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2.3 Allergy Medications




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This article is from the Children Allergies and Asthma FAQ, by Eileen Kupstas Soo kupstas@cs.unc.edu with numerous contributions by others.

2.3 Allergy Medications

OTC antihistamines - most are sedating but may overexcite kids or cause
hallucinations (in me, some do). For example, benadryl,
brompheniramine. Benadryl is the drug of choice for an acute allergic
attack because it is effective within 20 minutes, reaches maximum
effectiveness at an hour, and wears off in 6 hours.

OTC decongestants - only help stuffy nose. May excite.

Other antihistamines such as seldane (12 hour) and hismanol (24 hour) -
for adults only! May or may not work. May have severe side effects -
talk to your doctor. Some, such as Guaifed, are available in dosages
for children; your doctor will have to decide whether these are
appropriate.

Sodium cromolyn (nasalcrom nosespray for allergies, intal by nebulizer
or in-haler for asthma). Prevents mast cells from reacting,
preventing allergic reactions. Takes at least a week for enough to
build up in body, so needs to be taken regularly as preventative. Not
useful for current symptoms. No known side effects. Won't work for
some people.

Steroid nasal sprays [beconase, rhinocort] also prevent and reduce
inflammation, but need several days of use before they are fully
effective. They must be used daily in order to remain effective. Great
preventative! Often works better than nasalcrom in adults.

Antihistamine eyedrops (optcon-a, vasocon-a) - immediate relief for 8
hours. Works, but stings.

Bronchodilators [Ventolin, Bricanyl] - to open bronchial tubes for
immediate relief from attack. Nebulizer most effective in acute
attacks, then turbuhaler [not yet available in the US], then
metred-dose inahlers and dischalers/rotohalers. Oral preparations
[syrups, tablets] are least effective, requiring higher dosages to
achieve the same effect as mDIs, and having generally significant
side effects [because of the oral route]. These can makes kids
hyper, grumpy; they make me shake. Great for occasional use. Most
often used to treat acture asthma flare-ups, although some asthmatics
must take them daily in addition to other medications. If you need
to use bronchodilators more than twice a week , discuss with your
doctor the use of an anti-inflammatory medication or other
appropriate medication (Ex. intal, steroid, or theophyline).

Epipen/AnaKit (epinephrine autoinjector) - an autoinjection (shot) most
commonly given for anaphylactic reactions. Carry this with
you at all times if you've ever had this severe a reaction!

Nebulizer vs. inhaler (puffer, MDI) for intal and ventolin: Some
individuals have poor reactions to [including having asthma attacks
triggered by] the propellants in MDIs and cannot use them. Also, most
children can't manage them until age 5, though some can manage at a
younger age (some as early as 3). Children should use them with a
spacer.

The nebulizer is a machine which drives air through liquid medication
to make mist for a patient to breathe. Treatment takes 10-20
minutes. This is the most effective delivery system. Adults use a
mouthpiece. Kids use a mask; if they refuse, you can blow the mist
at them by mouthpiece.

Other alternatives to MDIs include rothalers and dischalers, which are
powder inhalers, and a turbuhaler [not yet available in the USA],
which is a breath-activated inhaler containing a very fine powder form
of the drug. Turbuhalers contain ONLY the pure drug; there are no
propellants, preservatives or other compounds present. Turbuhalers
are more effective than MDIs, and some Paediatric ERs have switched to
using Turbuhalers in the place of mask treatments for non-severe
attacks. Turbuhalers should be available in the US within the next
year; both inhaled corticosteroids and bronchodilators are available
in turbuhaler form [e.g. Bricanyl and Pulmicort].


 

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