DIY Hay Fever Therapy- The Time is Now

Do-it-yourself (DIY) management is now something many if not most hay fever sufferers can effectively accomplish. The approval of an over-the-counter nasal corticosteroid, Nasacort OTC in October 2013 makes this the first spring where the drug most of us prescribe as the mainstay of hay feverpre therapy is available without a prescription. This is an FDA decision that has really changed the playing field. In this post I’ll outline an approach I think is reasonable for many people with hay fever without seeing your physician.

Seasonal allergic rhinitis or hay fever affects about 7.8% of adults and 10% of children in the US according to the American Academy of Allergy, Asthma and Immunology. Typical symptoms are predictable seasonal recurrence of various combinations of nasal congestion, runny nose, nasal itching and/or sneezing. Other symptoms may include itchy eyes, headache, fatigue and malaise that occur during the spring or summer in most sufferers.  In Washington state, where I practice, symptoms for those with tree pollen allergies start as early as the end of February and last into May. Grass allergies start in late April or May and last into mid-summer.  Less common are weed allergies in late summer and mold allergies in fall and winter.  Indoor allergens like house mite dust can cause year-round symptoms.

For many years antihistamines like diphenhydrazine (Benadryl®) and chlorpheniramine (Chlortrimeton®) have been available over-the-counter (OTC) and in recent years the third-generation antihistamines fenofexadine (Allegra®),loratidine (Claritin®) and cetirizine (Zyrtec®) much less-sedating antihistamines have become OTC options. For patients with mild symptoms the occasional or seasonal use of these antihistamines is adequate therapy.  When these have not worked until this yearthe next step for most patients was to see their physician for prescription medications.  Most physicians next prescribed the often more effective corticosteroid nasal sprays like Nasacort®, Flonase®, Nasorel, and others. This year the ability for patients to manage their allergic symptoms without a doctor visit has changed. Now by using the newly available Nasacort OTC® allergy sufferers have the option of DIY allergy therapy that is likely to be both as effective and less expensive than what their physician can offer.  Here is a Dr. Pullen algorythm for DIY allergic rhinitis therapy.

  1. First my disclaimer. If you are not confident your problem really is allergic rhinitis, see your physician to confirm the diagnosis. Warning symptoms that you may need a physician evaluation include high fever, stiff neck, confusion, neurologic symptoms like weakness, numbness or facial swelling or redness. If you are in doubt as to whether you are having allergy symptoms see your doctor.  If you are confident you have allergic symptoms you can often DIY.
  2. A safe, non-pharmaceutical remedy nasal rinse can be remarkably effective for some allergy sufferers. This involves using a product like Neil-Med Sinus Rinse or a neti-pot to wash pollen or other allergens out of the nose.  This is often a good option although additional treatment is usually needed.
  3. For mild or intermittent symptoms consider one of the less-sedating antihistamines like the OTC once daily generic fenofexadine 180 mg, loratidine 10 mg, or cetirizine 10 mg.
  4. If the help from these is suboptimal the next reasonable step is the use of Nasacort OTC 2 sprays in each nares once daily.  For patients with good insurance coverage it may be less expensive to buy a prescription generic intranasal corticosteroid. Still the cost of Nasacort OTC is remarkably low, priced at about $18 for a 120 spray bottle. (The generic prescription intranasal corticosteroids cost at least this much without insurance help and brand name Nasacort, the exact same product, is much more expensive.) All of these intranasal corticosteroid medications take several days to reach maximal benefit, and are best used daily rather than intermittently as needed during the allergy season.  Adding oral less-sedating antihistamines as needed of your worse days is a good strategy.
  5. Oral decongestants like pseudoephedrine (Sudafed®) is found helpful by some people, although no controlled studies have found it effective. Try not to use this daily for very long as rebound congestion on stopping regular use can happen.
  6. If you have itchy eyes that don’t respond to the above treatments, or if itchy eyes are your primary or only allergic symptom, you may find OTC sodium cromalyn (Opticrom®) and other brands) may be really helpful.  I’ve prescribed this for years as a safe, effective option for add-on or stand-alone treatment of allergic conjunctivitis.  It’s now available OTC.  Ask your pharmacist if you can use these eye drops.

If you try these therapies and don’t give you adequate relief there are still some options that your physician may offer to help. An oral medication that blocks a non-histamine inflammatory cascade step called Singular® may help some sufferers that don’t respond to intranasal corticosteroids and anti-histamines.  I avoid injected corticosteroids, but sometime a short course of oral prednisone can get symptoms reduced enough to allow the above therapy to keep you more comfortable. Preventative desensitization therapy, usually injections, but for grass allergy the new Oralair® may be needed.

This is the first year that you can really use most of the same therapy that your physician is likely to recommend for treatment of allergic rhinitis.  DIY allergic rhinitis therapy is finally a realistic option for many patients. Good luck.

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