If you’ve worked in a community pharmacy before it’s not hard to tell by looking at the shelves when allergy season hits. The disorganized allergy section gives it away. Within the last few weeks I’ve been bombarded with many of the same questions. All related to allergies. Some questions, although not initially concerning to allergies end up with me recommending allergy medications. Most people who’ve never suffered from allergies mistaken their symptoms with a long lasting cold or flu. After a few questions I am usually able to determine if they’ve developed allergies.
The city that I work in is particularly bad for allergies. Well, most all highly populated cities are terrible for allergy sufferers. One of the big reasons is because cities like to decorate their landscape with easy-to-look-after trees. These are trees that do not bear seeds or cones and hardly come with any maintenance costs i.e., clean up. However, the downside to all male trees (non-cone bearing) is that they produce pollen and depending on the conditions can produce a lot! Recently, the conditions have been ideal for pollinating. Warm, sunny, and a bit of a breeze.
Allergy sufferers typically complain of very classical symptoms: watery and itchy eyes/nose, congestion, sneezing, coughing and scratchy throat. These can all be treated with over-the-counter products and has been a constant source of questions for me, the pharmacist. The products that are available in your local pharmacies are generally very safe, with some exceptions of course. Generally speaking, all of the above classical symptoms of allergies can be treated with medications called: anti-histamines.
Anti-histamines do exactly what their name suggests. They help to decrease histamine release. Histamine is a natural chemical that is found throughout our bodies. It is a messenger for other cells in the body and can be said to be responsible for most of the symptoms allergy sufferers have.
In Canada, there are a handful of antihistamines available for use.
- Cetirizine (Reactine)
- Loratadine (Claritin)
- Fexofenadine (Allegra)
- Desloratadine (Aerius)
- Diphenhydramine (Benadryl) – Sedating
- Chlorpheniramine (Chlor-tripolon) – Sedating
- (A few other uncommon sedating ones)
The first 4 medications on the list are called the second-generation antihistamines. These are ones that do not generally produce sedation as one of their side effects. (Exception: cetirizine causes drowsiness in approximately 10% of users). First-generation antihistamines are ones that are known for their sedating effects. They’re also the main ingredient in most sleep aids but marketed differently. So one could use a sleep aid for allergies and vice versa.
The #1 most frequently asked question is: Which anti-histamine is the BEST(most effective)?
The answer is almost always… I don’t know. Generally, the anti-histamines, as a class, are equally effective. So there is not one anti-histamine that has been targeted as being more effective than others. There are, however, slight differences. For instance, cetirizine causes drowsiness in 10% of people. So, does this mean it is less superior than others? That’s not up to me to decide. Some people do not mind being drowsy. Others, do not want to take the chance. Desloratadine (Aerius) is said to be better at treating congestion than the other anti-histamines. Personally, the data doesn’t really convince me. Chemically speaking, desloratadine (Aerius) and loratadine (Claritin) are almost identical. When one takes loratadine orally, it is transformed in the liver (by multiple cytochrome p450 enzymes) to desloratadine. So saying that Aerius, out of the whole pot of anti-histamines, is the only one that helps with congestion seems a little fishy to me.
My recommendations to people are to pick one, try it for 5-10 days and if at that point it doesn’t seem like it’s working for them, switch to a different one! You must try them longer than one day. When your body has reacted to an allergen (such as pollen) it takes a while for the medication to have an effect. I understand that to some people it may seem like a quick-shot answer. But it is honestly that easy.
If after having tried multiple medications for allergies and still not seeing results then there is a benefit in seeing your family doctor. There are many different medications that seem to be very effective in those who do not respond to regular over-the-counter medications (i.e., nasal sprays, eye drops, certain tablets).