If you've got a stuffy nose and your box of Kleenex is getting more use than your iPhone, you might have hay fever. But you're not alone -- tens of millions of Americans suffer from spring hay fever. With the warmer weather, longer days and greener plants, you can expect lots of sneezing, itchy eyes, and a runny nose. What can you do to combat spring allergies this year? You have a wide range of strategies to choose from in order to get your spring allergies under control. See some of these strategies on this great slide show, and then check out the following articles to learn more:
Primatene Mist CFC Inhaler was an over-the-counter (OTC) inhaler used for the treatment of immediate asthma symptoms, but was removed from the market in late 2011 because the harmful effects of its propellant on the environment. Since that time, the only available OTC asthma medications were Primatene in tablet form and Asthmanefrin in nebulized solution form. All prescription asthma inhalers were required to switch to a different propellant, called hydrofluoroalkane (HFA), which doesn't have harmful effects on the environment.
Primatene Mist HFA OTC was recently submitted for FDA approval, but subcommittees on OTC Products and Allergy/Pulmonary Drugs rejected this proposal. The reasons cited for the rejection included the lack of a dose counter, frequent clogging of the inhaler, and the fact that inhaled epinephrine is not routinely recommended for the treatment of acute asthma symptoms.
While physician groups are happy with the FDA's decision to reject the approval of Primatene Mist, this decision may make it harder for people with asthma to obtain OTC medications for the treatment of their symptoms. This may lead to more visits to urgent care centers and emergency rooms, as well as hospitalizations for asthma. On the other hand, given the better availability of healthcare as a result of Obamacare, asthmatics should be able to see a healthcare provider for the purpose of asthma treatment, which for most asthmatics includes the use of an asthma controller therapy -- none of which are currently available OTC without a prescription.
Urticaria, the medical term for hives, is caused by the release of histamine into the skin by allergic cells such as mast cells. Chronic urticaria is often due to unknown causes or due to autoimmune disease. While antihistamines are the mainstay of treatment for chronic urticaria, many people find that there symptoms are not controlled with routine dosages of antihistamines. Xolair, an injectable medication for the treatment of asthma, targets IgE before it has the chance to bind to mast cells and cause the release of histamine into the skin. Xolair has been shown to reduce, and in some cases eliminate, symptoms in people with chronic hives. It will be interesting to see if Xolair is eventually approved for the treatment of chronic hives.
There are a number of different kinds of unusual allergies, and I've highlighted quite a few in the past (allergic to money, exercise, sex, cold, work, etc). A particularly rare allergy is aquagenic urticaria, which is defined as an allergic reaction after direct skin exposure to water. Aquagenic urticaria is very rare, with only a few dozen reports over the past 50 years. Affected people will experience hives within a few minutes of exposure to water on the skin, regardless of the water temperature. Why this occurs isn't known, although some researchers think that water allows for a certain protein in the skin to be dissolved in the water, and that dissolved protein is then able to reach deeper layers in the skin where an allergic reaction will occur. The diagnosis of aqaugenic urticaria involves simply the placement of a drop of room temperature water onto the skin and observing for the formation of a hive within a few minutes. Treatment is similar to that of other forms of hives -- oral antihistamines may reduce or eliminate hives from forming with water formation. Other treatments have included smearing the skin with petroleum jelly prior to water exposure, which can prevent the allergic reaction as well.
A story of a woman in the United Kingdom with aquagenic urticaria who can't leave her home during a rainstorm raises questions: Why would she live in such a rainy place? Has she tried antihistamines to prevent the reaction? Why not move to drought-stricken California? Despite the article suggesting that people with aquagenic urticaria see a dermatologist, in my opinion allergists are far better equipped to treat this condition.
The question of acupuncture helping allergies has been posed for years, and in the past the results were questionable. Acupuncture seems to help symptoms of allergies, but when compared to sham acupuncture (needles at sites without any meaning or significance), results were disappointing. Placebo effect is very strong, and therefore acupuncture treatment cannot be compared to no treatment -- rather acupuncture needs to be compared to sham acupuncture (placebo). A recent study compared the effects of acupuncture, sham acupuncture and no treatment in people with seasonal allergies. After a course of 12 acupuncture treatments over the course of 8 weeks, people receiving acupuncture treatments had less allergy symptoms compared to people receiving sham acupuncture or no acupuncture treatment. Unfortunately, the benefits didn't last beyond 8 weeks after the acupuncture treatment was stopped.
