Thanks for these great tips. I recently discovered Blexten (Bilastine) antihistamines and they have been life changing (prescription only - at least in Canada). I am also on my second year of sublingual immunotherapy (Itulatek) for birch pollen (my main allergen) and so far I notice a big difference. It is a commitment but can take the daily dose at home which makes it easier! Much more convenient than allergy shots.
Showering at night to get the day's general residue off has made such a huge difference for me, even in non-allergy season. I sleep so much better; plus it's a way to tell my brain to start winding down for bedtime.
Does Flonase help with clogged sinuses, or just with running and clogged noses?
Do you have any experience with intralymphatic immunotherapy (ILIT). I've been on conventional shots for about 3 years and have had some relief but still have constant sinus clogging, which an several ENTs over the years have said is not structural. ILIT is spposed to be 3 shots and done, but is not covered by most insurance.
Data point of one here, but definitely try allergy shots! I started a course last fall and I am on maintenance dose now. The difference this spring versus last spring is amazing. No need for Zyrtec! I went from not even being able to use my screened porch for several weeks to being able to garden without any issues. I used to have problems sleeping at night during allergy season because of so much congestion. Not a problem anymore. The time to do it is a pain, but once you get to maintenance, it's a once-a-month thing, so not so bad.
Thank you, Dr. Jeremy. I decided to try Systane complete since you mentioned you use it for dry, itchy eyes. It seems to be working much better than Refresh Plus. Fingers crossed.
You don't mention Xyzal (levocetirizine), which is similar to Zyrtec, and which I've found helpful - though like Pam Kilberg's experience with Zyrtec, I do find some drowsy-like side effect. Neither Claritin nor Allegra works for me. (I had gotten pretty good at titrating dosage of chlorpheniramine, but if I was off even a little, it either wouldn't work or would make me very drowsy.) I suspect the makers of Xyzal recommend taking it before going to bed because then if it is somewhat soporific, it won't be so noticeable. -- Regarding eye issues, can you comment on Alaway (ketotifen)? I've sometimes found that if my primary symptoms are itchy eyes, that has helped. Though I try a "dry-eye" medication first - Systane, Refresh, Soothe have all been recommended by ophthalmologists; I don't find much difference in their effect on me.
As a family doc with personal and professional experience (😞) I agree - Xyzal seems to be the best option. It’s the isolated L-isomer. Zyrtec has both L and R. The L isomer in Xyzal does most of the work, and has less side effects.
Chronic antihistamine use has been associated with cognitive decline and higher long term dementia incidence, likely from anticholinergic effects. Acetylcholine is highly involved in memory neurochemistry. I try to recommend short term/situational/seasonal use if desired.
Some of my older male patients also notice urinary stream slowing with antihistamines so caution if enlarged prostate.
Antihistamines can also depress mood. I’ve noticed that myself.
And finally I’ve been cautious with nasal steroid sprays. I haven’t wanted to immunosuppress my nasal mucosa since the pandemic started. Also the benzalkonium chloride used as a preservative has been shown to mow down the nasal ciliary layer, which is akin to dropping the phalanx of your castle’s defenses. I think nasal steroid sprays without benzalkonium chloride include Rhinocort, Omnaris, and Flonase Sensimist.
Nasal steroid sprays also increase the risk of glaucoma and cataracts. I use them only when I really need them, and just endure the allergies more than I used to.
A quick shower/rinse off before bed is great advice. Maybe a nasal saline rinse, too. Clean sheets and pillows. Breathing exercises can actually open the airways a little, too. I didn’t believe it until I tried it after reading the book “Breathe.”
Singulair is another option that helps block inflammatory leukotrienes released alongside histamine, and is probably underutilized.
And 100% wear an N95 while mowing your lawn, if you have one. Living in the city I don’t have that allergen at least. Lots of other respiratory irritants, but not much grass!
Cheers from a family doc in the allergy trenches 🤧
I take Xyzal and Singular. Works great for me! I also wear my N95 on windy days when I am outside. If I don’t, my allergies go crazy and sometimes even go into an asthma attack. Before the pandemic I was getting allergy shot. Talk about a game changer! But when the pandemic hit and everything shut down, I was not able to get my shots. Talk about complete misery! I suffered for several months trying to get a handle on my allergies. I need to go back and start again. When they did my full panel allergy test, I was told I was allergic to everything! 😐 They did the skin prick test on my back. I also use Flonase.
Thanks for these great tips. I recently discovered Blexten (Bilastine) antihistamines and they have been life changing (prescription only - at least in Canada). I am also on my second year of sublingual immunotherapy (Itulatek) for birch pollen (my main allergen) and so far I notice a big difference. It is a commitment but can take the daily dose at home which makes it easier! Much more convenient than allergy shots.
