Allergic reaction

Gazette, The (Colorado Springs), Apr 8, 2004 by BILL RADFORD THE GAZETTE

If a drippy nose and watery, itchy eyes didn't tip you off, the onslaught of commercials for Claritin, Zyrtec and the like should make it clear: Allergy season is here.

And it's just beginning. For now, tree pollen is the culprit. Grasses will start causing problems in mid-May or so, and weeds will attack in July.

"It's always something," says Dr. Bill Storms of Asthma & Allergy Associates in Colorado Springs. "It just changes from month to month."

Warm weather has gotten the allergy season off to an early and fierce start. That doesn't necessarily say anything about the rest of the season, but Storms suspects it will be worse than usual.

Allergies, often dismissed as simply a nuisance, shouldn't go untreated, Storms says. They can leave you feeling fatigued and miserable. And allergies can lead to other problems, such as ear infections and bronchitis.

The good news is that there are more weapons than ever in the fight against allergies -- although Storms frets that managed care is restricting doctors' use of those weapons. Here's a look at the allergy arsenal:

ANTIHISTAMINES

Antihistamines ease allergy symptoms by blocking the effects of histamine, a chemical substance the body releases during an allergic reaction. Older over-the-counter antihistamines, most notably Benadryl, cause drowsiness and can impair driving.

Claritin, part of a second generation of nonsedating antihistamines and once the nation's most-prescribed allergy medicine, shifted to over-the-counter at the end of 2002. That saved allergy sufferers a visit to the doctor, but for those used to paying an insurance copay of $5 or $10 for their Claritin, the over-the- counter price caused sticker shock: about a dollar a pill, or $30 for a month's supply.

Schering-Plough's patent on Claritin (loratadine) has since expired, giving rise to a wave of generic versions. With the generic, "you can cut the cost down to at least half," says Greg Wall, a pharmacist at a Colorado Springs Walgreens. Generic loratadine is sold under various names; Walgreens' version is Wal-itin.

The problem, Storms says, is that although loratadine is widely effective, it's not for everyone. Some patients benefit more from other second-generation antihistamines, such as Zyrtec and Allegra, still available by prescription only. Dr. Rohit Katial, an allergist with the National Jewish Medical and Research Center in Denver, regards Claritin as probably the weakest of the nonsedating antihistamines.

But with Claritin readily available, insurance companies have hiked their copays on the prescription-only drugs or denied coverage. "There's a lot of individual response (to medications)," Storms says, "but insurance companies aren't taking that into account."

NASAL SPRAYS

Prescription-only nasal steroid sprays, such as Flonase and Nasacort, decrease inflammation caused by allergic responses. They may be used in place of or together with an antihistamine.

Decongestants, which reduce nasal congestion, also are often paired with an antihistamine and come in liquid, tablet and spray form. A decongestant can cause sleeplessness in some people, Katial cautions.

Decongestant sprays, he adds, should not be used for more than a few days. Extended use can cause a rebound effect, increasing congestion rather than decreasing it.

Nasalcrom, which switched from prescription to over-the-counter several years ago, is a nasal spray designed to block allergic reactions, but the effect is very mild, Storms

says. "It doesn't do much."

ANTI-LEUKOTRINES

Leukotrine (loo-koh-TRY-een) inhibitors block certain substances that, like histamines, are produced during allergic reactions. Singulair, a leukotrine inhibitor initially used to control asthma, was approved by the Food and Drug Administration about a year ago for treating seasonal allergy symptoms and is available by prescription only. Katial says it's effective for mild allergies but not more serious cases.

ALLERGY SHOTS

Prescription and over-the-counter medicines address allergy symptoms. Allergy shots, known as immunotherapy, attack the underlying cause. Immunotherapy helps the body develop immunity to whatever is causing the allergic reaction and is the closest thing there is to a cure.

"We're seeing more people say that, with the cost of medicines, they'd just as soon go on allergy shots," Storms says. Most insurance companies cover the shots. The big drawback is that they require a significant time commitment, with shots given over the span of three to five years.

CONTACT THE WRITER: 636-0272 or comics@gazette.com

RESOURCES

For the daily pollen report for Colorado Springs, call 473-6673.

For "allergy forecasts" across the country, go to www.pollen.com.

An "Allergy and Asthma Medication Guide" is available online at www.aaaai.org, Web site of the American Academy of Allergy, Asthma & Immunology.