Episode 2 -  How to manage allergic rhinitis with over-the-counter medications.
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Amber: Welcome back to Allergy Actually.

Today we're talking about how to manage allergic rhinitis with over-the-counter medications. Um, last episode you learned about things we can do to modify your environment if you suffer from pollen allergies. And today we're gonna dive into medication options.


Which Allergy Tablet is Best? Doctor's Top Picks Revealed
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Kara: So I think one of the questions I get asked all the time is, which allergy tablet is the best?

Meagan: I have a preference. 

Amber: Okay. Wait, Wait, wait, should we should 

Meagan: could tell you why. Yeah. Same time. 

Say what our preference is? 

Kara: Generic name? 

Amber: Generic name? Yeah. Okay. After three. 1, 2, 3 

. 

Meagan: All right, so I picked Cetirizine because I find it's the most widely available. It's easy to find out there, you know, the time to onset of action is very similar to, um, diphenhydramine, which is the one that's Benadryl. That's what people, um, often whenever they think, "I have allergy symptoms, I need a Benadryl." And I'm like, no, don't use Benadryl. Zyrtec or Cetirizine will start, um, working within the same timeframe and it lasts longer. And it's very cheap. And I'll say the advantage of that over Fexofenadine is that you don't. Hey, now.

I know, right? I I I know. I'm gonna go ahead and pick on, I'm already going over your, it's a cute, is it a purple or pink pill now? I think it's maybe.

Amber: The box is purple. The pill is pink. 

Meagan: Okay, got it. Yeah.

So a mine's just a little white tablet. 

Amber: but. 

Meagan: But I keep a warning or I have a, my dot phrase has a warning that, um, you shouldn't take it with, um, grapefruit juice because of the CYP450 enzyme. And I'm sure no one really does that. But I have it on there, and

Amber: We're 40, not 80. 

Meagan: Right? I know. 

Amber: No offense, year 

Meagan: olds 'cause 

Amber: drinking. 

Meagan: Yeah, we, we will, yeah. But that's always in my mind. But there are advantages of  Fexofenadine that I will admit to. Oh, and also for Cetirizine, it's once daily dosing for children. Who has time for twice daily dose? Yeah, nobody. 

Kara: I, I think where my hangup is, is I'm very sensitive to medication side effects. And so, on the occasion that I have taken Cetirizine, I am out like a light. And that's how it is for, I mean, it's even more so even with half of a Diphenhydramine. Um, I'm, you know, even feeling hungover the next morning.

And so as someone who is more sensitive, we we're kind of taught that it's about 1 in 10 people who will have some sedation, even though it is a less sedating option. But I do prefer the tablets are smaller. And frankly, I'm not great at swallowing pills. I mean, I do choke down my fish oil that I take, but

Amber: Wait, which one? Did you say Cetirizine, too?

Kara: No, I say Fexofenadine.

Amber: Oh, you said Fexofenadine?

Kara: Yeah. So,

Meagan: It's two against one. 

Amber: Yeah. Well, okay, so first let's lay the groundwork here. 


Understanding Antihistamine Generations (1st, 2nd, 3rd)
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Amber: There are different types of antihistamines. So we're talking about H1 histamine blockers, the type that we mostly are targeting for treating environmental allergies.

And there's first generation, things like Diphenhydramine or what most people know of as Benadryl. Um, then there's second generation, that's the Cetirizine, the Allegra, the Loratadine. And then there's a third generation, Levocetirizine. Is Clarinex also?

Kara: Desloratadine.

Meagan: Yeah, that's a third generation too. 

Amber: Okay. So we are all talking about our favorites, which happen to be second generation antihistamines that are all supposed to be non-drowsy. But I agree with you, Kara. I do have quite a few patients that say they get drowsy with Zyrtec.

Now, plenty of patients love Cetirizine. It works great. I do like that too. But I think the reason if I was forced to pick a favorite, I would pick  Fexofenadine is because it does not cross the blood-brain barrier as easily as Cetirizine so there really should be no drowsiness with it.

And I just feel like it works really well when you have, if you're dealing with hives or swelling too, you know? Like so many people with allergies have other things going on, and I just like that one. And the pill's pink and the box's purple. 

Meagan: It's pretty, right?

Amber: What do you like about it?

