Apr 26, 2018

By: Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

You are wrong. You might not even know it yet, but you are wrong. So, let's try this again. Your favorite food is…….Come on people. This isn't that hard. Peanut Butter. Your favorite food is peanut butter. Peanut butter is perfect. It has lots of protein, fiber, vitamin e, niacin, magnesium and copper. Peanut Butter has so little water in it that bacteria and fungi can't grow. This means it doesn't spoil. And the oils in is are very stable too. It won't go rancid for at least a year. When the Zombie apocalypse comes, grab that jar of peanut butter. But, of course the best thing about peanut butter is how amazing it tastes.

I know a small percentage of you, like my niece, are actually allergic to peanuts. My condolences. That is almost as bad as being allergic to Spring. Wait a minute. With Spring comes pollen. Spring pollens mean itchy watery eyes and stuffed up noses for many people. There are a bunch of you allergic to Spring! We call this condition allergic rhinitis. The usual quote is that about 10% of the population has hay fever or allergic rhinitis. However, some estimates peg the number closer to 30-40%.

If we look inside the nose of someone with allergic rhinitis, there is a lot going on. Allergens, in this case pollens, are inhaled and bind to an antibody called IgE on the surface of special immune system cells called mast cells. These mast cells live in the lining of the nose, which is called the nasal mucosa. After exposure to the allergens, mast cells quickly release a bunch of chemical signals. These signals include histamine, tryptase, vascular endothelial growth factor, and other inflammatory mediators. This leads to nasal itching and sneezing. Leukotrienes increase vascular permeability, causing runny nose and congestion. Then, 4 to 12 hours later, nasal congestion is increased due to the influx of different immune cells called T-cells, basophils, and eosinophils. These cells then release their own batch of chemical messengers.

Allergic rhinitis is when the immune system over reacts to pollens, which really aren't a threat. The best way to avoid allergy symptoms would be to avoid the pollen. Some tips include using air conditioning instead of opening windows, showering and changing clothes after being outdoors and use a clothes dryer rather than hanging linens outside to dry. Frankly, though, if you go outside, you will probably be exposed. If you get allergic rhinitis, the most common over the counter medications we reach for are the antihistamines. Antihistamine medications block the histamine receptor which hopefully stops the allergic cascade and reduces the allergic rhinitis symptoms.

There are two basic types of medications that block the H1 histamine receptor. We call these the first and second generation antihistamines. The first generation antihistamines are have names like chlortripolon (chlorpheniramine), and benadryl (diphenhydramine). They are inexpensive, work quite well, but they also often cause drowsiness, and some other side effects like urinary retention, and worsening glaucoma. They work fast, which is great if you have an itchy rash, but they don't last that long and so if you have allergic rhinitis, you may have to take several pills a day. So, they are cheap and fast, but have no staying power and might put you to sleep. Thus, they aren't usually the first choice for allergic rhinitis.

Second generation antihistamines cause much less sedation, have far fewer side effects, but they are more expensive. These are agents like reactine (cetirizine), and claritin (loratadine). A nice benefit is one pill often lasts all day. Reactine is good for both runny noses and itchy rashes, but I have seen it occasionally make some people sleepy. Claritin only works well on runny noses, but it is much less likely to make someone sleepy. Between the two, I usually recommend the Claritin or loratidine for allergic rhinitis.

Now we have another allergic rhinitis option available without a prescription. Recently steroid nasal sprays like triamcinolone or fluticasone became available without a prescription. Nasal steroids work better than oral antihistamines on runny noses, stuffy congested noses, sneezing and nasal itch. They work as well as oral antihistamines on itchy red eyes. Nasal steroid sprays definitely won't make you sleepy. Nasal steroids are quite safe, but there are some cautions to keep in mind. Steroids suppress the immune system, so shouldn't be used if you had a bacterial, virus or fungal infection, especially in your nose. Nasal steroids can accidentally get sprayed in the eye, so shouldn't be used if you have glaucoma or cataracts. Talk to your pharmacist if you take asthma medications to make sure you aren't already taking an inhaled steroid. Finally, it should go without saying, but don't share your nasal spray with anyone else. That is an excellent way to spread infections around.

Nasal steroids like triamcinolone and fluticasone do not work quickly. It might take up to a week for them to kick in. After that, you will use them for a few weeks during your allergy season. However, if you are into your second week of trying a nasal steroid and are experiencing no relief, talk to your pharmacist. Nasal steroids might not be the medication for you. If you find you need your nasal steroid for 6 months continuously, talk to your doctor or pharmacist. It is not that you can't use a nasal steroid that long, but it is probably a good idea for the doctor to check you out to make sure the problem really is just allergic rhinitis.

Arachibutyrophobia is the fear of getting peanut butter stuck to the roof of your mouth. I guess my condolences to those people too. But I've convinced the rest of you right? Peanut Butter is the best. Now, bonus points. Crunchy or smooth? I'll give you a minute. The correct and only answer is….No, no, no, no, NO! Of course it is crunchy. How can you even think it is smooth. What is wrong with you people? Crunchy peanut butter is the best! You people are Wrong! So, so, so wrong!

As always if you have any questions or concerns about these or other products, ask your pharmacist.

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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