Jun 26, 2020

TRANSCRIPT

Interviewer: There is no cure for allergies. Really the best you can do is manage the symptoms, and the first step to doing that is to avoid the things that give you allergy symptoms, but that can be hard. A lot of times you can't do that. So then the next step are sprays, pills, and eye drops.

Dr. Gretchen Mae Oakley is a nose and sinus expert at U of U Health. She's also an allergy expert, and she's going to take us through the process of trying to figure out how to manage those symptoms and then maybe help us understand when you might need to get professional help. So Dr. Oakley, let's first start with allergy sprays.

Managing Allergies with Nasal Sprays

Dr. Oakley: There are a couple main nasal sprays that work really well and have great evidence behind them for the treatment of allergies. Our first-line treatment based on the literature and just how well it works in patients is nasal steroid sprays, and fortunately they're all over the counter. Some of those sprays would be, if I were to name some, Fluticasone nasal spray, Mometasone, Budesonide. Those are probably some of the three most common. There're a couple others in that, you know, similar family and those work really well.

You can use them up to twice a day, more than that is not going to help anymore, but once or twice a day use. They're very reliant on regular consistent use, and they have a bit of a slower ramping up effect, so you really want to use them for at least, you know, a few weeks on a daily basis just very regularly to get their full effect rather than, you know, here and there when your symptoms bother you.

Interviewer: If the over-the-counter stuff doesn't work, are their prescription ones that are very different from that, or is most of them over the counter nowadays?

Dr. Oakley: There's an antihistamine spray that is a prescription that can actually work great for a lot of patients too, either as their primary treatment or as a, you know, secondary, an additional treatment if the corticosteroids sprays alone don't work enough for them. That antihistamine spray is called Azelastine, and it works particularly well for those let's call them the wet allergy symptoms, which is, you know, more of those like sneezing, runny nose, itchy, watery eyes, that kind of tickle sensation that we can get with allergies. They work okay for the nasal congestion symptoms, but the steroid sprays work better for that.

Why Some Treatments Aren't Effective for Everyone

Interviewer: What is it that makes it so different from person to person that perhaps maybe a steroidal spray would work for one person but not another, they'd have to use, you know, an antihistamine spray? Is it just the difference in us as humans?

Dr. Oakley: We don't always know exactly why some patients respond better to some sprays, you know, versus others. It may just be a severity of their symptoms. You know, they may get 75% better with the steroid sprays, but it may just not quite be enough. Whereas somebody else where their symptoms are maybe moderate rather than severe, they may do great, and that's all they need.

Some patients may be a little more bothered by like the runny nose and the sneeze, whereas, you know, in those cases antihistamine sprays would work better for them. So sometimes we just get different presentation of our allergies, different symptoms and different severities. But you're right that the other factor is we're all just a little bit different and we respond just a little bit different to certain treatments.

Interviewer: It can be a little frustrating as an allergy sufferer sometimes because I think sometimes as patients we think, "Well, I'm going to go in and the doctor's going to give me the cure," right? But with allergies it sounds like, you know, sometimes you have to do some experimenting on what's going to work best for that individual person.

Dr. Oakley: Exactly. There's definitely some trial and error there to try to get it just right for that patient. The third thing in terms of nasal treatments I didn't mention, that I'd be remiss if I didn't mention, is very straightforward, and it's just some saline in the nose, saline irrigations specifically. Those can work really well as an adjunct treatment. It's not going to in and of itself fix your allergies, but it can help with some of the symptoms along with some of these other treatments by mechanically washing, you know, those allergens, those irritants, those pollens out of the nose so they're not just sitting, you know, on the lining of the nose inflaming it. So it can help, you know, in some of those ways as well.

Oral Treatments for Multiple Allergy Symptoms

Interviewer: So do you normally go nasal spray first and then oral medication? Is that how that usually goes?

Dr. Oakley: I would say, in general, yes. I like to give people topical treatments over oral treatments if possible, just because your side effects tend to be lower. The other thought in that however, that I'll talk to patients about, is that certain oral treatments, like oral antihistamines specifically, those tend to work similarly to a nasal steroid spray, have similar effectiveness, but sometimes patients will have symptoms that are not just in the nose. They'll have, you know, maybe some dermatitis that they get with their allergies that bother them or, you know, symptoms like that that are elsewhere, and sometimes the systemic therapy, an oral therapy in that case can be a little bit more helpful than a localized therapy.

Interviewer: So oral medications, let's talk about over the counter first. What are kind of the choices there?

Dr. Oakley: I would say the main one, the front runner are those oral antihistamines. So the newer versions that tend to work better for patients with fewer side effects are those medications like Loratadine and Cetirizine and Fexofenadine. Those are the main kind of newer generation oral antihistamines. The older generation antihistamines would be, you know, what we know as Benadryl, which can work too but has, tends to have higher side effects and be more sedating for patients. So we generally recommend those newer generation, non-sedating medications. And they have great evidence behind them, they work well, and those are over the counter.

Interviewer: And then itchy eyes is another symptom that a lot of people have with allergies. I used to suffer terribly, and then I was prescribed some eye drops, which now I think I can just get over the counter because I've bought them. I think they're the same thing, which makes all the difference in the world. Can you talk about some of the eye drops you might want to look for if itchy eyes are part of your allergy symptoms?

Dr. Oakley: Yeah, eye drops can actually help a lot, and it is generally an antihistamine eye drop. There are a couple different ones. One that's popping into my mind is Olopatadine. That can actually help patients significantly because a constant itchy eye will drive you crazy.

Finding the Right Combination for You

Interviewer: And just like all the other things, the nasal sprays, the oral medications, I had to try a couple of different antihistamine eye drops before I found the one that really kind of worked for me. So you know what, I started out thinking, well, let's see if we can give people, you know, some things they can try on their own, but then you start talking about how, you know, this combination isn't proven to work as well as that combination, and it can get really complicated really fast. So I'm starting to think maybe if like the first nasal spray doesn't work, maybe go see a doctor to try to figure out what combinations of stuff because that does get complicated pretty fast, doesn't it?

Dr. Oakley: It does get complicated pretty fast. It is certainly reasonable to try a couple over-the-counter meds on your own. I personally, you know, if I were in the patient's shoes, I would start a nasal spray and give that a few weeks personally. If that didn't work, you know, I'd maybe try an oral antihistamine for a couple weeks and see how I do. But after that, I don't see a lot of sense in just suffering. I think it's worth going in and talking to your doctor about some alternative options that may help quite a bit rather than just being miserable.

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