Question for the hivemind: Allergy meds

I love Oklahoma... except for one thing.

You might think that one thing has something to do with insane Christian Evangelicals or creepy perverted 'Conservative' Republicans, but really, you just get used to those sorts of things. I think I would genuinely miss them if they were gone.

No, the 'one thing' is... allergies.

As Ive loled about before-- I never had allergies until I moved to OK. Grew up surrounded by trees, but in Oklahoma, Im apparently allergic to tree pollen (I also think its funny that my dog also has allergies, to trees and grass. A DOG.)

Now normally I harass bug my classmates and professors about my allergies, thats how I found out about Ketotifen Fumarate. But I never got a good answer from them on actual systemic allergy meds. One of the professors I used to harass bug every Spring has retired, so I cant harass bug him about my latest question: Allegra.

Allegra, one of the last second generation antihistamines to go over the counter, is doing so this week.

So heres my question-- I tried Alavert. Didnt work. Tried Claratin. Didnt work. Tried Zyrtec. Didnt work. I can count the number of years Ive been in OK by the different kinds of allergy meds Ive tried :-/ Is there any chance in hell Allegra is going to work? Or should I just save my money?

(got any ideas, Kevin??)

More like this

I never had allergies until I moved to Oklahoma. Evidently, when the wind comes sweeping down the plain at +45 mph, its carrying billions and billions of grains of cedar pollen. So even though I grew up in a damn forest, Im now allergic to 'trees'. *bonus* Arnie is allergic to trees AND grass. A…
Hay fever, as those of you who have it know, can be a most remarkable feeling. Your eyes itch, and your joints ache. You feel as though you were coming down with the flu. Time itself can seem distended, warped. Your hands feel like balls of dough, and you're sleepy. You feel…
Every Spring, you can count on a handful of posts here at ERV on allergies. Ive got em. I hate em. But I recognize that in many ways, Im 'lucky' as far as allergies go. I only have to deal with them for a few months of the year, I can move somewhere else and not have to worry about them at all…
If there were a parallel universe, and in that universe medicine, instead of being based on science, was simply a gemisch of various folkways and superstitions, medicine in that universe would be called "naturopathy". "Remember. Hey, how come this never works with water?" I've discussed the…

Mucho sympathies re: the allergies. I can definitely relate considering my eyes are watering like crazy right now.

I've been through a lot of allergy meds over the years. I've never found anything that I am truly satisfied with, but some work better than others. I've been using Benedryl for ages. At least it provides some relief for me.

We all have slightly different body chemistry and all meds will work for some people and not work for others. My best advice...give it a shot. Heck, I'll probably try it out. I'm ALWAYS in the market for a better antihistamine.

I have real bad spring allergies for about 3-4 weeks starting in mid April, and I'm a real mess (I always say I'm allergic to doing my taxes :-). FWIW: I used to use Allegra for many years, but one year, it just stopped working for me. FEH!

I currently use a combination of Zyrtec (antihistamine), Sudafed (decongestant), Nasonex (nasal steroid). Sometimes I use Zyrtec-D instead of manually adding Sudafed as needed, depending on how my allergies are acting (I'm a bit of a control freak about my pills during allergy season). BTW: you can get 365 pill bottle of Zyrtec from Costco generic for quite cheap (and I'm assuming Wallmart, etc. too).

Starting with the first hint of spring allergies, I start taking Zyrtec daily (usually early April) and when the real bad allergies start I add in Sudafed (or switch to Zyrtec-D) and use the Nasonex as needed.

Good Luck!

By Bob in Chicago (not verified) on 02 Mar 2011 #permalink

I agree with Mobius. All the meds are slightly different. Alavert/Claritin doesn't do much for me. Zyrtec does. Chlorpheniramine is even better. This might be the one for you. Give it at least a couple of weeks to have its full effect before you decide it isn't working.

Good luck. Tree sex sucks.

I find I need to keep changing antihistamines. One will work one year, but not the next, or will work for only part of the season...

Get a tape worm?

So glad I don't have hay fever like my dad and grandad (although my dad's allergy to pollen has really improved since he hit 40). However, I do have a rather exciting rash allergy to cephalosporins. Possibly a slightly bigger issue.

Allegra does fuck all for me. Oddly enough, Claritin works like a charm.

