Potentially Harmful Treatments for Seasonal Allergies
This article is a follow up to my video discussing seasonal allergies (aka “hay fever” or allergic rhinitis) and how I treat it to relieve symptoms of sinus congestion; stuffy ears; and itchy, watery eyes. This article will instead focus on a few treatments that may be effective for seasonal allergies but have unwanted side effects, making them worse options.
Antihistamines and Dementia Risk
“First generation” antihistamines like diphenhydramine (Benadryl) or chlorpheniramine all tend to cause drowsiness due to crossing into the central nervous system (brain and spinal cord). This may contribute to the observed increased risk of dementia, including Alzheimer’s, with long term use of this class of medications, particularly in those age 65 and older. Studies have shown that they are generally no more effective than “second generation” antihistamines like cetirizine (Zyrtec) and fexofenadine (Allegra), which have a lower risk of causing drowsiness and do not generally cross into the brain.
Steroid Pills and Injections
Systemic steroid treatment with pills (like Medrol dose packs) or injections (like Depo Medrol) can be effective for allergies, reducing the immune system overreaction. The problem is that steroids have many other, unwanted effects on the body. They reduce bone mineral density, increasing risk of hip and spine fractures even with a temporary dose. Steroids also raise both blood sugar and blood pressure, particularly increasing risk of harm among patients with diabetes or hypertension. The immune system depression is helpful for allergies, but it also increases the risk of systemic infections and sepsis. These side effects are NOT present when using intranasal steroid sprays since the steroids are not significantly absorbed into the bloodstream, and intranasal steroids are generally as effective as systemic steroids. As a result, intranasal steroids are the better option for the vast majority of patients.
Montelukast and Mood Disorders
Montelukast (aka Singulair) is in a class of medications called leukotriene-receptor antagonists (LTRA) that reduce inflammation. It has historically been used to treat asthma and other allergic diseases, including seasonal allergies. Unfortunately, montelukast has since been associated with an increased risk of sleep problems, anxiety, depression, and even suicidal thoughts, leading to the FDA to issue a Black Box warning about these neuropsychiatric effects and recommending it generally be avoided when treating seasonal allergies.
Decongestants and Dependence
Lastly, intranasal decongestants like oxymetazoline (Afrin) are incredibly effective at reducing congestion quickly after using them. They work by constricting blood vessels in the nose: a rapid way to reduce sinus swelling. The problem is that these decongestant sprays and tablets can cause dependence and rebound congestion, particularly when used beyond 2-3 days. Our blood vessels quickly adapt to the medication and become reliant on it to stay at their normal level of constriction. I have unfortunately had countless patients with severe allergies who have used Afrin for weeks, months, or even years before seeing me who say that it no longer works like it used to, but that not using it makes their symptoms even worse. We then have to make a treatment plan not only for their seasonal allergies, but also to wean them off of the Afrin that makes their problem worse.
Unfortunately medications always carry a risk of side effects, and sometimes those side effects make it so the medication is rarely or never worth using, even if they are effective. If you’re suffering from seasonal allergies or want to stop relying on one of the potentially harmful medications discussed above, I would love to meet with you to come up with a safe, effective treatment plan so you can get back to enjoying the Spring weather!
Dr. Wenzell is a family physician who recently joined Simplicity Health Direct Primary Care and is now accepting new patients of all ages. Call 937-813-2124 or click here to schedule your free, no obligation Meet-and-Greet to learn more about our practice and why we think Direct Primary Care is the best way to return the focus of medicine to the patient-physician relationship.
References
Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, Yu O, Crane PK, Larson EB. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015 Mar;175(3):401-7. doi: 10.1001/jamainternmed.2014.7663. PMID: 25621434; PMCID: PMC4358759.
Dvorin EL, Ebell MH. Short-Term Systemic Corticosteroids: Appropriate Use in Primary Care. Am Fam Physician. 2020 Jan 15;101(2):89-94. PMID: 31939645.