November 25, 2015 | Black & Kletz Allergy
Any Arlington allergist can tell you: millions of allergy sufferers reach for over-the-counter (OTC) allergy medications daily to try to get relief from their allergy symptoms. There are numerous medications available and they come in a variety of routes of administration. The medicines come in the forms of tablets, capsules, syrups, powders, nasal sprays, eye drops, creams, ointments, and inhalers.
Most OTC medications use additional ingredients, referred to as inactive ingredients, which may include preservatives, coatings, dyes, lubricants, sweeteners, flavoring agents, and binding materials. Not all inactive ingredients are always inactive. Alcohol is added to some OTC medications and may be inactive or active. Alcohol is often found in OTC cough syrups which many allergy patients use. Some individuals have allergic reactions and/or untoward side effects to some of these inactive ingredients. Common inactive ingredients that cause reactions for some individuals include: aspartame, benzoates, benzyl alcohol, sulfites, benzoates, lactose, oleic acid, propylene glycol, saccharin, sorbitan trioleate, and soy lecithin. There are over 450 inactive ingredients used in OTC medications.
Many individuals can also have allergic reactions and/or unwanted side effects from the active drug found in OTC allergy medications. The active drug is the drug that is meant to “work” on the symptoms. An allergic reaction to a drug can occur with any drug and usually involves symptoms that may include: hives (urticaria), itching (pruritus), swelling (angioedema), rashes, abdominal discomfort, nausea, vomiting, wheezing, shortness of breath, throat closing sensation, chest tightness, itchy eyes, watery eyes, redness of the eyes, itchy throat, and anaphylaxis (a life-threatening systemic allergic reaction).
OTC allergy medications can be even more confusing since many of them contain more than one active drug. An example of a single drug medication is Claritin, which contains loratadine, whereas an example of a medication that has 2 drugs is Claritin-D, which contains both loratadine and pseudoephedrine. There are many OTC allergy medications that contain more than 3 drugs in a single pill. To the average consumer, whose knowledge of the field of medicine is rudimentary, this can present a potentially serious problem. In the example used above with Claritin and Claritin-D, any allergist in Arlington will agree that a person with high blood pressure (hypertension) and/or heart disease should not take the Claritin-D because the active ingredient, pseudoephedrine, can elevate one’s blood pressure and increase their heart rate. It should also not be taken in individuals with an enlarged prostate, glaucoma, kidney disease, and/or overactive thyroid (hyperthyroidism). In a healthy person, it usually is not a problem; however, in patients with the diseases listed above, it can potentially be devastating.
Another potential problem with using OTC allergy medications involves the interactions they may have with other medications that the individual may be taking. These other medications may be prescribed or they may interact with other OTC medications. Certain medications may diminish the efficacy of other medicines causing them not to work as well as they were intended. On the other hand, certain medicines can have the opposite effect and increase the effect of another medicine making it potentially dangerous as well. An example of the latter would be an individual with attention deficit hyperactivity disorder (ADHD) who takes the medication Adderall (mixture of the salts of amphetamine and dextroamphetamine) with the OTC medication pseudoephedrine (e.g., Sudafed). The pseudoephedrine could potentiate the effect of the Adderall or vice versa. Therefore, an understanding of pharmacology is recommended for self-medicating.
Drugs tend to be classified in “classes.” For example, beta blockers, angiotensin inhibitors, and calcium channel blockers are 3 common classes of high blood pressure medications. Likewise, penicillins, macrolides, and quinolones are 3 common classes of antibiotics. Individuals who are allergic to a drug in a particular “class” of medications tend to be more likely to have an allergy to another drug in that same “class.” For example, someone who is allergic to amoxicillin is more likely to be allergic to another penicillin derivative such as ampicillin. An individual that has a known allergy to a drug may take an OTC allergy medication that may contain an active or inactive ingredient that may be in the same “class” as that drug. The person may not have checked the ingredients in the OTC medicine, may not have known that the OTC medicine was in the same “class,” or more likely, did not even know about cross-reactions to medications within “classes.” A good example of this would be when someone takes a sinus relief allergy OTC medication that contains ibuprofen. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) which is also known under the brand names Advil, Motrin, Nuprin, as well as many other names. That individual may have known that he/she was allergic to naproxen (e.g., Naprosyn, Aleve, Anaprox) but did not know to avoid that “class” of medications, namely NSAIDS’s or he/she did not know that the generic name for Advil was ibuprofen.
In addition to the above reasons to be careful when using OTC allergy medications, one must recognize that there are side effects that are not allergic in nature, but still affect average people in different ways. It is fairly common for many OTC allergy medications to cause drowsiness. There are typically warnings on the sides of the boxes or bottles, but one may become extremely drowsy to a medication whereas someone else may have no drowsiness to the same dose of the same medication. Still others may have a paradoxical effect where it causes them to feel “hyper” and “agitated” like the feeling of too much caffeine (which by the way, is also used in a great deal of OTC allergy and sinus medications).
Even though OTC allergy medications can be beneficial, one must use caution when using them. There are other side effects not listed in this article, but this article is meant to warn people about the possibility of having potentially serious reactions from OTC allergy and sinus medications. If you have allergies and need advice on any type of medication whether OTC or prescribed, please feel free to make an appointment for a consultation with our board certified Arlington allergists at Black & Kletz Allergy. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All our offices have on-site parking and the Washington, DC and McLean offices are Metro accessible. There is a free shuttle that brings patients back and forth between our McLean office and the Spring Hill metro station on the silver line. Please call us to make an appointment or you can click Request an Appointment and we will respond within 24 hours on the next business day. We treat both adults and children and have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 50 years.
