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Choices, choices, choices when it comes to allergy meds

| Monday, May 14, 2018, 9:00 p.m.

Your eyes are red, itchy and watery. Your nose is clogged and runny. Clouds of pollen swirl through the spring air.

Sound familiar?

You may be one of 50 million Americans who suffer from seasonal allergies, the sixth most common chronic illness in the country.

“The pollen count is high, but fairly stable,” said Dr. Allison Freeman, an Allegheny Health Network allergist. “The problem is allergy season got a late start. The pollen from the trees and grasses are happening at the same time.”

The Pittsburgh region placed 30th in The Asthma and Allergy Foundation of America's ranking of the 100 most allergy-challenged cities. Allergy season usually begins in May with tree pollen, then comes grass pollen, followed by weeds. It continues through the first frost, Freeman said.

Getting relief from your allergy and its symptoms is not as easy as it may look. There are a myriad of over-the-counter options available at the local pharmacy such as Claritin, Zyrtec, Xyzal and Allegra, all similarly priced antihistamines. These second-generation drugs are touted as an improvement to Benadryl because they do not put you to sleep, said Dr. Andrej Petrov, a UPMC allergist and immunologist.

“They are all comparable,” he said.

Spray antihistamines are also available — by prescription — and work faster than oral medication, allergy experts said.

But even if the sneezing has stopped, there may still be nasal congestion and discharge. Here, an over-the-counter steroid nasal spray can be used, said Maggie Mizah, a clinical pharmacy specialist at St. Clair Hospital in Mt. Lebanon.

“Flonase and Nasacort are two of the most readily available,” Mizah said.

“Neither has stomach absorption,” she said.

The sprays work by reducing swelling and inflammation in nasal passageways, but it takes several days of use before the effects are fully felt by the sufferer. Also, sometimes a doctor may recommend the use of a saline nasal spray first to clear up debris in nasal passages.

It's important to use steroid nasal sprays for no more than five or six days. Otherwise, there is a possibility of getting rebound congestion, Freeman said. Rebound congestion is the worsening of congestion usually caused by overuse of nasal spray. In extreme cases, the condition can only be remedied by surgery.

Over-the-counter decongestants also come in pill form such as Claritin-D, Mucinex-D, Allegra-D, Zyrtec-D and Sudafed. Some have both decongestants and antihistamines and again are similarly priced.

“They are effective, but can cause a fast heart rate and insomnia,” Petrov cautioned.

In some cases, allergy medications are available over the counter and by prescription. Both are regulated by the U.S. Food and Drug Administration, but prescription allergy medication may be stronger than its OTC counterpart.

Zyrtec, for example, used to only be available by prescription. It is now available both by prescription and over the counter. Prices vary.

“It depends on the patient's insurance plan,” said Mizah, when asked about cost. “For generic medication, it can be $10, sometimes less.”

Allergy shots are another option, but they are a process because they involve getting injections with increasing amounts of allergens two or three times a week usually for a six-month period. Once the effective dose is reached, then a maintenance phase is reached and there will be longer periods between shots.

“Allergy shots can be a five-year process,” Freeman said.

Petrov said it is important for allergy sufferers to be smart and use common sense.

“I tell them to keep their windows closed at night,” he said. “Change their clothes when coming in and use air filters.”

Suzanne Elliott is a Tribune-Review staff writer. She can be reached at, 412-871-2346 or Twitter@41Suzanne.

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