Kara: The, so the, the less sedating aspect I think that's the biggest, um, you know, reason that, um, that I've leaned towards that. Not Not a huge fan of the tablets being larger and the twice daily dosing for kiddos. Um, but, you know, it is what it is. And then 

Amber: You can break them in half.

Kara: Yeah, and I'll say from the one we're leaving outta the conversation is Loratadine, which also known as Claritin. And for some, every once in a while I have a patient that will tell me, "Gosh, I have tried, I've tried Allegra, I've tried Zyrtec. Claritin is my jam. It is the one that works the best for me." 

Amber: OGs love Claritin. It was the first.

Meagan: That is true. That is very true.

Kara: And I will say that is where, you know, you could ask us all day our favorite, or you know, if we, if we had to choose, you know. but at the end of the day, there is some individuality and some variation between each and every one of us and each and every one of our patients. And so I think that has to be recognized. If Claritin is your jam, well, heck, it is cheap. It is easily available. And it is a small tablet, too. 

Meagan: It is. 

Amber: Yeah. I actually recommend to patients, get one of them. I don't care which one, start with the cheapest one. And then when you're out of that bottle, then pick a different one and, and work through the ones to compare. See which one works best for you because, um, you may have just said this, Kara, but most people, Claritin or Loratadine is on the weaker side, and for some people that's what they want so that'd be a good choice. But for 25% of people, it actually is, works better for them. So yeah, you don't know who you are, which one's best for you until you try them. So you kind of have to try them all.

Kara: That's why I always loved having samples in the, in my office when it was allowed. Um, and now that I'm on my own and we'll have, you know, like be able to do that again. But because it gets expensive to try, you know, and if we're gonna talk about where we can save money and where the best place to get them. But if you can get a little sample pack of five, it gives you enough days to say, you know, which might be my best fit. 

Amber: Yep. 


When should I use my antihistamines?
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Meagan: So for me, I always, patients will say, you know, "When should I use my antihistamine?" And, and I want to first say that I typically at that point sort of clarify with them, what are you taking it for? Because I always say antihistamines are good for itchy, watery, sneezy. If you have a lot of nasal congestion, you can take it, but typically we aren't gonna treat the nasal congestion unless we have targeted direct nasal therapy.

Kara: And let's say congestion, stuffiness, and drainage, but especially the stuffiness or trouble getting air in and out.

Amber: Yep.

Meagan: Absolutely.

Kara: because I think that sometimes I didn't realize how some people congestion is the mucus or the snot or the boogers 

Meagan: good point Or it's chest. 

Kara: Yeah. 

Meagan: And not nose. Yeah. So, yeah, we do have to be careful about that. Mm-hmm.


Favorite OTC Nasal Sprays for Allergy Relief
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Meagan: So as far as moving on to some type of spray next, do we wanna do that again? Where we say our favorite over-the-counter Oh, 

Amber: I don't know if I can decide. 

Meagan: I have an absolute one. 

Hands down. My problem though is I can't remember, um, the, the second chemical for the generic name. So I think we're gonna have to say

Amber: The brand name?

Meagan: Yeah.

Kara: Fluticasone furoate?

Meagan: Is that for the?

Kara: Sensimist 

Meagan: Yes. That is. Okay. 

Amber: okay. 

Meagan: It's ruined. I love that 

Amber: 1, 2, 3. Fluticasone,

Meagan: Fluticasone furoate. 

Amber:  Furoate. 

Meagan: Yeah. And I have many reasons why I like that one the best. It is, um, so it actually used to be a different medication under a different brand and then was bought by another company and rebranded. And so it's over-the-counter. And I also have to tell my patients that typically if we send in a nose spray to insurance, they will sub out the other Fluticasone propionate, um, which it's truly a different medication. And so what I tell patients the difference is that, uh, the Fluticasone furoate has, um, a softer puff back when we did have drug reps who came around and sort, sort of sold those types of things, they would say, look, and they would squeeze and have the old brand like. Yeah, and they would show it, it would touch your hand and they would be like, "Look, it doesn't drip." And you're like, "Wow, indeed. It doesn't drip." And so it doesn't go down your throat and it doesn't have any flavor. It doesn't smell like floraly or you know, anything like that. And

Amber: It's a mist instead of a squirt. 