Zyrtec Withdrawal Is a Nightmare.
What's your reaction to this?
https://www.peoplespharmacy.com/articles/zyrtec-withdrawal-is-a-nightmare
These are great tips, thank you!
Showering at night to get the day's general residue off has made such a huge difference for me, even in non-allergy season. I sleep so much better; plus it's a way to tell my brain to start winding down for bedtime.
Does Flonase help with clogged sinuses, or just with running and clogged noses?
Do you have any experience with intralymphatic immunotherapy (ILIT). I've been on conventional shots for about 3 years and have had some relief but still have constant sinus clogging, which an several ENTs over the years have said is not structural. ILIT is spposed to be 3 shots and done, but is not covered by most insurance.
Data point of one here, but definitely try allergy shots! I started a course last fall and I am on maintenance dose now. The difference this spring versus last spring is amazing. No need for Zyrtec! I went from not even being able to use my screened porch for several weeks to being able to garden without any issues. I used to have problems sleeping at night during allergy season because of so much congestion. Not a problem anymore. The time to do it is a pain, but once you get to maintenance, it's a once-a-month thing, so not so bad.
Thank you, Dr. Jeremy. I decided to try Systane complete since you mentioned you use it for dry, itchy eyes. It seems to be working much better than Refresh Plus. Fingers crossed.
The interview and Q/A’s worked for me. Thank you. Went to an allergist. Switched some meds around. So far so good
You don't mention Xyzal (levocetirizine), which is similar to Zyrtec, and which I've found helpful - though like Pam Kilberg's experience with Zyrtec, I do find some drowsy-like side effect. Neither Claritin nor Allegra works for me. (I had gotten pretty good at titrating dosage of chlorpheniramine, but if I was off even a little, it either wouldn't work or would make me very drowsy.) I suspect the makers of Xyzal recommend taking it before going to bed because then if it is somewhat soporific, it won't be so noticeable. -- Regarding eye issues, can you comment on Alaway (ketotifen)? I've sometimes found that if my primary symptoms are itchy eyes, that has helped. Though I try a "dry-eye" medication first - Systane, Refresh, Soothe have all been recommended by ophthalmologists; I don't find much difference in their effect on me.
As a family doc with personal and professional experience (😞) I agree - Xyzal seems to be the best option. It’s the isolated L-isomer. Zyrtec has both L and R. The L isomer in Xyzal does most of the work, and has less side effects.
Chronic antihistamine use has been associated with cognitive decline and higher long term dementia incidence, likely from anticholinergic effects. Acetylcholine is highly involved in memory neurochemistry. I try to recommend short term/situational/seasonal use if desired.
Some of my older male patients also notice urinary stream slowing with antihistamines so caution if enlarged prostate.
Antihistamines can also depress mood. I’ve noticed that myself.
And finally I’ve been cautious with nasal steroid sprays. I haven’t wanted to immunosuppress my nasal mucosa since the pandemic started. Also the benzalkonium chloride used as a preservative has been shown to mow down the nasal ciliary layer, which is akin to dropping the phalanx of your castle’s defenses. I think nasal steroid sprays without benzalkonium chloride include Rhinocort, Omnaris, and Flonase Sensimist.
Nasal steroid sprays also increase the risk of glaucoma and cataracts. I use them only when I really need them, and just endure the allergies more than I used to.
A quick shower/rinse off before bed is great advice. Maybe a nasal saline rinse, too. Clean sheets and pillows. Breathing exercises can actually open the airways a little, too. I didn’t believe it until I tried it after reading the book “Breathe.”
Singulair is another option that helps block inflammatory leukotrienes released alongside histamine, and is probably underutilized.
And 100% wear an N95 while mowing your lawn, if you have one. Living in the city I don’t have that allergen at least. Lots of other respiratory irritants, but not much grass!
Cheers from a family doc in the allergy trenches 🤧
I take Xyzal and Singular. Works great for me! I also wear my N95 on windy days when I am outside. If I don’t, my allergies go crazy and sometimes even go into an asthma attack. Before the pandemic I was getting allergy shot. Talk about a game changer! But when the pandemic hit and everything shut down, I was not able to get my shots. Talk about complete misery! I suffered for several months trying to get a handle on my allergies. I need to go back and start again. When they did my full panel allergy test, I was told I was allergic to everything! 😐 They did the skin prick test on my back. I also use Flonase.
Is the cognitive decline associated with all antihistamines or just first generation antihistamines?
Excellent deep dive. Thank you!
Thanks for this helpful info. FYI… maybe it’s just me, but Zyrtec makes me drowsy