DRUG BUST by Alan Cassels

If a drippy nose, itchy eyes and bouts of sneezing are getting to you, join the club of suffering folks heading to the drug store for the latest in fast acting, non-sedating pharmaceuticals. There are a million products to choose from that contain antihistamines, decongestants, and steroids, or mixtures thereof, all designed to stave off the worst that allergy season throws at us. The plethora of products is surely one sign that medicating our allergies is on the verge of becoming one of the fastest growing spring activities.
One problem with the way many of us gleefully enter into some form of relationship with pharmaceuticals, to protect ourselves from ugly allergy symptoms, is that we do so in a state of blissful ignorance. I mean, do we really know what’s in that stuff that we’re compelled to squirt up our noses?
You might argue, “What’s the big deal?” given that these are allergy medications, most of which are sold (over the counter) OTC and probably a lot “safer” than the drugs prescribed by your doctor. While this column doesn’t have the space to examine the nuance of classifications between “prescription only” drugs and OTCs, which you can grab by the armload from your local pharmacy, suffice to say that any drug taken in great quantities needs to be packaged with at least some level of “informed consent,” regardless of how it is dispensed. Here are a few pointers to help ease your way through a pharma-fun allergy season:
1) Isolate the problem. Always try to avoid the underlying cause of your allergy, if you know what it is. If you are allergic to cats, try to avoid them like the plague. This is difficult to do, however, because cats are statistically more attracted to people who have cat allergies, than to those who aren’t. Scientists think it is because people with cat allergies have warmer laps than others, but this has yet to be empirically verified. If your friends have cats and you want to visit, tell them to air the felines (throw them outside) before you arrive. Open a few windows, that sort of thing. On the other hand, if you don’t know the cause of your allergic reactions, and you’ve ruled out the likely seasonal culprits – pollen, dust or grass clippings – you may need to see an allergist to help determine the cause. An allergist can determine, using skin patch tests, whether you have allergies to certain foods. Unfortunately, however, an allergist, even after sending you home with an excruciatingly long list of foods to avoid, may be unsuccessful in pinning down the problem. That’s right. Consume nothing but tofu and water and you could still be drippy, sneezy and itchy.
2) Avoid combo products. No doubt if your allergy is due to something that you really can’t avoid, such as being outdoors in spring, you will likely find yourself diving straight for the pharmacy shelves for some product to control the symptoms. Be warned: this is likely to be a disorienting experience and a bit of a minefield. A lot of OTC allergy medicine comes in combination products – different shapes, different sizes, different prices and so on. If you can, try and stick to single-ingredient versions of products, a principle that applies to much other drug-taking activity as well. Nowadays, pharmaceutical companies are making more and more combination products, but we savvy consumers, whenever possible, should avoid this “shotgun” approach. Think of your drug as a sushi roll. If something goes wrong, and it often does, and you find yourself reacting adversely to a combo product, you won’t know if it’s the wasabi, the shrimp, the tobiko or the Japanese mayo that is to blame.
3) Go low and go slow. The most common thing you’ll be looking for to treat your allergic symptoms is an antihistamine, such as diphenhydramine (the main ingredient in Benadryl) chlorpheniramine, brompheniramine, pheniramine and clemastine. With these older antihistamines, the most common side effect is drowsiness, so take care in operating that fax machine or keyboard. Seriously, driving a car or operating a 500-tonne crane is not a good idea when you are under the influence of an antihistamine. As with any drug regimen, the key to avoiding adverse effects is to start low and go slow, “dose-titration” as the medical-types call it. Don’t go rushing for maximum doses every hour, as you may be subjecting your system to serious overkill. You should do this every time you decide to take a drug: take it in the lowest, effective dose that works for you. Why? Because everyone is different. What “works” for
one person may be enough to anesthetise another. Higher doses of drugs may contain unwelcome adverse effects. Getting too much of a good thing can sometimes turn into a really bad thing.
4) Non-sedating antihistamine drugs, such as fexofenadine (Allegra) and loratadine (Claritin) are wildly popular but should not be used by the elderly. They are apparently less sleep inducing than the older antihistamines, but they too can cause a number of unpleasant side effects, both mental and physical, including confusion, delirium, short-term memory problems, dry mouth, constipation, difficulty urinating and blurred vision. These tend to make your original problem – a case of itchy eyes or congestion – appear somewhat mild.
5) Congestion: don’t get so stuffy about it. Sometimes, when you have an allergy, you can become badly congested, and you’ll likely be overwhelmed by a burning desire to squirt some product up your nose. This is normal, yet nose-squirting drugs, such as beclomethasone nasal steroid spray or fluticasone (brand name Flovent or Advair), which work for many people, can potentially cause other problems. They may, in fact, weaken your immune system and make you more susceptible to colds. One of the side effects of nasal steroids is the suppression of the adrenal glands, which can cause low blood sugar, unconsciousness, coma, or even death. There is also some concern that steroids may stunt the growth of adolescents, especially with long-term, high-dose use, yet the jury is still out on this one. Again, the principle of going low and slow applies.
6) Try and avoid being taken to the cleaners over your allergy pills. Great savings can be had if you look for generic products. For example, at my local pharmacy, the brand name Benadryl (diphenhydramine) costs $6.99 for 12 pills (58 cents each). The same dosage size in a generic drug costs $4.99 for 20 pills (25 cents each).
7) Questions about long-term use? Again, like any other drug, taking it over the long term is a gamble. For example, a recent study questioned whether antihistamine use might be linked to the development of brain tumours. It appears there is an association (remember, association is not causation) between people who have allergies or asthma and a lower risk of glioblastoma, a deadly type of brain tumour. Scientists theorize that allergies and asthma perhaps cause inflammation in the brain, and that this is a good thing, as it might keep immune system cells active and working to prevent these cancers. They reason that if people are using antihistamines to get rid of their allergic symptoms, they might also be eliminating the protective effect (the inflamed brain).
According to the findings of one study, “While the use of antihistamines had no effect on the risk of developing glioblastomas, they were associated with other types of brain tumours.” This is all preliminary, of course, and people who use antihistamines should not stop taking the drugs if, and when, they need them. All we can say is that it seems that the inflammatory process is somehow involved in the development of cancer, but we really can’t say that the drugs themselves cause cancer.
At the end of the day, drugs for allergies don’t cure your allergy per se; they just provide some relief to get you through the season. Happy sneezing.
Alan Cassels is the co-author of Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients, and a drug policy researcher at the University of Victoria. He is also founder of Media Doctor Canada which evaluates reporting of medical treatments in Canada’s media. www.mediadoctor.ca