Meagan: Absolutely. And it can help with eye symptoms. That was one of the big things that in their FDA clinical trials, they looked at eye symptoms. So people who have allergic conjunctivitis, I really push using that for them.

Kara: I, I found it much better tolerated in children. Um, you know, trying to wrangle a nose spray into a kid is an alligator wrestling match at its, you know, at its easiest. So having something that is more gentle and doesn't smell or drip is, is huge. 

Amber: I agree.

Meagan: The actuator? 

Amber: Yes. The actuator.

Meagan: On the side is actually,

Amber: Like these actually on our microphone. 

Meagan: It is. Did squeeze the side? When I'm asking people, I use Fluticasone. I'm like, "Do you pump up and down or do you do it to the side?" And that's how I know which one they're actually using if they can't remember which or don't know, the second, you know, name and the, the, um, chemical name. So yeah.


When to START Taking Your Allergy Medications
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Kara: So I think one of the other really important tips that we have to hit on is when do we use medications? When do we start them and when, because everyone wants to minimize how much they take, right? We don't wanna take if we don't need it, 

Amber: So it kind of depends on when you're having symptoms. If you are one of those people that just has pollen allergy, you don't have allergies the rest of the year, then you can focus on, "Okay, when do I normally start having symptoms?"

So like in our part of the world, grass pollen starts pollinating in May-ish, usually May, June. So you wanna think a couple weeks before that and start taking your medicine routinely before the season if you normally have a pretty bad allergy season, because then you get ahead of it, you have the medicine in your symptom, in your system and helps you feel good.

but what about people who are like, well, " I'm, I can manage it, except for like a few days out of the season." What do you guys tell them?

Kara: A few things. I mean, sometimes I'll say, you know, generally, and this is all for educational purposes and not direct medical advice. 

Meagan: Right 

Kara: It's reasonable to take a second antihistamine on a bad day. And although we see the most benefit from using the nose sprays on an everyday basis, if you're having a rough day, taking it that day isn't a total wash, you may still actually have some benefit. It's just you see the optimum benefit, especially in the stuffiness if you're using it on a regular basis. 

Amber: Yep.

Meagan: Good point. 


Memory Trick: The Valentine's Day Rule for Allergy Season
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Meagan: One thing I like to tell people, I think holidays are easy to remember. And so I sort of group tree allergy and grass allergy together and, and again, in our neck of the woods, trees start blooming typically March, just getting a little earlier at the end of February, but I tell them start your medications on Valentine's Day, right? Yeah. And then I say, yeah, yeah, absolutely. 

Amber: It's almost like we were trained at the same place. 

Meagan: It is almost like that. It is very shocking. And I say use that through the 4th of July and then July you get a reprieve. And then if you're unlucky enough to also have grass allergy, um, or, you know, mold is an allergen that's present year round, but much worse in the fall. Then I tell people to, you know, restart that, um, usually at the 1st of August. But there's no holiday I could come up with at that time. But at least the Valentine's Day is there. 

Amber: I agree with that. And I think for those of our patients that are on multiple medications, because there are many of them that are on an antihistamine, a nose spray, an eye drop, uh, maybe an inhaler for asthma.

If you're, you know, in your season, and you're doing really well on all those medications, but you're feeling like you don't wanna have to be taking all those, just talk with your allergist or talk with your doctor because maybe you can come up with a plan where you're on maybe two of the medicines routinely and you just add the other ones in.

Or if you're on all of them all the time, certain times you can take a break because our goal is to help you use as little medicine as possible. And also our goal is for you to feel great. So if that means you have to take your medicine routinely, do it. You deserve to feel great all the time.

Meagan: And that leads us, I think to our next episode where we are going to talk about what we can do beyond medication for more lasting, uh, relief from, uh, environmental allergies.

And thank you so much for joining us today. And please, um, leave, um, you're better at saying this in the shownotes.

Amber: What do the kids say? Like, follow subscribe?

Kara: Like, follow, hit that bell. Uh, no. But if you have ideas, suggestions on topics you wanna hear us talk about, you know, certainly there's some medications that we didn't have time to cover today. Um, we wanna hear from you. 

So leave those comments below.

Meagan: So thank you for joining us today on Allergy 

Amber: Actually.

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