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5.1 Introduction


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

5.1 Introduction

Hayfever is caused by allergy to pollens from trees, grasses, and
ragweed. Typical symptoms are itchy and watery eyes, runny nose, nasal
congestion, sneezing, itching of ears, nose and throat, respiratory
problems such as wheezing or asthma (occasionally).

There are 3 ways to control hayfever:

1. avoid exposure to pollens
2. take allergy medications
3. Undergo allergy injection therapy

Using an air conditioner and staying indoors ... is the best way to
avoid pollens. Most patients, however, don't find avoiding pollens to
be a practical solution.

The goal of allergy injection therapy (allergy shots) is to immunize a
patient to allergens and thereby reduce or eliminate the symptoms
produced by exposure to pollens. Although this kind of treatment can be
very effective, it is time-consuming and is generally considered only
after other methods fail to provide satisfactory relief. ......

Many patients find that hayfever symptoms can be treated satisfactorily
with allergy medications, which provide relief from symptoms but do not
cure the allergy. The most common medications are discussed below:
drugs are listed by familiar name (which are often brand names). Ask a
pharmacist about the availability of generic equivalents, which may be
less expensive and equally effective.

Antihistamines are the most widely used hayfever drugs because they
are safe and effective. They prevent the effects of histamine, the
substance released by the body during an allergic reaction.
Antihistamines reduce or control most hayfever symptoms, but can also
cause sleepiness. (Many patients adapt rapidly, and stop having this
reaction after just a short time of regular use.) Antihistamines can
provide dramatic relief and may make more complicated treatment
unnecessary. ... Well known examples include chlorpheniramine
(Chlor-Trimetron), brompheniramine (Dimetapp, Dimetane), and
diphenhydramine (Benadryl).

Decongestants are helpful drugs that shrink swollen membranes, thereby
decreasing nasal congestion. They can cause mild stimulation
(nervousness, palpitations, insomnia), but most patients tolerate these
drugs quite well and often obtain relief with few side effects. The
most common decongestant is pseudoephedrine (Sudafed is one example).
Another is phenylpropanolamine. It is most commonly marketed as a diet
pill (Dietac, Dexatrim, etc.), but is quite effective as a
decongestant. (Caution: Neither pseudoephedrine nor
phenylpropanolamine should be taken regularly or over an extended
period of time without a clinician's supervision. This is particularly
important for people with high blood pressure, heart disease, diabetes,
an overactive thyroid, or glaucoma).

Combination drugs (antihistamines and decongestants) are formulated to
enhance the benefits and cancel out the respective side effects of
sedation (antihistamines) and stimulation (decongestants). This
combination has long been the cornerstone of allergy management and
many trade names have been given to the various common mixtures
(Dimetapp, Drixoral, Actifed, Allerest, ARM, Triaminic, etc). All of
these are available without a prescription and are very helpful for
many patients. Other preparations available by prescription
(Deconamine, Naldecon, Tavist-D, etc.) may offer advantages for some

Cortisone and its many derivatives are the most effective drugs
available for hayfever treatment, but they occasionally cause side
effects, particularly after oral treatment. Consequently these
medicines are used only when others have not been effective. In
recent years, topical cortisones (nasal sprays) have become available;
they can dramatically reduce symptoms. These topical drugs are highly
recommended and include Vancenase, Beconase, and Nasalide. They
usually require regular use for one or more days before benefits
become apparent.

Cromolyn is a unique drug which prevents the histamine release in
tissues following an allergic reactions. It is available in eye-drop
form (Opticrom), as a nose spray (Nasalcrom), and as an asthma inhaler
(Intal). One limit to cromolyn's usefulness is that it is not
immediately effective and requires regular and faithful use (often for
days) before relief can be expected. Side effects are minimal. (n.b.
Opticrom is not available at this time in the US, due to contamination
of supply several years ago)

Topical agents (antihistamine and decongestant nasal sprays and eye
drops) are almost immediately effective, but their benefits are
short-lasting. Many decongestant dye drops are available over the
counter, but the more effective combination (decongestant and
antihistamine) eye drops require a prescription. Non-prescription
nasal sprays (Afrin, Dristan, Newsynephrine) also offer immediate
relief, but can cause "rebound" irritation, whereby the symptoms they
are intended to relieve actually worsen. For this reason, they should
be used for only three days at a time, and are more helpful in the
treatment of colds than allergies. Cortisone-derivative and cromolyn
nasal sprays are generally preferable to non-prescription nasal sprays
for hayfever patients.

Side effects: Some people, especially young children and the elderly,
experience side effects when taking medication. Be sure to consult a
clinician if your hayfever medication causes you discomfort of any

Remember, do not take allergy medications without consulting a
clinician if you have:

heart disease
high blood pressure
an overactive thyroid

Allergy medications may cause adverse reactions if they are taken in
combination with other drugs. Always consult a physician before taking
allergy medications if you are already taking another medication.
If you are pregnant or breastfeeding, consult and allergist or
obstetrician before taking any hayfever medication (over-the-counter
or prescription).


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