[Allergy & Asthma Corner]

Cough and cold medications have been in the headlines for the last two weeks.

A special advisory committee to the Food and Drug Administration (FDA) has recommended caution in giving children under age 12 years of age, and especially those under 6, over the counter (OTC) cough and cold medication. Some studies have shown that the use of these medications contributes very little to reducing symptoms of the common cold. In fact, a number of young children have suffered from adverse effects of these OTC medications especially when not dosed properly. Unfortunately, some deaths related to use of some of these medications have been reported.

On the one hand, many of these medications that contain combinations of antihistamines, decongestants and analgesics (pain killers like Tylenol and Motrin) are commonly used to treat allergy problems. Antihistamines and decongestants are the most common components of prescribed pills for hay fever (Allergic Rhinitis). See my posting on antihistamines- Feb 18th.

Allergists and primary doctors have safely prescribed antihistamines and decongestants for treatment of allergic nasal disorders for many years. The selection of the brand, dose and frequency of doses are an integral component of success in achieving the desired response and avoiding side effects.

I agree with the withdrawal of some of these medications which for years have been available OTC for treatment of kids down to age 6. I also agree that caution should be taken with all children regarding the use of all OTC meds but even further, all holistic, organic and alternative medications should be included.

The so-called organic medications for cold and allergy relief have even less proof (compared to FDA approved OTC cold medication) of being good remedies for children as well as adults. Furthermore, the organic drugs (Herbs, teas etc.) have no published studies on safety, and are very poorly regulated (many are not regulated at all). See my posting on Herbals and Allergy- April 21st.

The bottom line-

My take is that allergists and primary doctors will need to play a greater role in managing the nasal-sinus problems of children and adults. Many people that have treated themselves for recurring or prolonged colds often have allergic problems.

The safest antihistamines (non-sedating and low sedating) have for years required a prescription but are gradually going OTC (Claritin, and soon, Zyrtec). Yes, a doctor visit won’t be necessary to acquire these meds but they will be significantly more expensive. Daily use for seasonal and perennial (year round) allergy problems may not be affordable for many people. I anticipate seeing more people because many medications previously covered by insurance will not be accessible because of cost. As more safe and effective allergy medication goes OTC, insurance companies will make it mandatory to use these before covering prescribed medications of the same class (we have already begun to experience this). Therefore more people will need higher levels of allergy care because of complications (cough, sinus infections, worsening asthma) and likely need immunotherapy (allergy shots) to better manage allergic rhinitis.

I really think the governing powers of health insurance and managed care have failed to see the big picture regarding medications and disease prevention. Medications are being removed, others drugs are being added that were previously prescribed, alternative meds are looking more attractive to some, so where do we end up?

I guess we will have to wait and see. In the mean time, read labels and warnings on all OTC drugs very carefully. This should be done whether it’s for the common cold or other illnesses. Ask your doctor, allergist or pharmacist about any drug interactions if you are on other medications. Seek further advice from your doctor if your needs are not met or if you notice any unusual signs or symptoms that may be related to a new drug.

Key Players

-Genetic or family history of dry skin or eczema

There are several publications on allergic rhinitis but few on non-allergic rhinitis. Many adults are surprised and sometimes disappointed when I inform them of their non-allergic status (allergy tests all negative). Parents also respond in a similar manner when the children they suspected were allergic fail to have any identifiable allergic triggers.

Non-allergic rhinitis is a mixed bag of disorders that include:

-Perennial non-allergic rhinitis (PNAR)

-Rhinitis Medicamentosa -nasal damage from over-the-counter nasal sprays

-Atrophic Rhinitis- mostly occurs in the elderly and is associated with congestion and crusting, sometimes accompanied by a foul smell

-Infectious Rhinitis- bacterial or viral induced infection

-And other rare causes

PNAR is very common and represents 30 to 60 percent of patients referred to an allergy office. This type of nasal problem differs from allergic rhinitis in that all allergy tests are negative. Itching, sneezing and runny nose are less common symptoms. Patients often complain of nasal congestion and post nasal drainage. Triggers include cold air, drafts, tobacco smoke, fumes, weather changes, spicy food and alcohol.

Treatment is focused on avoiding trigger factors when possible and reducing symptoms with medications. Antihistamines and topical nasal steroids commonly used in allergic rhinitis are effective half the time in people with PNAR. Oral decongestants and nasal sprays indicated for non-allergic rhinitis or runny nose (Astelin, Atrovent nasal spray) may be more helpful. Nasal sinus rinses with saline (See May 19th posting) may also help manage PNAR. Regular aerobic exercise for 20 to 30 minutes 2-3 times weekly may reduce some of the symptoms.

PNAR does not warrant antibiotics or surgery unless there are associated complications or other underlying problems. Allergy shots are not an option since there are no established allergic triggers.

Don’t be discouraged if you or your child has non-allergic nasal problems. They actually have a better prognosis (outlook) not being allergic to environmental factors. You see, people with allergy problems are plagued not only by specific allergy triggers but also by the non-allergic (irritants, chemicals etc.) factors which bother folks with PNAR.

Furthermore, many people with PNAR respond to the above mentioned treatment schemes although your specialist or primary doctor may have to work at it for a while. So be patient, follow through with recommendations and follow-up with your doctor. Inform your doctor of your progress or any troublesome problems along the way.

Here is another source for information:

www.mayoclinic.com/health/nonallergic-rhinitis/DS00809