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When the wind blows, hay fever awakes
If you're one of some 30 million Americans who suffer annually from "hay fever" or other allergic reactions, you'll want to remember two words: antihistamines and decongestants. Make that three words: antihistamines, decongestants, and planning.
Nothing can really cure allergies, but over-the-counter antihistamines can usually offer immediate, temporary relief from sneezing, wheezing, and itching. Decongestants will open up stuffy noses to make breathing easier.
But here's the real trick. Since respiratory allergies, also called allergic rhinitis, are usually seasonable, pharmacists suggest you plan ahead by choosing an effective antihistamine as a preventive measure. You'll feel better faster when the sneezing starts.
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A Little About Allergens
Those who suffer from seasonal allergies already know that allergies can be caused by pollen from such plants as ragweed and goldenrod. Allergies can be caused by many other things, too, including the following:
- Dander from cats, dogs, and other animals
- Exposure to air pollutants
- Cigarette smoke
- Mold spores
- Household dust
- Certain foods
Two types of over-the-counter medications help combat sniffling, sneezing, and watery eyes: antihistamines and decongestants.
Antihistamines
- Don't expect a miracle. Antihistamines will not cure allergies, but do provide fast symptomatic relief.
- If you know you have a seasonal allergy, be prepared and get your medication ahead of time.
- Antihistamines can make you sleepy, so it's best to take minimal doses during the day to remain alert.
- NEVER take alcohol if you are using antihistamines. This may produce a severe sedating effect.
- Seniors and youngsters are generally more sensitive to antihistamines and may experience nervousness, irritability, and excitation. These symptoms are in contrast to the normal sedating effect of antihistamines.
- Women should avoid antihistamines during pregnancy or when breastfeeding.
- Some antihistamines may produce drying of mucous membranes, so if you have emphysema or chronic bronchitis this could exaggerate your symptoms.
- Antihistamines can also interfere with skin and blood tests. So tell your physician before you take any of these tests.
Decongestants
Decongestants come in spray or tablet form. Tablets act over a longer period but can cause more side effects. Sprays work quickly with fewer side effects, but their effects also fade quickly.
- Rebound congestion may occur when you overuse decongestant sprays. The mucous lining in your nose will become resistant and symptoms will reoccur. Symptoms may even be more severe than before the start of treatment.
- Do not take decongestants close to the time you want to sleep because they are stimulants and can keep you awake.
- Higher than recommended dosages of the drug could cause nervousness, insomnia, or dizziness.
- Women should avoid decongestants during pregnancy or when breast-feeding.
Some Final Tips
- Buying antihistamines and decongestants over-the-counter is convenient, but if drowsiness, dizziness, or other side effects become a problem, it's best to contact your doctor.
- Allergy drugs and drugs to relieve coughs and colds are often placed in the same category by manufacturers, resulting in expensive combination products. Allergy sufferers can avoid confusion by purchasing single-ingredient antihistamine or decongestant products.
- Take time-released products whole. If they are crushed the medication will be released immediately, not over a prolonged period. This surge of medication could also produce excessive side effects.
- Seniors and children should use shorter-acting medications at first to discover if they are prone to more pronounced side effects.
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Antihistamines
During an allergic reaction, body cells secrete a substance called histamine, which causes itchiness, watery eyes, and other symptoms. Antihistamines are a versatile class of drugs used to alleviate the effects of allergic reactions in the respiratory system and to treat motion sickness and insomnia. They work by blocking histamine's effect on certain secretory cells and drying mucous membranes. First-line agents for the treatment of allergic rhinitis, they are only about 40% to 60% effective. Why? Because while they reduce the symptoms of sneezing and itching by blocking the action of histamine, they have no effect on other components of the allergic reaction, especially those that cause nasal congestion and stuffy nose.
Decongestants
Drugs that unstuff clogged nasal passages and improve breathing for allergy sufferers. They work by significantly constricting, or narrowing, blood vessels to decrease blood flow to the nose. This shrinks the swollen tissues and reduces secretions, allowing you to breathe more easily. Oral decongestants have a longer lag than spray decongestants before taking effect, but they last longer. While not associated with rebound congestion -- as nasal sprays are -- oral decongestants are more likely to affect major organ systems and produce systemic side effects. Because of this, those with high blood pressure, heart disease, diabetes, or thyroid disease should consult their physicians before taking oral decongestants.