By Optimus Primate (not verified) on 02 Mar 2011 #permalink

Have you considered going back to first generation antihistamines?

I have had terrible allergies my whole life. I have tried the whole range of over the counter second generation antihistamines and have even tried perscription medication and none of it seemed to do a damn thing. My doctor recomended I try some first generation antihistamines instead and in my experience they work much better.

Several first generation drugs have worked the problem with them is side effects, mainly drowsyness. The first couple I tried worked better than sleeping pills. So you may need to do some shopping around to find one that works for you. In my case it's Novo-Pheniram those little pills are a godsend. They help with my allergies are cheap come in big bottles and I experience no side effects.

So consider giving first generation a try, in my experience they are far more effective in treating allergies than the second generation just be carefull as they are more likely to have side effects.

Are you sure you have allergies - many other conditions can have similar symptoms, but be refractory to anti-histamines. Chemical sensitivities, chronic upper respiratory tract infections, etc, can all lead to similar symptoms, but will not respond to anti-histamines.

If you haven't already, you should go see an MD who specialises in allergies; S/he should be able to identify if you have allergies, and if so, what you are allergic to.

You may have to pursue prescription options if OTC fails.

EDIT: upon re-reading our post, it sounds like you have already had a positive diagnosis

Allegra (fexofenadine) itself is no more effective than any of the "1st gen" anti-histamines. The only real difference is it doesn't get across the blood-brain barrier very well, so it has fewer issues with side-effects like drowsiness. I do not have serious allergies, but I do get the odd flair-up. Good'ol cetirizine hydrochloride works for me.

Nothing has really worked for me since terfenadine was taken off the shelves, and people moved away from the anticholinergics. I agree with DB, trying to get teh first-generations is work a shot, I use them sparingly as the ones I can get knock me out for about 12+ hours

By CB Goodman (not verified) on 02 Mar 2011 #permalink

Terfenadine worked for me, but so do all of the second-generations that I've tried. Only drawback is that they all give me a dry mouth.

Dunno if you've tried cromolyn sodium or not. Can't be ingested, but for some it's great.

By D. C. Sessions (not verified) on 02 Mar 2011 #permalink

2 suggestions--try all the antihistamines available (at prescription doses)---lack of effect from one doesn't predict your response to another.
2nd suggestion--see a reputable allergist. If you anticipate living there for more than a couple of years, desensitization shots might help.

Start prescription generic Flonase mid March and use through out the hay fever season. It is an inhaled steroid and you must plan ahead but it is very effective.

Damn, didn't you guys take organic chemistry?
Structurally, ketotifin, allegra, and claritin are all very similar. Allegra is terfenadine with a carboxylate group substituting for one of the methyl groups to preclude CNS penetration. Zyrtec is the other that is more structurally similar to Allegra (and terfenadine) than the tricylics but really pretty different. So, since you didn't mention trying terfenadine, as a medicinal chemist; I'd try it. But I'm not making any promises.

You could move over here to NC, but I think you'd find that you were better off in OK (and we have just as many bible thumpers and republicans as well). In a couple weeks, my house, car, windows, sidewalks ect. will be covered with the "green haze". And everyone sneezes. I don't have allergies (except to idiots) but even I sneeze then.

IMHO, based on personal experience, Claratin works for moderate chronic allergic events. I have to take it for a day or two before I see any result. Also when certain trees do their mass sperm dump, pollen so thick that even people who don't have allergies are sneezing and have scratchy throats, Claratin just barely takes the edge off. A those times I have to reinforce with one of the older antihistamines.

When nothing else cuts it dyphenhydramine, Banadryl, is my go to antihistamine. 25mg usually cuts it but up to 75mg can be used. The problem is that dyphenhydramine causes drowsiness in a very big way. Makes a damn good sleeping pill. The one time I was forced to take 75mg I was knocked out like I had been poleaxed. Slept for ten hours and woke up groggy. Good stuff but you have to be able to accommodate being prone.

I tried the low-dose cortosteroids, Rhinocort and Nasocort, and for moderate chronic conditions they worked very well but took several days, even at full dosage, to take effect. outside pollen season I was able to back off to half the normal dose and see good effect. Problem is that these gave me chronic a scratchy throat and, when the pollen overwhelmed it, sinus headaches that like to kill me. Having to pay to see a doc and prescription prices were the last straw and I shifted back to the Claratin even though the effect was less satisfactory.

