „extremely effective for the treatment of very mild symptoms and have been a boon to individuals who suffer from this form of asthma.” Beta-agonist bronchodilators {such as Ventolin, Proventil, Maxair, Brethaire, or Alupent) begin to work in minutes and the newest products can be effective for hours. Like any medication, they may produce side effects and should be taken with a physician’s advice. These side effects, which usually mimic the effects of adrenalin, appear as stimulation that includes agitation, rapid heart beat and shakiness. Overdosing may produce increased blood pressure and even heart strain. Maintaining the proper dose and time between doses is essential to the safe use of these medications.

Theophylline

Theophylline, in one form or another, has been used since biblical times to treat asthma. The most important function of this medication seems to be its ability to relax the airway muscles which become spasmodic in patients with asthma. The medication is taken by mouth, and it may take up to a day before there is any important benefit. When given intravenously, the medication may work within hours.

Theophylline comes from the same class of substances as caffeine (typically found in coffee, tea or cola). As expected, it produces many of the same side effects associated with excessive consumption of caffeine. These include stimulation, insomnia, shakiness and irritability. Excessive doses may have profound and serious consequences. Some patients cannot tolerate even a small dose of theophylline. The characteristics of theophylline preparations vary greatly, even from brand to brand. It is essential the product brand not be changed or substituted without approval of the physician. In some cases, the physician may wish to monitor the blood level of theophylline to achieve the greatest benefit without increasing the risk of significant side effects. Theophylline should be taken exactly as prescribed-dosing and product brand should never be changed without the physician’s approval.

Cromolyn

Cromolyn is a relatively new medication, remarkable in its benefit to patients with hay fever as well as those with asthma. It is administered only in spray form, either in the nose or by metered inhaler for the lower airways. Unfortunately, the onset of action is slow and may take from weeks to a month or more. In addition, cromolyn must be taken on a regular basis, usually three to four times a day, and may be decreased to twice daily after regular usage. The benefit of this medication is to prevent reactions. It does not reduce symptoms after a reaction has occurred. On the bright side, however, the medication is remarkably free of side effects and is safe for infants, children, the elderly and patients with coexisting heart conditions. Do not expect the medication to work quickly, and do not begin a trial of the medication unless you can be faithful to the frequent dose schedule.

Corticosteroids

Corticosteroids are as misunderstood as they are beneficial. This class of medication is life-saving in a wide range of illnesses and has been used in varying forms for both typical hay fever and asthma. However, the name itself is often confused with „steroids”-sometimes abused by athletes who use male hormones to increase muscle size and improve performance. There is no connection between these substances. But to further confuse the issue, corticosteroids were also misprescribed and abused when they were first introduced many decades ago. Today, the important side effects are well-recognized and carefully monitored by physicians who prescribe them. In patients with hay fever, their use is generally limited to nasal sprays. Although the benefit may take days to appear, the improvement can be dramatic. Furthermore, when used as directed, the minimal side effects are usually less significant than the disease. Corticosteroids are beneficial for patients with asthma and are given by injection, by mouth and by metered-dose inhaler. In 1991, the National Institutes of Health recommended inhaled corticosteroids as a first-line drug for mild to moderate asthma. Despite the delayed benefit, corticosteroids significantly reduce the severity of the disease process, improve the activity level of the patients using them and reduce the reliance on other medications. As with other medications for asthma, faithful use and adherence to the dose schedule is of great importance.

Management

These medications form the cornerstone in the management of allergic diseases and asthma. Advances in the formulation and delivery systems have improved their effectiveness and reduced potential side effects. Every day, research into improved forms and dosing schemes, as well as innovations in chemistry, seek to provide us with effective, safe and reliable means to manage these diseases. To the patient, a broad understanding of each medication, recognition of the potential side effects and careful attention to the physician’s instructions will provide the keys to a healthier life.

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