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Month: November 2015

Over-The-Counter Allergy Medications and Their Possible Side Effects

Any Arlington allergist can tell you: millions of allergy sufferers reach for over-the-counter (OTC) allergy medications daily to try to get relief from their allergy symptoms. There are numerous medications available and they come in a variety of routes of administration. The medicines come in the forms of tablets, capsules, syrups, powders, nasal sprays, eye drops, creams, ointments, and inhalers.

Most OTC medications use additional ingredients, referred to as inactive ingredients, which may include preservatives, coatings, dyes, lubricants, sweeteners, flavoring agents, and binding materials. Not all inactive ingredients are always inactive. Alcohol is added to some OTC medications and may be inactive or active. Alcohol is often found in OTC cough syrups which many allergy patients use. Some individuals have allergic reactions and/or untoward side effects to some of these inactive ingredients. Common inactive ingredients that cause reactions for some individuals include: aspartame, benzoates, benzyl alcohol, sulfites, benzoates, lactose, oleic acid, propylene glycol, saccharin, sorbitan trioleate, and soy lecithin. There are over 450 inactive ingredients used in OTC medications.

Many individuals can also have allergic reactions and/or unwanted side effects from the active drug found in OTC allergy medications. The active drug is the drug that is meant to “work” on the symptoms. An allergic reaction to a drug can occur with any drug and usually involves symptoms that may include: hives (urticaria)itching (pruritus)swelling (angioedema), rashes, abdominal discomfort, nausea, vomiting, wheezing, shortness of breath, throat closing sensation, chest tightness, itchy eyes, watery eyes, redness of the eyes, itchy throat, and anaphylaxis (a life-threatening systemic allergic reaction).

OTC allergy medications can be even more confusing since many of them contain more than one active drug. An example of a single drug medication is Claritin, which contains loratadine, whereas an example of a medication that has 2 drugs is Claritin-D, which contains both loratadine and pseudoephedrine. There are many OTC allergy medications that contain more than 3 drugs in a single pill. To the average consumer, whose knowledge of the field of medicine is rudimentary, this can present a potentially serious problem. In the example used above with Claritin and Claritin-D, any allergist in Arlington will agree that a person with high blood pressure (hypertension) and/or heart disease should not take the Claritin-D because the active ingredient, pseudoephedrine, can elevate one’s blood pressure and increase their heart rate. It should also not be taken in individuals with an enlarged prostate, glaucoma, kidney disease, and/or overactive thyroid (hyperthyroidism). In a healthy person, it usually is not a problem; however, in patients with the diseases listed above, it can potentially be devastating.

Another potential problem with using OTC allergy medications involves the interactions they may have with other medications that the individual may be taking. These other medications may be prescribed or they may interact with other OTC medications. Certain medications may diminish the efficacy of other medicines causing them not to work as well as they were intended. On the other hand, certain medicines can have the opposite effect and increase the effect of another medicine making it potentially dangerous as well. An example of the latter would be an individual with attention deficit hyperactivity disorder (ADHD) who takes the medication Adderall (mixture of the salts of amphetamine and dextroamphetamine) with the OTC medication pseudoephedrine (e.g., Sudafed). The pseudoephedrine could potentiate the effect of the Adderall or vice versa. Therefore, an understanding of pharmacology is recommended for self-medicating.

Drugs tend to be classified in “classes.” For example, beta blockers, angiotensin inhibitors, and calcium channel blockers are 3 common classes of high blood pressure medications. Likewise, penicillins, macrolides, and quinolones are 3 common classes of antibiotics. Individuals who are allergic to a drug in a particular “class” of medications tend to be more likely to have an allergy to another drug in that same “class.” For example, someone who is allergic to amoxicillin is more likely to be allergic to another penicillin derivative such as ampicillin. An individual that has a known allergy to a drug may take an OTC allergy medication that may contain an active or inactive ingredient that may be in the same “class” as that drug. The person may not have checked the ingredients in the OTC medicine, may not have known that the OTC medicine was in the same “class,” or more likely, did not even know about cross-reactions to medications within “classes.” A good example of this would be when someone takes a sinus relief allergy OTC medication that contains ibuprofen. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) which is also known under the brand names Advil, Motrin, Nuprin, as well as many other names. That individual may have known that he/she was allergic to naproxen (e.g., Naprosyn, Aleve, Anaprox) but did not know to avoid that “class” of medications, namely NSAIDS’s or he/she did not know that the generic name for Advil was ibuprofen.

In addition to the above reasons to be careful when using OTC allergy medications, one must recognize that there are side effects that are not allergic in nature, but still affect average people in different ways. It is fairly common for many OTC allergy medications to cause drowsiness. There are typically warnings on the sides of the boxes or bottles, but one may become extremely drowsy to a medication whereas someone else may have no drowsiness to the same dose of the same medication. Still others may have a paradoxical effect where it causes them to feel “hyper” and “agitated” like the feeling of too much caffeine (which by the way, is also used in a great deal of OTC allergy and sinus medications).