Basically keep trying stuff until something works. And get ready to change medications in case it stops working. I've never found a good study where the different allergy meds were compared head to head in a large group of people - maybe I'm missing it? It seems to me that each type of allergy med works differently for different people, probably because although the basic 'allergic' pathway is the same there are some modifiers also involved, that are different in different people, but again can't really find a study that backs that up.

As someone else states, Allegra used to work great for me (with pseudoephedrine) but stopped working during one really bad allergy season. Now I take Claritin, or when it gets really bad, generic Zyrtec, and psuedoephendrine if needed. I've never tried a nasal spray that worked for me, including Flonase. Some doctors will also prescribe a mix, so maybe just one medication won't work for you too.

I do allergy shots (I'm in maintenance mode) and Allegra, with Benadryl as needed. Claritin is useless. Zyrtec makes me fall asleep. None of the decongestants on the market do a damn thing for me, either. Oh, and for me it's year-round, though I do live in California where green things that I'm allergic to (like the weeds in my neglected garden) grow year-round.

I do have to put in a good word for allergy shots, though. When I started them I was easily going though a (200-ct)box of tissues in a day. Though I need the other meds on top of them for complete control, the shots made 80% of the difference.

Some of the common OTC allergy medicines worked for me, but since I'm an old(er) male, decongestants had unacceptable side effects. I currently use Flonase or Nasonex, the inhaled steroidal medications. I worried for a while about constant use, because my allergies can occur at any time of the year and steroids can do so damned much harm over time, but the literature indicates that systemic levels are below the detection level. I still use it as sparingly as possible. It works quite well to control sneezing, itchy nose/eyes, runny nose and congestion. I have found that its effectiveness decreases somewhat over time, but I would be lost and miserable without it.

I used to use Nasalcrom, Cromolyn Sodium. It was never really popular but worked for me. It claimed to build up a resistance to allergens over a short period. I shelled out for a bottle and used it as directed for a few months and realized I wasn't really using it much anymore. I don't know how available it is, or how well it works for everyone else, but I carried that bottle everywhere for a month, then lost track of it as I didn't seem to need it. I get a new bottle evey year.

By John Horsey (not verified) on 02 Mar 2011 #permalink

Abbie, what are you actually allergic to, and what kind of reactions do you get ? And how often, for how long ? That would kinda help to decide what would be the best drug for you. Can discuss here or on FB, cheers !

Allegra (it's called Telfast where I live) works better for me than any of the other antihistamines you mentioned. In some cases (e.g. loratidine), the difference isn't that great, but is enough to be noticeable.

My personal experience of cromolyn sodium is that it can give some marginal short term relief when used in eye drops and nasal sprays but doesn't work for long.

While it won't help you in the short term, you should definitely consider immunotherapy to avoid a season of misery next year.

By The Chimp's Ra… (not verified) on 02 Mar 2011 #permalink

Its def allergies, and its def tree pollen-- cedar. We have a looooooong season in OK, too. I mean, tree pollen has already been up for a few weeks now. None of that 'mid-April' nonsense :P More like mid-Feb. And its been high/very high the whole time. Awesome.

Im assuming this is going to be a forever problem, now. I mean I never had a problem in MO or NE, but now that Ive got them, theyre never going to go away, as long as Im somewhere with some kind of cedar pollen season? Right? I should probably look into the shots unless Im planning on moving to Antarctica forever (real possibility).

cynical-- hmmmmmm ketotifen fumerate works really well for me, but applied as eye-drops. If its got the same structure as a couple of the others (that dont work) maybe its a dose thing?

I heard an internet rumor that some of the 2nd generation ones? You actually need twice the dose for them to work. But most people get drowsy if they take that dose, so they 'recommend' the smaller dose to keep the 'non-drowsy' tag. hehehe. Internet allergy med rumors, LOL!

And I might try some of the 1st gen you all have mentioned. I take 75 mg Benadryl at night :-/ Like I said, this has been going on for weeks, so I think the 'drowsiness' side-effect has worn off. But Im still to paranoid to take it during the day (working with radioactive HIV, and such). But that leaves me with no relief during the day except for the eyedrops (for real, they keep me from clawing my eyeballs out, Im glad I found them).

