What is the best over the counter allergy medicine for adults
Eosinophilic esophagitis is a new disease defined by specific criteria that include a constellation of symptoms. Consensus guidelines define it as a chronic antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation.1
Ten years ago, a biopsy that revealed eosinophils in the esophagus was diagnostic, because normally eosinophils are not seen in the esophagus.
The current definition has evolved to become more comprehensive and includes clinical, demographic, and radiographic criteria.
This article presents an overview of eosinophilic esophagitis—its pathogenesis, epidemiology, clinical presentation, diagnosis, and management.
Eosinophilic esophagitis is best regarded as a systemic rather than a single-organ disease, although current treatments are mostly directed specifically at esophageal inflammation.
Evidence is clear that eosinophilic esophagitis is allergy-mediated.
The current “two-hit” etiologic model involves exposure first to aeroallergens that prime the esophagus, followed by food allergens that cause an eosinophilic response with antigen recognition and stimulation of immune cells from the bone marrow. Other allergic avenues may also be present, including those involved with atopy, asthma, eczema, and food allergies, which stimulate the Th2 pathway and lead to esophageal eosinophilia and inflammation.2
The two-hit model is supported experimentally: the disease can be induced in mice by injecting ovalbumin under the skin as a sensitizing agent, then exposing the airway to an aerosol of Aspergillus fumigatus, producing an allergic reaction involving classic Th2 allergy pathways.3 Further evidence is that numerous patients report that asthma or rhinitis developed years before esophageal disease began.
Patients with eosinophilic esophagitis and their family members own a high prevalence of allergies, and the disease frequently flares up during allergy season.
Endoscopic biopsy specimens from patients often reveal increased T cells, mast cells, interleukin (IL)-5, and tumor necrosis factor alpha, every of which stimulate eotaxin and are essential to an allergic reaction.
They also own high levels of CD3, CDA, and CD1A antigen-presenting lymphocytes, which are every associated with allergy.
Eosinophilic esophagitis responds to allergy medications, including corticosteroids and IL-5 or IL mast-cell inhibitors. The strongest evidence for an allergic etiology is that withdrawing culpable food allergens leads to resolution of the disease. Peterson et al4 gave 18 adults with eosinophilic esophagitis an elemental diet (ie, a pure amino acid, carbohydrate-based diet in which every suspected allergens own been removed), and in 2 to 4 weeks, the mean number of eosinophils seen histologically fell from 54 to 10 cells per high-power field.
The response was almost finish (≤ 10 eosinophils per high-power field) in 72% of patients. When patients resumed a normal diet, the eosinophil content increased substantially within a few days.
Radiographic findings—a narrow esophagus
On radiography, the esophagus may appear narrow—not uncommonly one-third to one-quarter the caliber of a normal esophagus. As the esophagus progressively narrows, both eating and treatment become extremely difficult.
Role of leaky tight junctions
Normally, the junctions between epithelial cells are tight, but numerous conditions, including allergic and autoimmune diseases, are now believed to involve altered permeability of this tissue.
Tight-junction proteins frolic an significant role in regulating antigen delivery and are modulated by cytokines. Activation of cytokines causes the membrane to become more permeable, allowing antigens to get through, leading to an enhanced reaction. In eosinophilic esophagitis, it is postulated that food antigens that pass through the leaky membrane activate CD1-antigen-presenting cells, which then initiate an allergic reaction.5–9
Eosinophilic esophagitis was first described in with a report of 12 patients who had dysphagia, normal endoscopy, no acid reflux, and intraepithelial eosinophilia.10 The authors recognized that these patients had a distinct disease.
Since then, the disease has increased in prevalence.
Kapel et al11 reviewed more than 74, endoscopy slides from a national pathology database and found cases, with increasing prevalence during the study period from to Looking back further in a similar study, Whitney-Miller et al12 found a % prevalence from the years to vs % from to
Sealock et al13 reviewed the literature to assess the prevalence of eosinophilic esophagitis and found considerable variation depending on the populations sampled.
One study from Sweden14 found a prevalence of % by performing endoscopy in 1, randomly selected people from almost 3, responders to a questionnaire on abdominal symptoms. A study based on a Swiss database15 found only a % prevalence. Other studies show higher rates: a study from Florida that examined biopsy specimens from patients who underwent endoscopy for any reason found a prevalence of 1%.16 Another US study found a 15% prevalence in patients with dysphagia.17 Since these studies were done almost a decade ago, we can expect the prevalence to be higher today.
Celiac disease has also been increasing in recent decades, as has gluten sensitivity.