Even though OTC allergy medications can be beneficial, one must use caution when using them. There are other side effects not listed in this article, but this article is meant to warn people about the possibility of having potentially serious reactions from OTC allergy and sinus medications. If you have allergies and need advice on any type of medication whether OTC or prescribed, please feel free to make an appointment for a consultation with our board certified Arlington allergists at Black & Kletz Allergy. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All our offices have on-site parking and the Washington, DC and McLean offices are Metro accessible. There is a free shuttle that brings patients back and forth between our McLean office and the Spring Hill metro station on the silver line. Please call us to make an appointment or you can click Request an Appointment and we will respond within 24 hours on the next business day. We treat both adults and children and have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 50 years.

Respiratory Infections and Asthma

As we enter into the “cold and flu” season, children and adults with a history of asthma may experience an increase in the frequency and severity of their asthma symptoms triggered by these infections.

Most of us have to contend with a few upper respiratory infections (e.g., cold, flu, sinusitis) each year. Viruses are the usual culprits and the rhinovirus is the most common virus causing upper respiratoryinfections in all age groups.  Respiratory syncytial virus (RSV) usually affects the upper and lowerrespiratory tracts in infants and young children.

Upper respiratory tract infections are usually mild self-limited illnesses in otherwise healthy children and adults.  The common symptoms of nasal congestion, runny nose, post-nasal drip, sneezing, sore throat, achiness, and an occasional dry cough may last for about a week.  However, in individuals with a history of asthma, these infections can trigger a flare-up of their asthma by causing wheezing, coughing, chest tightness, and/or shortness of breath.  Once the asthma symptoms are triggered, they can linger for several days to weeks, even after recovery from the infection.

Viral infections also can predispose one to secondary bacterial infections which can lead to complications like sinus infections causing discolored nasal discharge, facial (sinus) pressure and pain, persistent mucus drainage into throat, and coughing.  Fever, chills, night sweats, fatigue, coughing up discolored sputum, and/or soreness in the chest while breathing, may be indicative of pneumonia. A few precautions may help prevent or alleviate respiratory infections and reduce the risk of asthma exacerbations:

  1. Viruses causing respiratory infections are highly contagious.  Avoid contact with others with active infections can minimize the risk of contracting the illness.
  2. Wash hands frequently with soap and water.  This will eliminate most germs causing infections. Hand sanitizers are useful while traveling.
  3. Refrain from touching one’s eyes, nose, and mouth which can minimize the germs from entering into the body.
  4. An annual influenza vaccine (i.e., flu shot) is highly recommended in all children (above 6 months of age) and adults with asthma.  FluMist (the flu nasal spray vaccine) is not indicated in asthmatics and only approved for use in persons 2 through 49 years of age.
  5. Many children and adults also benefit immensely from a pneumonia vaccine to prevent bacterial infections from pneumococcus, a type of bacteria that causes respiratory tract infections.  The two most common vaccines available are Prevnar 13 and Pneumovax.  It is important to check with your primary care physician to check for documentation of what type of pneumonia shot you may have had and when it was administered.  Depending on this information, your physician will recommend which type of pneumonia vaccine may be needed and when it should be given.  The age of the patient, underlying diseases, and history of previous vaccinations all will play a role in determining what, when, and if the vaccine is needed.
  6. Rest, drinking plenty of fluids, and the use of certain over the counter medications may alleviate some of the symptoms.
  7. Prescription antiviral medications [i.e., Tamiflu (oseltamivir), Relenza (zanamivir), Rapivab (peramivir)] can reduce the duration of the flu and they may also decrease the risk of an increase in asthma symptoms.
  8. Monitoring peak flows is helpful in predicting asthma exacerbations.
  9. If the infection ends up triggering asthma symptoms, one should begin using a rescue inhaler or nebulized medications at regular intervals for symptom relief.
  10. Either initiating the preventative controller medications or increasing their doses at the onset of cold or flu symptoms, (as directed by the physician), may be useful in preventing or reducing the severity of asthma flare-ups triggered by viral infections.

The board certified allergists of Black & Kletz Allergy have been treating adult and pediatric patients with asthma for over 5 decades.  We are very familiar with upper respiratory tract infections as well as other triggers that cause asthma exacerbations.  In addition, we also treat all kinds of upper respiratory infections.  Black & Kletz Allergy has 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have convenient offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Our offices in Washington, DC and McLean, VA are Metro accessible with free shuttle service between the Spring Hill metro station and our McLean office.  All 3 locations offer on-site parking.  To make an appointment, please call us, or alternatively you can click Request an Appointment and we will respond within 24 hours on the next business day.  The allergy doctors at Black & Kletz Allergy strive to manage your asthma to your utmost satisfaction in a professional caring environment.