But how stupid is that 'well, one works for some people, and another one works for others...' crap! Thats bullshit! LOL!! Its fucking biochemistry and we are all, for all intents and purposes, basically identical (humans have like, no genetic diversity). How can that possibly be? BULLSHIT! LOL!

Depending on your point of view, humans are identical, practically identical, really similar, pretty much the same, or completely different. That's why some people get side effects and some don't. And that's why Nasonex/Flonase require use for about two weeks for the greatest effect for most (many? some?) people, but the very first dose was the most effective for me and subsequent doses were somewhat less effective. It's biochemistry, but biochemistry is, like, really hard. How can you expect a dumb little pill (or squirt of fluid) to figure all this stuff out?

#21, 22:

I'm too tired to check, or even think much, now, but maybe CYP polymorphism? Or another enzyme or something.

Yes, just suppress your symptoms with a synthetic drug, instead of addressing the cause(s) of your allergies.


Ugh. Yeah, Abbie, cedar is a killer for me, too. And it is high right now. Again, ugh.

The OTC Benadryl I have is 25 mg. I usually double the dosage since one doesn't do much. I can see why you wouldn't want to take anything that would make you drowsy during the day.

What symptoms give you the most problems?

For me, swelling of tissues in the sinuses is a real problem. Lots of ache. One thing that is easy, pretty much side effect free and helps is to use a saline nose spray. Helps wash that nasty pollen out. It isn't a cure all by any means, but anything that helps is good.

Good luck.

Kelly @ #24:

Yes, just suppress your symptoms with a synthetic drug, instead of addressing the cause(s) of your allergies.

Are you suggesting that ERV chops down all the cedar trees in OK?

By The Chimp's Ra… (not verified) on 03 Mar 2011 #permalink

I've been taking some form of Allegra ever since it was first put on the market. The non-decongestant form always worked.

By Katharine (not verified) on 03 Mar 2011 #permalink

Wish I could help - type 2 immunity is not my thing. The only allergy I ever had was some mysterious hives thing that happens for no discernable reason and is easily knocked back by benadryl (which for some reason does not make me sleepy).

I'm with #5 - except not tape worm. Hookworm is your ticket. (note for those among you from Betelgeuse - DO NOT infect yourself with hookworm unless prescribed by your doctor).

I have a really good anecdote. When I increased my NO level by innoculating myself with ammonia oxidizing bacteria, my seasonal hay fever went away. That was before I had read up on how NO regulates the immune system, so I think a placebo effect is unlikely. I have written up some of the theory behind it. It is like the tape worm idea, but these bacteria are a lot more benign.…

Low NO makes mast cells degranulate easier. That is part of what makes the immune system turn on robustly, the respiratory burst lowers the local NO level, that potentiates mast cells, the mast cells activate and release their junk which causes positive feedback. Just a little better regulation and they don't.

Flonase every day, and Allegra for flareups. Also, allergy shots. I have Sampter's Syndrome, though, so the Flonase is mostly for that, with the happy side effect of reducing allergic symptoms.

You may be right that humans are all the same (although, if so, why are some groups of people more predisposed to diabetes than others, for instance)? All I know is, Claritin does nothing for me, and Allegra does, while Allegra does not have any effect on my daughter's allergies, but Claritin works for her. I hear that Allegra will be over the counter as of tomorrow, here in the USA, so I guess you could just buy some and try it....

I can take up to three different antihistamines (all under the advice of my allergist) as I wait to learn whether my allergy shots will work or not. I find Allegra works pretty well as a maintenance med, especially if I start double doses of it at least a week before I expect a flareup (assuming it's a flare I can see coming ahead of time, like the onset of late-May allergy season here). I'll take chlor-tripolon if allegra isn't cutting it, and benadryl is my quick-relief and/or bad reaction med (but the downside to benadryl is that I either have to be pretty much going crazy from the allergy symptoms or just not need to be anywhere for the next three hours or operate any vehicles or heavy machinery for a good six hours since it knocks me out as well as the conscious sedation I had for the removal of my wisdom teeth).