Allergies in general are on the rise worldwide, including asthma and atopic dermatitis. Theories as to the cause of these increases own focused on ambient antigens, food additives, proton pump inhibitors (PPIs), and the microbiome.18,19
Eosinophilic esophagitis is diagnosed with a combination of symptomatic, histologic, and radiographic findings (Table 1). The classic patient is a white male—a kid, teenager, or young adult—with dysphagia.
A case series of 23 adult patients20 found a mean age of 35 (age range 18 to 57), with a male preponderance ().
There is commonly a history of other allergies, including asthma, allergic rhinitis, and atopic dermatitis. Patients more commonly present with dysphagia than heartburn or other esophageal symptoms.11
Endoscopic findings—eosinophils, later fibrosis
Finding eosinophils in the esophagus is nonspecific and is not sufficient to make the diagnosis. Other systemic diseases can involve esophageal eosinophilia, including Churg-Strauss syndrome, Crohn disease, and helminthic diseases. Whether some are related to eosinophilic esophagitis or are independent is not well understood.
Characteristic findings on endoscopy include a corrugated or ringed appearance and linear furrows, resulting from fibrosis and scarring.
“Micro-tears” may also be visible projecting linearly up the esophagus. Multiple white specks are signs of conglomerations of eosinophils and are easily confused with yeast infection. Strictures from scar tissue cause the mucosa to be tight and fragile, making the esophagus extremely susceptible to tearing during endoscopy.
After years of untreated disease, the esophagus becomes increasingly inflamed and fibrotic. Adult patients with eosinophilic esophagitis who were followed for a decade were found to develop increasing collagen deposition in which the submucosa or even the entire esophageal wall was diffusely fibrotic.21
Symptoms are diverse in children and adults
Symptoms reflect the endoscopic changes over time.
In children, the condition manifests with feeding difficulties, vomiting, symptoms of gastroesophageal reflux, and abdominal pain as signs of inflammation. As the esophagus becomes fibrotic, teenagers and young adults tend to present with strictures, dysphagia, and food impaction. Of patients who present to an emergency department with food impaction, the major cause is now eosinophilic esophagitis.22
It is significant to pay attention to symptoms in children to diagnose the condition and start treatment early to prevent or postpone disease advancement.
Medical therapy does not clearly reverse the fibrosis.
As in numerous chronic benign diseases, patients study to compensate, so a careful history is essential. Numerous deny having a swallowing problem, but questioning may reveal that they own always been slow, picky eaters, consuming mostly soft foods and drinking fluids with every bite.
Allegra and Zyrtec are both antihistamines, but is one more effective or less likely to cause sedation than the other?
Allegra has the lowest risk of sedation out of every antihistamines so is preferred if an antihistamine is needed for people working in safety-critical jobs.
Even though Zyrtec is times more likely to cause sedation than Allegra, it is still much less sedating than some older antihistamines such as promethazine.
- Allegra should not be taken with grapefruit juice. Zyrtec has no reported food interactions.
- Allegra works within two hours and Zyrtec works within one hour.
- Studies own not compared the effects of Allegra and Zyrtec for conditions such as postnasal drip, but research suggests intranasal antihistamines such as azelastine are more effective.
- Several studies own found cetirizine (Zyrtec) to be more effective than fexofenadine (Allegra) at relieving symptoms of allergic rhinitis and urticaria, and it appears to own a longer duration of action.
- Zyrtec and Allegra should not be taken at the same time, instead, if symptoms are persisting, it is better to take another drug with a diverse mechanism of action.
Allegra is a brand name for the drug fexofenadine and Zyrtec is a brand name for the drug cetirizine.
Both fexofenadine and cetirizine are favorite antihistamines with numerous similarities but there are some significant differences.
Which is more sedating? Allegra or Zyrtec?
Allegra (fexofenadine) and Zyrtec (cetirizine) are second-generation antihistamines. Second-generation antihistamines were first developed in the s to provide allergy relief without the unwanted side effect of sedation common to first-generation antihistamines such as promethazine and diphenhydramine. However, it soon became apparent that not every second-generation antihistamines were equal when it came to not causing drowsiness or affecting other thought processes.
Cetirizine is significantly more likely than fexofenadine to cause drowsiness.
Fexofenadine (Allegra), even in dosages exceeding those recommended, is the least sedating of every second-generation antihistamines, so is considered the antihistamine of choice for people in safety-critical jobs such as airline pilots.
Which is more effective for Allergic rhinitis?
Trials own shown both Allegra (fexofenadine) and Zyrtec (cetirizine) are significantly more effective than placebo (a pretend pill) for reducing symptoms associated with allergic rhinitis, hay fever, and other allergies.
