With OTC Meds
Do I Need to See
First, allergies are the catch all explantion of sinus problems. People love to shoot from the hip, and declare all sinus problems to be allergies. Its simply not true. The following recommendations assume that you have already determined by some means that allergies are a large part of your problem. I would venture to say, that if the standard treatments for allergies are not effective, you should consider the possibility that there is a different cause of your problem. If you are unsure, go throught the diagnosis section of this web site for more advice.(note: it is your responsibility to be sure that the recommended medicines are appropriate for you, considering any health problems you have and any medicines your are currently on. When side effects are listed here, they do not represent a comprehensive list
1) Start with antihistamines - Get Tavist Allergy, not Tavist-D. Clemastine is one of the first generation antihistamines, they are more effective than the newer generations, but they have the side effects of occaisional sedation and dry mouth. If you have side effects that are not tolerable, try Claritin. Claritin has almost no side effects, but unfortunately it is not as efficacious as other antihistamines. If Tavist Allergy doesn't help your allergies, you can be sure that Claritin won't either. No antihistamines help congestion much, they help the sneezy, itchy, runny, symptoms most. Antihistamines are OK to use routinely and can be used for long periods of time without losing effectiveness. Another OTC antihistamine that is worth trying is Chlortrimeton, especially if you can find time release tablets.
Also see the dedicated section on treating allergies with OTC medicines for more details.
2) Chromalyn sodium nasal spray- Nasalchrom is the only allergy spray available OTC. It is very safe, not particularly expensive, and has almost no side effects. It must be used consistently to be effective. It can and usually should be used with antihistamines. Chromalyn sodium can be used for long periods of time safely.
3) Oral decongestants- Almost all of the allergy and sinus medicines available over the counter have pseudoephedrine or phenylephrine in them. These are basically the only two oral decongestants available. I do not think that this type of medicine is appropriate for routine frequent use. Both almost always interfere with sleep if taken in the evening and can raise blood pressure in some people. Their useful effects may diminish with long term use. This medicine is helpful for acute flare ups of allergies that are expected to have a short duration, like ragweed pollen blooms or one time exposures to mold spore or pet dander.
4) Spray decongestants- OTC sprays like "Afrin" and "Neo-Synephrin" can be very helpful medicines, but they must be used correctly. These are the types of sprays that people can become "addicted" to. Its not really addiction, but after too much use you get a cycle of swelling when the spray wears off, so you need more, ect...it is called the rebound phenomenon. These sprays are the most effective medicines for decongesting your nose, period. If used for only 3 days in a row, there is little chance of the so called rebound phenomenon occurring. They can be used longer if you limit the use to one side at a time, and only use a little bit, and only when you really need it. I would guess that one could use 4 to 6 sprays a week, even for long periods of time, and not develop rebound. That’s not enough to keep prominent symptoms down, but can be very helpful if you cant sleep because of congestion occasionally. These sprays usually do not interfere with sleep like the oral decongestant do, and they only rarely will affect blood pressure.
A healthcare professional can prescribe various medicines that are not available OTC.
The most important of these are the steroid nasal sprays. Look for this category to be available OTC in the near future. Steroid sprays are more effective at relieving congestion than antihistamines and they have less side effects than decongestants. If you see a primary care physician, encourage them to prescribe sprays instead of or in addition to antihistamines. Steroid sprays are indicated as safe even down to 2 year old for daily use. They do not have the potential to cause “addiction” like the OTC decongestant sprays. They are most effective when they are used routinely, I prefer the dose be given before bedtime.
Prescription antihistamines, such as Allegra, Zyrtec, and Clarinex have the advantage of lasting 24 hours, and having much less sedation and dry mouth than the OTC antihistamines. The exception is the OTC form of Claritin, however Claritin is not efficacious enough to be helpful to everyone.
First it is helpful to decide what specialist to see. If you are certain that you have allergies only, then an allergist can help. If you have sinus or facial pain, one sided complaints, or failure to respond to allergy medicines, then allergies may not be the whole story. If this is the case, you should see an ENT doctor.
Specialist can help you be more certain what the exact nature of your problem is. I believe that the majority of patients who do not respond well to the allergy medicines that are commonly prescribed by primary care physicians have problems other than allergy alone.
Specialists are best at making decisions about uncommon medicines such as Atrovent, Astelin, Singulair, and oral steroids. Decisions concerning when to consider allergy testing and perhaps immunotherapy, and decisions related to when to consider radiological studies are the purview of sinus specialists.
I personally believe allergy testing should be reserved for the following situations. The following is only regarding nasal allergies
- Patients who have very clear symptoms of seasonal allergy and do not get good relief from steroid nasal sprays and modern antihistamines.
- Patients who do get good relief from appropriate medicines, but who wish to identify those allergens that they react to, and who might consider immunotherapy in the hopes of eventually controlling allergies without medicines.
- Patients who have allergic fungal sinusitis have been shown to benefit from immunotherapy to mold spore allergens
- Patients who also have asthma
- Patients with long term severe chronic problems
- Just because a person tests positive to certain inhaled allergens, doesn’t mean that their symptoms are necessarily from those allergens. I have seen many patients with chronic sinusitis who tested positive to certain pollens, and underwent successful immunotherapy treatment, but they still have symptoms because more than one problem was present.
- The benefits of immunotherapy are not seen for many months or years. Immunotherapy is treatment for the long haul.
- It is expensive and time consuming
- Allergy testing and treatment is not a good way to determine if allergies are the cause of problems when it is unclear. This is most true when the symptoms include sinus pain, headaches, and recurrent infections. In these cases, other studies, such as a CT scan are more cost effective at being sure what the possible problems are.