In warm weather, East Tennessee is painted green, resulting from all our trees and plants. If it’s green, it reproduces with pollen, which is abundant in the spring. For the unfortunate, susceptible individual, pollen triggers the immune system to produce what are known as IgE antibodies. These antibodies bind to mast cells, which line our respiratory tract. When this binding occurs, there’s a rapid release of chemicals (histamine and leukotrienes) which cause inflammation and the symptoms of sneezing, itching, runny nose, and nasal congestion. While we can’t get rid of pollen or the aggravating mast cell, there are medications that can help. Here’s a summary of what is available over-the-counter (OTC) and by prescription. The chemical name is listed first, followed by the trade name:
- Nasal steroid/cortisone sprays: a) fluticasone-Flonase b) triamcinolone-Nasacort c) budesonide-Rhinocort.
- Available by prescription: a) mometasone-Nasonex b) ciclesonide-Omnaris/Zetonna
- Oral antihistamines: OTC: a) non-drowsy options: fexofenadine-Allegra, loratadine-Claritin b) low drowsiness options: cetirizine-Zyrtec, levocetirizine-Xyzal c) Fast acting: diphenhydramine-Benadryl. Because it induces drowsiness, it is used only for acute reactions and not for daily management. Also, it is not recommended at all for the elderly as they can cause falls, delirium, and acute psychosis.
- Nasal antihistamine sprays: OTC: azelastine-Astepro. Prescription:Dymista
- Saline spray. Fortunately, you cannot use too much of this as it must be used frequently.
- Antihistamine eye drops: OTC: olopatadine-Pataday, ketotifen-Zaditor
- Decongestant: OTC: pseudoephedrine-Sudafed. Use with extreme caution with a history of hypertension or heart disease.
- Mast cell stabilizer: OTC cromolyn-Nasalcrom.
For best results, begin these medications a week before known initial or heavy exposure. Finally, if all else fails, it may be time to visit the allergy doctor.
Dr. Charlie Barnett is a contributor to KnoxTNToday, where he writes a weekly column, DocTalk, sharing his expertise on health and wellness management.
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Thanks for the comprehensive list of OTC products. How about a follow up on what to expect from a visit to the allergist?
Benadryl works best for me, and I’m glad we now have it with no dye, brand name or Walmart brand. Sudafed will wire you up, increase your heart rate and blood pressure and subsequently interfere with your sleep, which you need more when sick. It is a close relative to amphetamines (speed). Saline is for a stopped up nose, natural and no side effects. I load up on a quercetin complex which helps the immune system deal with a spring/summer cold. There is some bad stuff out there not associated with pollen. Probably from China. Certainly not from Heaven.