Therefore, there may be some limited, short-term benefit from acupuncture for the treatment of allergic rhinitis symptoms, but this benefit is short lived. It is not clear if continued acupuncture treatments would lead to ongoing benefit, and what the optimal course of treatment is for people with allergic rhinitis who choose acupuncture as a treatment for their symptoms.
Nasacort AQ is finally available over-the-counter (OTC) without a prescription. While at the drugstore this weekend, I noticed that Nasacort AQ was being promoted for the treatment of allergic rhinitis -- and on-sale at a reasonable price. OTC Nasacort AQ is available in both 60 spray and 120 spray bottles, both of which were under $20. Since Nasacort AQ is a nasal corticosteroid, it represents the single most effective treatment for all symptoms or allergic rhinitis, and is FDA approved for adults and children 2 years of age and older. Given that many people have higher co-pays for even generic nasal corticosteroids than what OTC Nasacort AQ, it will be very interesting to see what happens to the rest of the prescription nasal corticosteroids over the next few months -- will medical insurance companies even want to cover the costs?
- OTC Nasacort AQ
- Is Nasacort AQ a Good Medication for Allergies?
- Nasal Corticosteroids for Allergic Rhinitis
There are a number of small studies focusing on the use of oral immunotherapy for the treatment of peanut allergy. These studies involve giving increasing amounts of peanut flour (often in gelatin capsules) to swallow on a daily basis, for a period of weeks to months. After this time period, an oral challenge to peanut is used to determine how much peanut the person could then tolerate without experiencing an allergic reaction. A few studies have shown that after children had undergone oral immunotherapy to peanut for many months, they could then eat a large amount of peanuts (approximately 20) without experiencing an allergic reaction. Unfortunately, almost all of these children experienced some form of allergic reaction during the course of the oral peanut immunotherapy. Find out more about the possibility of immunotherapy being a cure for peanut allergy.
- Oral Immunotherapy for Peanut
- All About Peanut Allergy
- Everything You Need to Know About Immunotherapy
Last fall, I blogged about the FDA approving Nasacort AQ being available over-the-counter (OTC) without a prescription. This follows a trend over the past many years of allergy medications going over the counter -- this trend started with the antihistamines Claritin, Zyrtec and Allegra. More and more allergy medications (including Zaditor eye drops), as well as non-allergy medications (such as acid reflux treatments such as Prilosec OTC, Pepcid AC and Zantac) are becoming available OTC. While this may seem like a positive trend (having more access to certain medications), it also shifts healthcare costs from insurance companies to the individual consumer. What do you think? Is having prescription medications available OTC a good thing or bad thing? Your prospective may depend on whether or not you have (good) medical insurance.
- Nasacort AQ Goes OTC -- A Good Idea or Not?
- Intranasal Corticosteroid Sprays
- OTC Allergy Medications
After years of waiting, it appears the U.S. Food and Drug Administration (FDA) is ready to approve two new products for the treatment of allergies: A sublingual grass immunotherapy tablet and a sublingual ragweed immunotherapy tablet. Sublingual immunotherapy (SLIT), or also known as allergy drops, has been available world-wide for decades, and offered by some allergists (including myself) for many years. SLIT offers an alternative to allergy shots in that allergy drops can be administered at home based on their safety record.
The new sublingual tablets, which are likely to be approved by the FDA in early 2014, will provide a treatment alternative to allergy shots for people with predominantly grass and/or ragweed allergy. It may take several more years until tablets are available for people with other allergies, such as cat, dog, dust mite, molds and other pollens. In the meantime, allergy shots continue to be the best way to take immunotherapy, and some allergists offering allergy drops (SLIT) as an alternative.
Looking for another reason to shed some pounds this winter? Being overweight can actually increase the risk of a person with asthma experiencing an exacerbation during the fall and winter months. A recent study examining thousands of people with asthma, including both children and adults, found that people who were overweight or obese were far more likely to experience an asthma exacerbation, particularly during the fall and winter months. Researchers theorized that this could be due to vitamin D deficiency -- which is more common in obese adults and children -- and can lead to an increase in viral infections and decrease response to inhaled corticosteroids. Vitamin D supplementation in obese asthmatics (or weight loss, for that matter) may decrease virally and seasonally induced asthma exacerbations.