Have a Sneeze-free Spring

For Charlotte residents, spring is synonymous with stuffy noses and sinus headaches. And this year, those sniffles and watery eyes could be even worse. The Asthma and Allergy Foundation of America ranked Charlotte as the third most challenging place to live with spring allergies for 2009 -- a twenty-place jump from last year. So to help you survive, we created a panel of area docs and pharmacists to weigh in on the massive array of allergy meds on the market to find out which ones actually work. Now you can get through these next few months as sneeze free as possible.

Drugs

GENERATION 2 ANTIHISTAMINES (Claritin, Alavert, Zyrtec)
These are the front line of treatment for chronic allergy sufferers, especially for those dealing with sneezing and runny noses, because they work without causing the widespread drowsiness seen with generation 1 antihistamines. "Zyrtec may cause drowsiness in some, but it's still recommended frequently in Charlotte due to its effectiveness against symptoms caused by a wide range of allergens," says Ciccarello. However, if you're suffering from congestion, your pharmacist or physician may recommend you add a decongestant as well.
Rating: C

Panel

Mike Richardson, MD
Internal Medicine, Charlotte Medical Clinic, Mint Hill

Joe Ciccarello
Pharmacist and CVS/pharmacy supervisor, Charlotte

Melissa Jones, MD
Pineville Primary Care, Charlotte

AIRBORNE
Though the manufacturers cite studies to support the assertion that the key ingredients -- vitamins A, C, and E, and minerals zinc and selenium -- have been shown to support a healthy immune system, our panel says it won't help your sinus headache. "This has no proven benefit whatsoever for anything, especially allergies," says Richardson.
Rating: D

CROMOLYN NOSE SPRAYS (NasalCrom)
These over the counter nasal sprays are used to treat symptoms of hay fever—itchy, watery eyes and sneezing -- but aren't the panel's first pick. "My partners and I don't prescribe them much or at all because the antihistamine and decongestant sprays seem to work better," says Jones. However, Jones says they are effective for preventing the onset of hay fever symptoms and should be used just before exposure to an allergen or one to two weeks before pollen season, in mid-March.
Rating: CD

ECHINACEA
This herbal supplement is marketed to boost the immune system, but it may actually worsen allergy symptoms. "It shares characteristics with ragweed, daisies, and chrysanthemums—if you are allergic to these plants you can react to echinacea also," cautions Richardson.
Rating: D

ANTIHISTAMINE EYEDROPS (Zaditor and Visine-A)
These over the counter drops help to alleviate itchy, watery eyes, but the panel advises against using them routinely. "They eventually cause dilation of blood vessels on the surface of the eye, leading to a red-appearing eye," says Richardson.
Rating: CD

GENERATION 1 ANTIHISTAMINES (Benadryl)
These drugs work to block the histamines, proteins that the body forms when you come into contact with an allergen -- aka the pollen from those pretty-but-problem-causing Bradford pear trees. Without an antihistamine, histamines bind to your cells, irritating them and causing the spring symptoms allergy sufferers dread: runny noses, itchy and watery eyes, and congestion. But although they stop the sniffles, generation 1 antihistamines can also make you sleepy. "Due to the drowsiness associated with these antihistamines, and the availability of newer medicines with fewer side effects, these older drugs are no longer the most widely recommended," says Ciccarello.
Rating: CD

OXYMETAZOLINE HCL NASAL SPRAYS (Afrin and Vicks Sinex)
"These work very well as nasal decongestants," says Jones, but she warns these over the counter sprays should be used no more than three days at a time—overuse can lead to a rebound effect, actually making congestion worse. For long-term relief try an oral decongestant instead, recommends Ciccarello.
Rating: CD

NASAL WASHES (Ayr, SaltAire, and the Neti Pot)
These nasal washes relieve congestion by flushing the nasal cavity with a saltwater solution. "Pharmacists often recommend using nasal washes by themselves or in conjunction with an antihistamine," says Ciccarello. "The Neti Pot contains no active drug and therefore has no drug interactions, and has become very popular in Charlotte."
Rating: C

VITAMIN C
Mom might praise this vitamin's healing powers, but our experts gave it the thumbs down. "Vitamin C has good marketing, but no effect on the immune system," says Richardson.
Rating: D

DECONGESTANTS (Sudafed)
Though decongestants help to relieve the itchy, stuffy nose associated with allergies, talk to your doctor before using them routinely. "They can raise blood pressure, cause heart palpitations, insomnia, prostate problems, and worsen glaucoma," cautions Richardson. Also, because Sudafed can be used to make methamphetamine, it's not easily obtained over the counter, and you may be asked to sign for it or show ID.
Rating: CD

What About Generics?
Forget about logos and gimmicky marketing—our panel says those boring generic boxes work just as well. "The FDA requires that a generic have the same quality and strength as its brand-name counterpart," says Ciccarello. "They offer significant cost savings to consumers, while providing the same active ingredients as brand-name counterparts." Translation? Ask your pharmacist to identify generics that can save you money.
Rating: CC

Prescription Options

PRESCRIPTION EYEDROPS (Optivar)
If you're dealing with watery, runny eyes, ask your doc about a prescription eyedrop, since they are more effective and last up to two times longer. "They work better than OTC," says Jones, who says she still doesn't prescribe them much, because the majority of her patients complain of stuffy noses and sinus headaches.
Rating: C

PRESCRIPTION ANTIHISTAMINES (Allegra D and Clarinex)
These drugs are very similar to the other generation 2 antihistamines, like Claritin, Zyrtec, and Allegra, in their ability to relieve allergy-associated symptoms. However, our experts say some people may respond to one antihistamine better than another, so if an over the counter version isn't working for you, ask your doctor about trying a prescription. "It's often a trial and error," says Richardson.
Rating: C

PRESCRIPTION STEROID NASAL SPRAYS (Nasonex and Flonase)
These sprays relieve stuffy noses by decreasing inflammation within the nasal passages. Jones recommends that patients struggling with seasonal allergies use them daily, even when they're not using antihistamines or decongestants. "They are very good at controlling most symptoms of allergies, such as sneezing, runny noses, itching, and congestion," she says. "They have the greatest benefit when combined with an antihistamine and/or decongestant, and serve well as maintenance therapy if used daily."
Rating: C

PRESCRIPTION NASAL ANTIHISTAMINE SPRAY (Astelin and Patanase)
Though these also work to relieve stuffed-up noses, our experts wouldn't pick them over nasal steroids. "These are useful, but they're a lot more expensive than other sprays," says Jones. "So it's not something I start with, mainly because of cost."
Rating: CD