Trials own not consistently shown that one antihistamine is more effective than another; however, one trial reported cetirizine produced a 26% greater reduction in the number of allergic rhinitis symptoms at 12 hours and 14% greater reduction in symptoms overall compared with fexofenadine. Cetirizine also appeared more effective for symptoms such as runny nose, sneezing, itchy/watery eyes, and itchy nose, mouth or throat. Cetirizine was slightly more likely (%) than fexofenadine to cause drowsiness. Another trial reported similar findings (33% greater reduction in allergic rhinitis symptoms) and also found cetirizine had a longer duration of effect.
Intranasal or ophthalmic (into the eye) antihistamines own a quicker onset of action than oral antihistamines (within about 15 minutes); however, they need to be istered several times daily.
In people with allergic rhinoconjunctivitis and predominantly eye symptoms, ophthalmic antihistamines work much quicker (within 3 to 15 minutes) and are much more effective than any other form of treatment. Intranasal antihistamines are as effective as intranasal cromolyn, intranasal nedocromil, and leukotriene modifiers in seasonal allergic rhinitis; however, are not as effective at relieving nasal congestion and other symptoms as intranasal glucocorticoids.
Allegra Vs Zyrtec for urticaria and other skin reactions
All second generation antihistamines, including Allegra and Zyrtec, are effective for acute and chronic urticaria, although more trials own been conducted in people with chronic urticaria.
One trial found cetirizine to be more effective than fexofenadine at relieving symptoms in 97 patients with chronic urticaria with % of participants taking cetirizine reporting themselves as symptom-free after 28 days of treatment compared with only % of participants taking fexofenadine. Partial improvement was reported by % of people assigned cetirizine (% assigned fexofenadine) and % experienced no improvement with cetirizine (% with fexofenadine). No difference in side effects was noted between the two.
Allegra Vs Zyrtec for Postnasal Drip
Post nasal drip may happen for various reasons — allergies (particularly to dairy), colds or flu, various drugs (including birth control pills and high blood pressure tablets), freezing temperatures, bright lights, hormonal changes and spicy foods.
Thin postnasal drip secretions caused by allergies may be treated with antihistamines.
Second-generation antihistamines such as Allegra and Zyrtec may offer better relief than older-type antihistamines such as promethazine (older antihistamines tend to thicken post-nasal secretions). Intranasal antihistamines, such as azelastine, own a faster onset of action (15 minutes) and appear more effective than oral antihistamines although require more frequent istration. Other treatments include decongestants, cromolyn, and corticosteroid nasal sprays.
In the treatment of post nasal drip caused by nonallergic causes, oral second-generation antihistamines are not extremely effective. However, the intranasal antihistamine azelastine is effective.
Azelastine improves every rhinitis symptoms including nasal congestion, postnasal drip, sneezing and sleeping difficulty. The most common side effect is a metallic aftertaste; however, this is more likely at higher dosages and tends to dissipate with continued use.
Allegra Vs Zyrtec To Relieve Freezing Symptoms
Second-generation antihistamines (such as Allegra and Zyrtec) own limited effectiveness at relieving symptoms of freezing such as a runny nose and sneezing (only 45% of adults felt better after using them compared to 35% with placebo [a pretend pill]).
Effects were only noticeable if used within the first two days of a freezing, use of antihistamines made no difference thereafter.
Allegra Vs Zyrtec: istration
The antihistamine effects of Allegra and Zyrtec final for at least 24 hours, therefore, they are both given once daily.
Fexofenadine, the athletic ingredient of Allegra works within two hours. Cetirizine, the athletic ingredient of Zyrtec works within one hour.
Allegra Vs Zyrtec: Side Effects, Interactions and Price
Side effects are generally mild with second-generation antihistamines and include a headache and rarely dry mouth, and nausea. Zyrtec is times more likely than Allegra to cause sedation; however, Zyrtec is still much less sedating than older antihistamines such as promethazine.
Side effects are generally mild with second-generation antihistamines and include a headache and rarely dry mouth, and nausea.
Every the second generation antihistamines currently on the market appear free from adverse cardiovascular effects. Few major interactions own been reported with either Allegra or Zyrtec; however, there is the possibility that side effects such as sedation, confusion, and mental alertness may be enhanced if given with other drugs with this side effect.
Grapefruit juice appears to decrease the rate and extent of absorption of fexofenadine (Allegra) by about 30%. Cetirizine (Zyrtec) has no reported interactions with grapefruit or grapefruit products. More studies are needed to determine if there are any interactions between second generation antihistamines and herbal products and other types of food.