| Antihistamines | Ingredient | Description |
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| Brompheniramine | | Considered safe and effective with very few serious side effects and a low risk of drowsiness. | | Clemastine | | A newer approved antihistamine found in long-acting products. | | Chlorcyclizine | | Safe, effective, and popular, with few known side effects. FDA approved, but not commonly found in nonprescription products. | | Chlorpheniramine | | This antihistamine has a proven low frequency of side effects. Effective against allergic runny nose and sneezing. | | Dexbrompheniramine | | A former prescription drug generally accepted as the most active form of brompheniramine maleate. Because of its strength, it can be taken in lower doses. | | Diphenhydramine | | A popular and effective antihistamine, but it has a strong sedating effect. | | Phenindamine | | Fast-acting and effective but known to produce more side effects than most antihistamines, including dry mouth, overstimulation, drowsiness, and insomnia. | | Pheniramine | | Safe and effective against hay fever and other allergies. | | Pyrilamine | | Highly effective against hay fever but with many reported side effects, including drowsiness, listlessness, irritability, loss of appetite, and nausea. But even at high doses this drug is not likely to produce fatal toxic effects. | | Thonzylamine | | One of the oldest antihistamines; generally considered the least toxic. FDA approved, but not commonly found in over-the-counter products. | | Triprolidine | | Safe and effective with a low incidence of side effects, the most common of which is drowsiness. | | Decongestants | Ingredient | Description |
|---|
| Phenylephrine | | Fast acting and effective. When taken orally provides significant decongestant effect, but can also raise blood pressure and increase heart rate if taken in high doses. This drug will produce serious cardiovascular effects if taken with prescription drugs containing monoamine oxidase (MAO) inhibitors. | | Pseudoephedrine | | Rated good marks in clinical and scientific studies of cold sufferers. Side effects are minimal, and include drowsiness, headache, and insomnia. Avoid if taking monoamine oxidase (MAO) inhibitors. | | Phenylpropanolamine (conditionally approved) | | (Including phenylpropanolamine bitartrate, phenylpropanolamine hydrochloride, phenylpropanolamine maleate) Studies show the effectiveness of phenylpropanolamines as nasal decongestants. However, there are concerns about potentially dangerous side effects. |
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FDA-Approved Uses
Antihistamines
- Temporarily relieve runny nose, sneezing, itching of the nose and/or throat, and itchy, watery, eyes due to hay fever and other upper respiratory allergies.
Decongestants
- Temporarily relieve nasal congestion due to the common cold, hay fever, and other upper respiratory allergies. Help clear nasal passages; shrink swollen membranes; and promote nasal and sinus drainage.
Recommended Dosage
| Recommended Dosage for Antihistamines | | Drug | Adults & Children Over Age 12 | Max. Daily | Children Ages 6 to 12 | Max. Daily | Children Under Age 6 | Max. Daily |
|---|
| Brompheniramine | 4 mg every 4 to 6 hours | 24 mg | 2 mg every 4 to 6 hours | 12 mg | Refer to package or consult a physician | | Clemastine | 1.34 mg every 12 hours | 2.68 mg | 0.67 mg every 12 hours | 1.34 mg | Refer to package or consult a physician | | Chlorcyclizine | 25 mg every 6 to 8 hours | 75 mg | 12.5 mg every 6 to 8 hours | 37.5 mg | Refer to package or consult a physician | | Chlorpheniramine | 4 mg every 4 to 6 hours | 24 mg | 2 mg every 4 to 6 hours | 12 mg | Refer to package or consult a physician | | Dexbrompheniramine | 2 mg every 4 to 6 hours | 12 mg | 1 mg every 4 to 6 hours | 6 mg | Refer to package or consult a physician | | Dexchlorpheniramine | 2 mg every 4 to 6 hours | 12 mg | 1 mg every 4 to 6 hours | 6 mg | Refer to package or consult a physician | | Diphenhydramine | 25 to 50 mg every 6 to 8 hours | 300 mg | 12.5 to 25 mg every 4 to 6 hours | 150 mg | Refer to package or consult a physician | | Doxylamine | 7.5 to 12.5 mg every 4 to 6 hours | 75 mg | 3.75 to 6.25 mg every 4 to 6 hours | 37.5 mg | Refer to package or consult a physician | | Phenindramine | 25 mg every 4 to 6 hours | 150 mg | 12.5 mg every 4 to 6 hours | 75 mg | Refer to package or consult a physician | | Pheniramine | 12.5 to 25 mg every 4 to 6 hours | 150 mg | 6.25 to 12.5 mg every 4 to 6 hours | 75 mg | Refer to package or consult a physician | | Pyrilamine | 25 to 50 mg every 6 to 8 hours | 200 mg | 12.5 to 25 mg every 6 to 8 hours | 100 mg | Refer to package or consult a physician | | Thonzylamine | 50 to 100 mg every 4 to 6 hours | 600 mg | 25 to 50 mg every 4 to 6 hours | 300 mg | Refer to package or consult a physician | | Triprolidine | 2.5 mg every 4 to 6 hours | 10 mg | 1.25 mg every 4 to 6 hours | 5 mg | Refer to package or consult a physician | | Recommended Dosage for Decongestants | | Drug | Adults & Children Over Age 12 | Max. Daily | Children Ages 6 to 12 | Max. Daily | Children Under Age 6 | Max. Daily |
