Patient Tips to Remember: Allergy and Asthma Medication

If you are one of the more than 50 million people in the United States suffering from allergies and/or asthma, there are many different medications that can help you feel better. In order to determine which medications are right for you, it is important to understand what triggers your symptoms. An allergist/immunologist, often referred to as an allergist, is the best physician to choose the appropriate treatment plan for controlling your allergies and asthma.

Antihistamines

If you have allergies, your allergist may prescribe an antihistamine. This medication treats allergic rhinitis ("hay fever") and conditions such as hives. Antihistamines help prevent the effects of histamine, which is a chemical released by your body during an allergic reaction. By preventing the action of histamine, your allergy symptoms can be reduced. Antihistamines are available as a liquid, tablet or nasal spray.

Antihistamines are divided into:

• "First generation, sedating," which may cause drowsiness
• "Second generation, low-sedating or non-sedating," which are much less likely to cause drowsiness

Potential side effects (usually associated with the "first generation" antihistamines):

• Dry mouth
• Trouble urinating (especially in men with prostate problems)
• Constipation
• Drowsiness
• In some children: nightmares, unusual jumpiness, restlessness, irritability

Decongestants

These medications may reduce your stuffy nose and other symptoms associated with allergies. Decongestants work by narrowing your blood vessels, which decreases the amount of fluid that leaks out into the lining of your nose. They are available as a liquid, tablet or nasal spray.

Potential side effects:

• Nervousness
• Sleeplessness
• Increased blood pressure or heart rate
• "Rebound rhinitis" can occur with the decongestant nasal spray if used for more than three or four days in a row. This rebound causes your stuffy nose to become more severe, which may lead you to become dependent upon the use of the medication

"Controller" Medications

If you have allergies or asthma, inflammation causes swelling and mucous production in the lining of your nose and airways, creating your symptoms. There are three classes of medications that can help prevent or reduce this inflammation.

• Mast cell stabilizers are non-steroid medications that help control inflammation by preventingthe release of chemicals. They are available in various forms to treat allergic disease, including rhinitis and asthma.
• Corticosteroids are anti-inflammatory medications that are very different from the kind of steroids that are misused by some athletes. Corticosteroids are available in topical creams or ointments, nasal sprays, inhalers, pills and by injection. Use of this medication must be supervised by your allergist. Inhaled corticosteroids are considered the most effective medications for long-term control of persistent asthma.
• Many of the cells involved in causing airway inflammation are known to produce chemicals within the body called leukotrienes (lu-ko-TRY-eens). Leukotrienes are responsible for increasing inflammation, causing your airway muscles to tighten and the lining of your airways to swell. Anti-leukotrienes are medications used in patients with mild persistent asthma, as well as in combination with inhaled corticosteroids in more moderate to severe asthma.

Bronchodilators

If you have asthma, the smooth muscle surrounding your airways can tighten, making it hard for you to breathe. These medications relax this muscle, improving air flow and helping you breathe. There are several classes of bronchodilators to treat asthma.

Beta-agonist bronchodilators relax the smooth muscle surrounding your bronchial tubes. Short-acting beta-agonist bronchodilators are used as quick-relief medications. These are available as inhalations, liquids, injectables and pills.

Long-acting beta-agonists bronchodilators (LABAs), such as salmeterol and formoterol, are used for long-term control of asthma. These medications are ordinarily meant to be used together with an anti-inflammatory medication on a regular (daily), rather than as-needed basis. These long-acting bronchodilators are available in combination with a corticosteroid within one inhaler.

Anti-IgE Antibody

IgE, an antibody that we all produce, is responsible for causing symptoms of allergic diseases. Omalizumab is a class of drugs, known as "anti-IgE," for patients with moderate to severe persistent allergic asthma. Anti-IgE may reduce allergic reactions by binding free IgE because bound IgE cannot produce an allergic reaction. In many cases, omalizumab has been shown to reduce the need for inhaled corticosteroids, while protecting against allergic disease symptoms.

Theophylline

For many years before the arrival of inhaled corticosteroids and long-acting bronchodilators, a commonly used medication was theophylline. Those individuals who are still on this medication need careful monitoring.

Anticholinergic Agents

Although not usually used as a first-line bronchodilator to treat chronic asthma, anticholinergic agents have been used with beta-agonists for the emergency treatment of acute asthma exacerbations. They are available in inhaled form and can be used alone or combined with the beta-agonist bronchodilators.

Healthy Tips

• Avoid using a decongestant nasal spray for longer than three or four days in a row. It may cause your stuffy nose to become worse and cause you to become dependent upon the medication.
• "Controller" medications, which include mast cell stabilizers and corticosteroids, help prevent or reduce the inflammation that causes your allergy and asthma symptoms.
• Bronchodilators treat asthma by relaxing the smooth muscle that surrounds your airways, improving air flow and helping you breathe.
• See your allergist to find out which medication is right for you.

Feel Better, Live Better

An allergist/immunologist, often referred to as an allergist, is a pediatrician or internist with at least two additional years of specialized training in the diagnosis and treatment of problems such as allergies, asthma, autoimmune diseases and the evaluation and treatment of patients with recurrent infections, such as immunodeficiency diseases.

The right care can make the difference between suffering with an allergic disease and feeling better. By visiting the office of an allergist, you can expect an accurate diagnosis, a treatment plan that works and educational information to help you manage your disease.