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« Do You Have Well Controlled Asthma? | Main | Were You Ready For Grass Season? »
Friday
Jun132008

Allergic Rhinitis: Over the Counter Nasal Sprays

1095899-1644972-thumbnail.jpg
Much to choose from OTC but read labels and exercise caution with nasal sprays.

More than 40 million people in America have allergic nasal symptoms. Many have turned to over the counter (OTC) medications to treat their allergy symptoms. Allergy medications have escalated in costs and are becoming less available by prescription. I recently posted comments on how to reduce costs associated with OTC antihistamines. Intranasal steroids are important for managing moderate to severe allergic rhinitis and may be used down to 2 years of age (depending on the brand of nasal spray). They are only available by prescription. What are you getting when you turn to an OTC nasal spray for your allergy symptoms?

The major OTC nasal sprays include:1095899-1644976-thumbnail.jpg
Nasal saline rinses are much safer than the nasal decongestant sprays.

Topical Nasal Decongestant (TND)- Very quick acting but may be addictive if used more than 3-5 days at a time. Are you taking a nasal spray that within seconds to minutes opens your nose up (almost instant gratification)? There is much more you should read about by clicking this link: Beware of the Topical Nasal Decongestant Sprays

Nasal Saline: (Ocean Spray, Ayr and others)- Nasal saline is salt water of similar consistency to body fluids. I previously discussed methods on moisturizing vs. irrigating the nasal passages. This has very little risk but is not effective alone, in treating seasonal or perennial allergic rhinitis. When a comprehensive program of environmental controls, avoidance, medication and nasal rinsing is followed, successful management is often achievable.

Nasalcrom (Cromolyn)- Previously only available by prescription, Nasalcrom is now OTC. It must be sprayed in the nose three or more times daily to be effective. Best results are achieved when the sprays are begun well before (about 2 weeks before) the allergy season starts. It is most effective for seasonal allergy. Children tend to have a better response compared to adults. Nasal steroid sprays are more effective overall.

Alternative (Holistic) Nasal Sprays- There is an endless number of such nasal sprays and drops which frankly have very little clinical research to support their use in allergic nasal conditions. Safety data tends to be lacking on many of them. I do not recommend them to my patients. I point out (to my patients) that people that have allergic problems may be more at risk of developing an allergic reaction to various herbs associated with some of the available allergy remedies in health food stores.

Have other comments?

Am I missing something that should be on the above list?

Let me know: AllergyQA@aol.com

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Reader Comments (7)

I have tested allergic to Butter fish. I have reacted badly and needed to go to the emergency room from shell fish. My throat was swelling shut and my eyes had swelled to the point that they were only narrow slits,== My question is are there other fish that are more likely to cause allergies than some, I have eaten Rainbow trout lately and had no reaction. I realixe that this is a cultivated fresh water fish. What about other ocean fishes? I am afraid to try any.

Thanks for your answer.

Norma

June 17, 2008 | Unregistered CommenterNorma

Hi Norma,

The answer to your question is YES. Other fish may cause a similar, milder or worse allergic reaction. Unfortunately, skin testing or allergy blood testing for many different fish may be misleading because of false positive and false negative potential.

Testing is best done after a reaction has occurred in order to confirm the culprit. It is possible to be allergic to only one fish, or many fish.

You should definitely avoid further contact with the fish that caused your reaction. An Epi-Pen or TwinJect should be maintained in case a severe reaction occurs in the future. Talk to your doctor about this. Seeing an allergist may be helpful.

Shellfish allergy is more common. Members of the shellfish family are more cross-reactive. This means all shellfish should be avoided if you are allergic to any one shellfish.

There are some interesting conversations about seafood allergy on another web site I write for: http://www.healthcentral.com/allergy/c/9061/3674/comments/

Best to you,

J. Thompson, MD

June 18, 2008 | Registered CommenterAllergist James

Hi Dr Thompson,

I have been diagnosed with severe oral allergy syndrome and asthma. I have learned to avoid the foods i am allergic to and take several prescribed allergy medications a day as well. I am currently having trouble with fish. I had a skin test and was only allergic to snapper. I eat saltwater fish frequently as well as shellfish with no problems but every time i eat freshwater fish i have severe allergic reactions. Is there a cross-reaction between the pollens or fruits i am allergic to with freshwater fish? and is there a possibility i will develop allergic reactions to the shellfish and saltwater fish i currently consume? I live in wisconsin and i am wondering if the fish i buy at the store may be exposed to other allergens or something. Thank you for your thoughts!

July 11, 2008 | Unregistered CommenterMargaret

Hi Margaret,

People allergic to non-shellfish fish are at higher risk to be allergic to other fish (whether saltwater or fresh). Patients I see that are allergic to multiple non-shellfish seafood are instructed to be very cautious about trying other seafood. You are at higher risk to develop allergy to fish you currently tolerate (smaller risk if you had no fish allergy). That said, it is possible you may continue to eat fish previously tolerated including shellfish, with no further problems.

I usually instruct patients that have allergy to some fish but a strong desire to continue eating seafood to avoid the previous fish that triggered a reaction, and always have two Epi-pens for emergency use. In the setting of shellfish allergy all shellfish should be avoided.

I am not aware of a cross-reactivity between pollens and seafood or fruit and seafood.

It is possible that there is cross contamination between different fish at the market (associated with the handling). Thorough and careful washing of the fish is important (if you buy it to be cooked at home).

Eating out presents additional concerns of potential contamination while cooking. Fish prepared on the same grill or with the same utensils, on common counter tops or plates can be a problem. This is why having an Epi-pen or TwinJect is important, just in case. Always in form the chef/waiter that you have allergy to the specific fish.

You should also have an identity bracelet or necklace with information regarding your food allergy. Chewable Benadryl tablets are good to have for milder allergic reactions.

See a board certified allergist (if you haven't already).


Good Luck!

J. Thompson, MD

July 12, 2008 | Registered CommenterAllergist James

Sometimes my congestion is so bad that I feel as though I cannot breath through my nose at all. I find myself trying to breath through my mouth. However Flonase over the counter I read up on at "kiwi drug" works immediately, no waiting. This is great if you are trying to sleep or trying to make it through a work day and I recommend it to all my friends and family! :0 Thanks flonase for making your product over the counter!

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