Always speak with your doctor of pharmacist before using any drugs in combination.
Cost is similar for 30 Allegra and 30 Zyrtec tablets and both are available as generics.
See also: Compare Tool — Allegra vs Zyrtec
- Day JH1, Briscoe MP, Rafeiro E, et al.
Comparative efficacy of cetirizine and fexofenadine for seasonal allergic rhinitis, hours postdose, in the environmental exposure unit. Allergy Asthma Proc. Jul-Aug;26(4)
- Simon FER, Simons KJ. H1 Antihistamines: Current Status and Future Directions. The World Allergy Organization Journal. ;1(9) doi/
- Handa S, Dogra S, Kumar B. Comparative efficacy of cetirizine and fexofenadine in the treatment of chronic idiopathic urticaria.J Dermatolog Treat. Jan;15(1)
- Slater JW1, Zechnich AD, Haxby -generation antihistamines: a comparative Jan;57(1)
- Mann RD, Pearce GL, Dunn N, Shakir S.
Sedation with “non-sedating” antihistamines: four prescription-event monitoring studies in general practice. BMJ?: British Medical Journal. ;()
- Sharma M, Bennett C, Cohen SN, Carter B. H1-antihistamines for chronic spontaneous urticaria. Cochrane Database of Systematic Reviews , Issue Art. No.: CD DOI: /CDpub2
- Meltzer EO, Caballero F, Fromer LM, Krouse JH, Scadding G. Treatment of congestion in upper respiratory diseases. International Journal of General Medicine.
- Post-Nasal Drip. American Academy of Otolaryngology — Head and Neck Surgery.
- Banfield C, Gupta S, Marino M, et al. Grapefruit juice reduces the oral bioavailability of fexofenadine but not desloratadine. Clin Pharmacokinet. ;41(4)
- Hampel F, Ratner P, Mansfield L, et al. Fexofenadine hydrochloride, mg, exhibits equivalent efficacy to cetirizine, 10 mg, with less drowsiness in patients with moderate-to-severe seasonal allergic rhinitis. Ann Allergy Asthma Immunol.
One long-ago summer, I joined the legion of teens helping harvest our valley’s peach crop in western Colorado. My occupation was to select the best peaches from a bin, wrap each one in tissue, and pack it into a shipping crate. The peach fuzz that coated every surface of the packing shed made my nose stream and my eyelids swell. When I came home after my first day on the occupation, my mom was so alarmed she called the family doctor.
Soon the druggist was at the door with a vial of Benadryl (diphenhydramine) tablets. The next morning I was back to normal and back on the occupation. Weeks later, when I collected my pay (including the ½-cent-per-crate bonus for staying until the finish of the harvest), I thanked Benadryl.
Today, I’m grateful my need for that drug lasted only a few weeks. In a report published in JAMA Internal Medicine, researchers offers compelling evidence of a link between long-term use of anticholinergic medications love Benadryl and dementia.
Anticholinergic drugs block the action of acetylcholine.
This substance transmits messages in the nervous system. In the brain, acetylcholine is involved in learning and memory. In the relax of the body, it stimulates muscle contractions. Anticholinergic drugs include some antihistamines, tricyclic antidepressants, medications to control overactive bladder, and drugs to relieve the symptoms of Parkinson’s disease.
How do I safely take OTC antihistamines?
Read the directions on the label before taking any medicine. Study how much to take and how often you should take it. If you own any questions about how much medicine to take, call your family doctor or pharmacist.
Hold track of which OTC medicines you are using and when you take them. If you need to go to the doctor, take the list with you.
Follow these tips to make certain you are taking the correct quantity of medicine:
- Mixing medicines can be dangerous. If you take a prescription medicine, enquire your doctor if it’s okay to also take an OTC antihistamine.
- Take only the quantity recommended on the medicine’s label. Don’t assume that more medicine will work better or quicker.
Taking more than the recommended quantity can be dangerous.
- Don’t use more than 1 OTC antihistamine at a time unless your doctor says it’s okay.
They may own similar athletic ingredients that add up to be too much medicine.
What the study found regarding Benadryl and dementia
A team led by Shelley Gray, a pharmacist at the University of Washington’s School of Pharmacy, tracked almost 3, men and women ages 65 and older who took part in Adult Changes in Thought (ACT), a long-term study conducted by the University of Washington and Group Health, a Seattle healthcare system. They used Group Health’s pharmacy records to determine every the drugs, both prescription and over-the-counter, that each participant took the 10 years before starting the study.
