The Minster Practice, Lichfield
|
|
|
Updated 05/08/2007 Pharmacist adviceMany preparations are available over the counter. The types of agent are antihistamines (topical and oral), topical corticosteroids, topical allergy blockers (eyes and nose), topical decongestants and herbal and homeopathic remedies. There role is briefly covered here but the site can be no substitute for advice from your local pharmacist. The generic name is given below with a typical brand name in brackets - branded drugs are usually more expensive but no more effective. Remember allergen avoidance including staying indoors when pollen count is high ( See daily UK pollen index http://www.bbc.co.uk/weather/pollen/ ), wearing wrap around sunglasses outdoors, installing pollen filters in the car and/or the home (look after them and change regularly: http://www.puravent.co.uk/ ). Other information sites include:
Oral antihistaminesThese are the mainstay of treatment for mild intermittent symptoms. They are particularly effective against itching, runny nose, sneezing and eye symptoms but not much help for nasal blockage. Chlorpheniramine (e.g. Piriton) is a standard treatment for many types of allergies. Its drawback is sedation leading to impairment of driving performance and operating machinery and also its interaction with alcohol. However, it can be useful at night. Diphenhydramine (e.g. Histergan) is also sold as an ingredient for sleep remedies! Newer antihistamines are less sedating but more expensive. They include cetirizine (e.g. Zirtek, Benadryl allergy solution), acrivastine (e.g. some Benadryl preparations), loratadine (e.g. Clarityn) and clemastine (e.g. Tavegil). The National Prescribing Centre review in April 2004 confirms little evidence of benefit from third generation antihistamines available on prescription compared to second generation and should be used if tolerance or lack of response is an issue.
Topical antihistaminesThe nasal sprays are useful if the eyes are unaffected, or only come out in sympathy and the eye drops unsurprisingly only help the eyes. Azelastine (e.g. Aller-Eze Nasal Spray) and levocabastine (Levocabastine 0.05% eye drops, Livostin Direct Nasal Spray) are the main examples.
Topical corticosteroid nasal spraysThese help all symptoms including the eyes and are valuable if nasal blockage is a problem. Whilst the onset of action is about 12 hours maximum benefit may take a few days. The dose can be varied according to the pollen count and symptoms but regular treatment may be necessary given the delay in maximum effect. Those who can time their symptoms to a particular pollen may benefit from starting treatment 2 weeks before the expected pollen rise in order to block the inflammatory process before it gets a grip. The 2 main sprays are beclometasone and fluticasone. There are several brands including Beconase Hay Fever containing the former and Flixonase Allergy containing the latter. Side effects include transient sneezing, haemorrhagic crusting and dryness. Retarded growth of children should not be a problem given the limited duration of treatment to a few weeks a year.
Topical decongestantsThere are several available which contain oxymetazoline, phenylephrine or xylometazoline. They work very well against nasal blockage but must only be used for NO MORE THAN 7 days whilst waiting for the steroid nasal spray to work. This is because a rebound congestion can occur and the nasal lining can swell permanently defying all other treatments. It is EXTREMELY IMPORTANT not to exceed this duration of treatment.
Topical allergy blocker - cromoglicateSodium cromoglicate is available as eye drops and nasal spray. Although the nasal spray is less effective than steroids, the safety profile and lack of side effects make it useful in childhood and pregnancy. The eye drops are effective against eye symptoms with benefit lasting 4 to 6 hours.
Herbal treatmentsFor butterbur and grape seed extract, see Herbs plants & flowers
HomeopathySeveral remedies are widely used in hay fever but trial evidence is lacking. However, an overview of 4 studies found a benefit particularly in nasal airflow. See the article published in the BMJ in 2000 by using the following link: http://bmj.bmjjournals.com/cgi/content/full/321/7259/471
|
Send mail to webmaster @minster.org.uk with questions or comments about our website. N.B. Website is for practice patients ONLY.
|