|---|
| Phenylephrine | 10 mg every 4 hours | 60 mg | 5 mg every 4 hours | 30 mg | Refer to package or consult a physician | | Pseudoephedrine Preparations | 60 mg every 4 hours | 240 mg | 30 mg every 4 hours | 120 mg | Refer to package or consult a physician | | Phenylpropanolamine | 25 mg every 4 hours | 150 mg | 12.5 mg every 4 hours | 75 mg | Refer to package or consult a physician |
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Warnings
Antihistamines
Consult a physician before using or do not use if you have:
- Allergy to any antihistamines
- Chronic respiratory conditions
- Enlarged prostate
- Glaucoma
- Urinary obstruction
Or if you:
- Are a pregnant or nursing mother
- Are a senior; you may require a lower dosage
- Are administering to a child under age 6
- Drive or operate machinery requiring alertness, dexterity, or quick reflexes
Or if you are taking:
- Alcohol: increases antihistamine side effects
- CNS depressants, such as:
- Diazepam (Valium): increases antihistamine side effects
- Phenobarbital (Luminal): increases antihistamine side effects
- Monoamine oxidase inhibitors (MOA, a class of antidepressants), such as:
- Phenelzine (Nardil): increases antihistamine side effects
- Tranylcypromine (Parnate): increases antihistamine side effects
- Other antihistamines, which can increase antihistamine effects
Decongestants
Consult a physician before using or do not use if you have:
- Allergy to decongestants
- Diabetes
- Enlarged prostate
- Heart disease
- High blood pressure
- Thyroid disease
Or if you:
- Are pregnant or a nursing mother
- Are a senior; you may require a lower dosage
- Are administering to a child under age 6
- Develop new or worse symptoms with the use of the medicine
- Use a larger dose than recommended
Or if you are taking:
- Antihypertensives, such as:
- Enalapril (Vasotec): may decrease enalapril's antihypertensive effects
- Nifedipine (Adalat): may decrease nifedipine's antihypertensive effects
- Methyldopa (Aldomet): may increase decongestant side effects
- Monoamine oxidase inhibitors (a class of antidepressants), such as:
- Phenelzine (Nardil): may increase decongestant side effects
- Tranylcypromine (Parnate): may increase decongestant side effects
- Phenothiazines, such as:
- Perphenazine (Trilafon): may reduce decongestant effects.
- Trifluoperazine (Stelazine): may reduce decongestant effects
- Reserpine: may increase decongestant side effects
- Tricyclic antidepressants, such as:
- Amitriptyline (Elavil): may increase decongestant side effects
- Nortriptyline (Pamelor): may increase decongestant side effects
Common Side Effects
Antihistamines
- Drowsiness
- Thickened mucus
Decongestants
- Excitability
- Headache
- Insomnia
- Nervousness
- Rapid heartbeat
Infrequent to Rare Side Effects
Antihistamines
- Diarrhea
- Dry mouth
- Headache
- Nausea
- Nervousness
- Tiredness
- Vomiting
- Hyperactivity in children
Decongestant
- Difficult urination
- Dizziness
- Nausea
- Vomiting
- Trouble breathing
- Weakness
Signs of Overdose
Antihistamines
- Confusion
- Hallucinations
- Loss of consciousness
- Loss of coordination
- Seizures
- Severe agitation
- Severe drowsiness
Decongestant
- Increased blood pressure
- Nausea
- Rapid and irregular heartbeat
- Seizures
- Severe agitation
- Vomiting
What to Do in Case of Overdose
- If you suspect that you or someone you know has taken an overdose of this medication, immediately STOP USING THE MEDICATION and SEEK MEDICAL HELP.
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Websites, Organizations & Manufacturers
Sources & Further Reading
Government Sources
- 1. Food & Drug Administration. Federal Register 12/9/92.
- 2. Food & Drug Administration. Federal Register 1/28/94.
- 3. Food & Drug Administration. Federal Register 4/9/96.
- 4. Food & Drug Administration. Federal Register 8/23/94.
- 5. Food & Drug Administration. Federal Register 3/8/96.
- 6. Food & Drug Administration. Federal Register 11/8/85.
Books
- 1. Covington, TR et al. Handbook of Nonprescription Drugs, Eleventh Ed. American Pharmaceutical Assoc. Washington, DC 1996.
- 2. Kastrup EK et al. Drug Facts and Comparisons. Facts and Comparisons.
- 3. Inlander, CB and Slamans, S.The Over-the-Counter Doctor. Cader Books. New York, NY 1997.
- 4. Zimmerman, DR. Zimmerman's Complete Guide to Nonprescription Drugs, Second Ed. Gale Research, Inc. 1983.
Find more books on health and wellness at  barnesandnoble.com.
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