Antihistamines: Not the Allergy Solution You Think They Are

Caitlin Whyte: For many allergy suffers anti-histamines are the main tool in their tool belt, but for when that daily pill doesn't cut it, there has got to be other solutions for relief, right? Joining us today to talk about how anti-histamines are not the allergy solution you think they are is Dr. Christopher Thompson, the Medical Director at Aspire Allergy and Sinus. This is Achoo! The podcast for people with allergies and sinus issues from Aspire Allergy and Sinus. I'm your host, Caitlin Whyte. Dr. Thompson, what are some common myths or misconceptions people might have about taking anti-histamines?

Dr. Thompson: Well, I think the most prevalent myth is that they are appropriate for daily use. And I think if you read the labels and talk to any physician, you'll find that those medicines really aren't meant to be taken every day for the rest of your life. I think people just kind of get used to that being their solution.

Host: How did we get to the point where people think that's okay and why are they not okay to take every day?

Dr. Thompson: Well, I think the first step was when the anti-histamines went from a prescription medication to an over the counter medication, that always makes it easier to obtain and gives patients, I think, a false sense of security. Then, you know, the marketing for them has been widespread. It's a multibillion dollar industry. So you see it on television and billboards and the radio and print ads. So it's just ubiquitous. You see it everywhere. So the expectation is that everybody's using it and it's okay to do it all the time.

Host: So what would be some other options for daily treatment and maintenance of allergies?

Dr. Thompson: It depends heavily on the severity level of your allergies. If you have significant allergies, the only way to fix them, to kind of fix the underlying disease process is to do immunotherapy, which comes in the form of allergy shots, allergy drops, or the new exact therapy where we go directly into the lymph node. And you're kind of fixed over two months. So when patients have significant allergies requiring meds all the time, they should really consider doing a course of immunotherapy to try and fix it. So you don't have to deal with this, you know, next year and the year after, and 20 years later, that's kind of our recommendation. Now, if you have mild seasonal allergies where they hit you every now and then, it is okay to use anti-histamines. We prefer the nasal steroid sprays, which are now, also over the counter, sprays like Flonase and Nasacort. Again for short term use, you know, you use them for a week or two rather than using it forever and ever, and ever. And those aren't absorbed obviously like histamines are cause you're swallowing them. So I think the topical meds are a better option for even seasonal or periodic use.

Host: If I'm someone who has been, you know, relying on anti-histamines every day, is there any reason I should be worried?

Dr. Thompson: Well, yeah, I think so. And it depends if you're an adult or a child, but adults have been demonstrated, have driving impairment with almost all of the over the counter Anti-histamines, some are worse than others. And what's really scary is the impairment is not evident. You wouldn't know that you're having any side effects. So in the study that was done in Great Britain, the drivers didn't feel stated at all. They felt perfectly normal yet their driving performance was impaired. And then of course, if you're giving your child a Zyrtec everyday on their way to school, you can imagine that if adult drivers are impaired, how is that impacting our children and their subsequent education? So those are my major concerns with it is that almost all of those meds cross the blood brain barrier, it's well demonstrated, so they can have an impact on our consciousness.

So I think it's important. People don't know that, you know, when I talk to patients, no one ever considers the possibility that they might be impaired, even because they feel normal. But the scary thing is it can happen without you knowing about it. And then the other thing is, is that antihistamines really don't work that well. I think in most studies that the improvement is in the 20% range, you know, it's something and people probably feel a little bit better, but I mean, you can do better than that, I guess is my point. And so why settle for that? It isn't the only thing out there. And I think people get locked into, you know, this is the only alternative I have is the easy alternative, right? You don't have to go see a doc and he's just cause of the drug store, get on Amazon and download it. But you know, it's expensive. There are potential side effects with kids. It's significant. And of course, if you're not really helping your allergies, then your quality of life just isn't as good as it could be.

Host: Are there other options for, like you said, those seasonal allergy suffers where it's not year round, it kind of just pops up randomly. Is there another option besides anti-histamine that isn't as maybe long-term as immunotherapy, something in the middle?

Dr. Thompson: Yeah. So I really like the nasal steroid sprays. I think those are, I think they're more effective and that's based on studies, they are designed so that you don't absorb them in any significant manner. They're safe in children. They don't have any of the cognitive effects on the brain, like most anti-histamines do. So I think they're great for short term use. They have, you know, there are problems that can irritate your nose and cause nosebleeds, some people don't like the feeling of it going in their nose or the taste or the smell. So, it's not without problems, but I think it's a better option. And that's what I've always, my kids have allergies and that's the way I go with them. When they're bothered, now they are also on therapy on any of the therapy. But anyway, that's my preference, especially in children.

Host: What do you see for the future of anti-histamines or just allergy therapy? Would it be a new type or just getting rid of them altogether?

Dr. Thompson: You know, we've introduced exact immunoplasty in the past year, we did a study, a placebo control, like a randomized, a real study on it last winter. And we're now doing it for all things allergic except for foods. But the beauty of that therapy is instead of having to do it for five years, which is traditional allergy therapy, you do three treatments over two months. I believe that over the next 10 to 20 years, as this becomes more widely known that why would you do anything? If you go in for three treatments and fix your allergies once and for all, why would you take an anti-histamine for the rest of your life? Why would you do anything that wouldn't fix the problem? So in my mind, once that gains momentum and is, you know, it's so poorly understood right now, I mean, most physicians have no clue that it exists. So it's hard to expect the lay public to understand it at this point, but we're trying to get the word out. And I think over time, we're going to see that the dominant allergy therapy

Host: Great, Dr. Thompson, is there anything else you want to add just about anti-histamines and what people can do moving forward with their allergies?

Dr. Thompson: And, you know, the only other thing that I think can be a bit alarming, there was an interesting study looking at, I believe it was third graders with allergies and they looked at their standardized testing results. And if these children were taking the test during their allergy season, they scored substantially lower on those tests. So I think really in children, we tend to underestimate the impact of allergies. And, you know, if it means that whether a child progresses onto the next grade level or not, I think most parents would agree that it's something that should be addressed. And we just, we tend to minimize it. Allergies doesn't always rise to the level of a serious medical condition, but I think if parents and people knew the real long-term impact that it had on them, then they'd probably give it a little bit more attention.

Host: Absolutely. Well, Dr. Thompson, thank you so much for the information and for your time today, we really appreciate it. That was Dr. Christopher Thompson, the medical director at Aspire Allergy and Sinus. Find more information and episodes at aspireallergy.com/podcast. This has been Achoo! The podcast for people with allergies and sinus issues from Aspire Allergy and Sinus. I'm your host, Caitlin Whyte. Thanks for joining us.

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