Participants’ health was tracked for an average of seven years. During that time, of the volunteers developed dementia. When the researchers examined the use of anticholinergic drugs, they found that people who used these drugs were more likely to own developed dementia as those who didn’t use them. Moreover, dementia risk increased along with the cumulative dose. Taking an anticholinergic for the equivalent of three years or more was associated with a 54% higher dementia risk than taking the same dose for three months or less.
The ACT results add to mounting evidence that anticholinergics aren’t drugs to take long-term if you desire to hold a clear head, and hold your head clear into ancient age.
The body’s production of acetylcholine diminishes with age, so blocking its effects can deliver a double whammy to older people. It’s not surprising that problems with short-term memory, reasoning, and confusion lead the list of side effects of anticholinergic drugs, which also include drowsiness, dry mouth, urine retention, and constipation.
The University of Washington study is the first to include nonprescription drugs. It is also the first to eliminate the possibility that people were taking a tricyclic antidepressant to alleviate early symptoms of undiagnosed dementia; the risk associated with bladder medications was just as high.
“This study is another reminder to periodically assess every of the drugs you’re taking.
Glance at each one to determine if it’s really helping,” says Dr. Sarah Berry, a geriatrician and assistant professor of medicine at Harvard Medical School. “For instance, I’ve seen people who own been on anticholinergic medications for bladder control for years and they are completely incontinent. These drugs obviously aren’t helping.”
Many drugs own a stronger effect on older people than younger people. With age, the kidneys and liver clear drugs more slowly, so drug levels in the blood remain higher for a longer time.
People also acquire fat and lose muscle mass with age, both of which change the way that drugs are distributed to and broken below in body tissues. In addition, older people tend to take more prescription and over-the-counter medications, each of which has the potential to suppress or enhance the effectiveness of the others.
First-generation OTC antihistamines
These were among the first antihistamines scientists developed. They are cheaper and widely available. They work in the part of the brain that controls nausea and vomiting. This means they can prevent motion sickness too. The most common side effects of first-generation antihistamines is feeling sleepy.
For this reason, they are sometimes used to assist people who own trouble sleeping (insomnia).
Some common kinds you can purchase over the counter include:
- Diphenhydramine (brand names include Benadryl, Nytol, Sominex)
- Brompheniramine (brand names include Children’s Dimetapp Cold)
- Dimenhydrinate (brand names include Dramamine)
- Chlorpheniramine (brand names include Chlor-Trimeton, Actifed Cold)
- Doxylamine (brand names include Vicks NyQuil, Tylenol Freezing and Cough Nighttime)
What should you do about Benadryl and the risks of dementia?
In , Indiana University School of Medicine geriatrician Malaz Boustani developed the anticholinergic cognitive burden scale, which ranks these drugs according to the severity of their effects on the mind.
It’s a excellent thought to steer clear of the drugs with high ACB scores, meaning those with scores of 3. “There are so numerous alternatives to these drugs,” says Dr. Berry. For example, selective serotonin re-uptake inhibitors (SSRIs) love citalopram (Celexa) or fluoxetine (Prozac) are excellent alternatives to tricyclic antidepressants. Newer antihistamines such as loratadine (Claritin) can replace diphenhydramine or chlorpheniramine (Chlor-Trimeton). Botox injections and cognitive behavioral training can alleviate urge incontinence.
One of the best ways to make certain you’re taking the most effective drugs is to dump every your medications — prescription and nonprescription — into a bag and bring them to your next appointment with your primary care doctor.
Second-generation OTC antihistamines
These are newer medicines.
Numerous treat allergy symptoms without causing sleepiness. Common kinds include:
- Cetirizine (brand names include Zyrtec)
- Loratadine (brand names include Alavert, Claritin)
- Fexofenadine (brand names include Allegra)
Note: Some antihistamines are mixed with other medicines. These could include pain relievers or decongestants. Numerous of the brand names above are for these combination medicines. These are meant to treat numerous symptoms at the same time. It is a excellent thought to treat just the symptoms that you own. If you own only a runny nose, don’t select a medicine that also treats headache and fever.
Related Information: A Guide to Coping with Alzheimers Disease
Path to improved well being
When your body is exposed to allergens (allergy triggers), it makes histamines.
Your body releases these chemicals to attack the allergen. Unfortunately, histamines cause the itching, sneezing, runny nose, and watery eyes associated with allergies. Antihistamines treat these symptoms.
How can I safely store OTC antihistamines?
Store every medicines out of reach and sight of young children. Store in a cool, dry put so they do not lose effectiveness. Do not store them in bathrooms. These areas can get boiling and humid.