I'm no medical expert, but I'll just say on a purely anecdotal note that I'm pretty happy with Allegra. It doesn't get all of my allergy symptoms, but then, my allergies are worse than most peoples'. Are there more effective antihistamines out there? Yes, but for me all of those ones come with unacceptable side-effects in the form of profound sedation. It allows me to function when my allergies would otherwise have me bedridden and/or taking up the ER's time and resources for an asthma attack. Since starting treatment with asthma meds, a leukotriene receptor antagonist, and antihistamines, my lung function has about tripled, so yay for modern medicine!

Like Bob in Chicago, I use a combination of drugs for my allergies: an antihistamine, a decongestant (one containing pseudoephedrine, which means showing ID to the pharmacist), and nasal steroids. (Plus eyedrops, which you already know about.) One drug alone didn't do it for me.

One of my friends swears by nasal irrigation, but when I tried my symptoms actually got worse. That might've just been because I tried it at the beginning of allergy season, when my symptoms were about to get worse anyway, but I also admit that squirting salt water up my nose twice a day just isn't appealing.

I have something more like chronic rhinosinisitus, and I've pretty much given up on drugging my way out and just irrigate on days that are especially bad. Sourced from pure woo, but there's at least a little evidence for it.

Another vote for fluticasone (generic Flonase spray). Beats hell out of anything else I've ever tried.

Depending on exactly your symptoms, I personally have found Allegra less effective than Claritin and Zyrtec (as in, I had a prescription for a while, needed the other two anyway, then stopped taking it...didn't notice a difference). I've found Atarax is extremely helpful with skin itchiness, which no one on earth but me seems to have as a primary allergy symptom, but I think it's still prescription only.... :/

Have you seen an allergist? Allergy testing might help you identify things that you need to avoid. And immunotherapy can be more effective than medications in the long run.

Among the OTC non-sedating antihistamines, Zyrtec is probably the most effective, (but a lot of people find it slightly sedating). Allegra is a close second, and is the least sedating. Military pilots can take it and still get a waiver to allow them to fly fighter jets, etc. Claritin is barely better than placebo. Claritin came out at a time when the FDA was keen to get Hisminal and Seldane off the market because there were too many serious drug interactions. If given at a truly effective dose, Claritin would not pass the non-sedating test. So they dosed it low enough to pass it, but at that dose it barely beats placebo. Xyzal (levocetirizine) is a prescription antihistamine that is the lev enantiomer of cetirizine (Zyrtec), and is less sedating and a little more effective, but much more expensive. (BTW cetirizine is a metabolite of hydroxizine (Atarax, Vistaril), so Xyzal is sort of a grandchild to hydroxizine)

Short of allergy shots, the most effective therapy are the topical corticosteroid nasal sprays like Flonase, Nasonex, Rhinocort, Veramyst, Omnaris, etc. They always come out way ahead of other meds in studies. The problem is that many people do not like nose sprays, and you have to use them on a daily basis in order to get the benefit.

BTW, what do you think of this XMRV story?…

Same state, same problem. I never once considered that it might specifically be the local fauna to blame, since I've never really been outside OK except for a couple weekend trips in my youth. Personally I just take sudafed if it gets too bad, or did years ago. Now I just deal with it, because I'm tough like that.

Incidentally, until I talked with a couple out of staters, I hadn't realized that apparently Ok plants are all "ugly". Who knew? Up until now when I saw this ridiculously colorful fauna in movies and so on, I just assumed it was Hollywood magic making them look like that.

By Dark Jaguar (not verified) on 26 Mar 2011 #permalink

None of the meds. you listed worked for me, either. Allegra was the only one to send me to the ER with anaphylaxis. Zyzal once a day works pretty well for me. In cases of severe hives and swelling (like after perfume/artificial fragrance overexposure), I take cortisone orally for a week or so. My doc also suggested a new drug: Ketotafin--but I haven't tried it yet.

By Sande Anfang (not verified) on 01 Apr 2011 #permalink

Don't know much about allergy meds, but if your nose runs constantly like mine does and gets sore from blowing it all the time, this stuff does wonders-

Just put a dab on your thumb and forefinger and rub it on the base of your nose like once or twice a day- no more red, sore, irritated nose!

Also I'm starting to notice that dairy really aggravates my allergies. When I eat dairy all my allergies go into overdrive- pet dander, dust, seasonal allergies, etc. When I don't eat as much dairy all my allergies are reduced. Still not sure if this season's allergies have started or if I'm possibly just lucky this year, have they started for you yet?