Dr. Grogg chooses Allegra to be the allergy medicine in her black bag. Two forms are available: (1) Allegra 60 mg BID and (2) 180 mg QD. The 180 mg once daily (qd) dose came out to compete with other once-daily allergy medications. Clinically what you will hear occasionally from patients is that their once-daily dose really only lasts for about 18 hours and they have a breakthrough of symptoms; thus, the patient may be better off with a twice-a-day 60 mg dose. The BID dosage will give 24-hour coverage.

Allegra-D 60 mg BID is a reformulation of seldane. It does not have the adverse effects with antifungals and macrolide (erythromycin).

Allegra is nondrowsy, comes at a moderate cost, and is well tolerated.

Zyrtec (10 mg QHS)--which is now available over the counter--is a very safe allergy medication; it is listed Category B in pregnancy. Its once-a-day dosing is convenient and aids in compliancy. Zyrtec produces a drowsy affect in about 15 percent of patients and is, therefore, taken at night to reduce that side effect. It is approved for the treatment of perennial allergies, but we all use any and all of these medications for patients with perennial allergies. Precaution in hepatic/renal dysfunction. Other adverse reactions include dizziness and dry mouth.

This is a picture of a typical allergy patient . . . Watery eyes, chemosis, degree of redness varied depending upon where the patient is in allergic cascade. The dark circles on eyes of allergic people (referred to as allergic shiners) are basically from vasocongestion.

Systemic Allergies

Dr. Grogg likes to do an ear, nose, and throat exam to determine whether the patient's condition may be viral or allergic. A cold typically lasts 10-14 days at the most. She starts to consider allergies playing a role in the patient's presentation when the patient reports a "cold" lasting for 4 to 6 weeks. Symptoms often include itchy roof of mouth, itchy ears, and clear watery nasal discharge.

Symptoms

• Sneezing
• Itchy ears, throat, soft palate
• Popping ears secondary to fluid due to swelling of the eustachian tube (swelling indicative of congestion)
• Runny nose

Signs

• Nasal mucosa pale, boggy (edematous), bluish in color. Pale bluish mucous membranes are a telltale sign of allergy, so be sure to look up the patient's nose. Palpebral conjunctiva often have pale look, too.
• Variants of nasal mucosa color: yellowish, gray, slightly erythematous
• SWELLING--may be very striking
• Lymphoid hypertrophy secondary to PND (post-nasal drip)
• "Allergic salute"--wiping, pushing up on nose because running all the time; develop crease in nose
• Profuse CLEAR discharge

Allergic conjunctivitis

Antihistamines Topical and oral antihistamines can be used as a possible "treatment" for ocular myokymia. Dr. Grogg suspects it is mostly a placebo effect, but there is some talk about antihistamines having membrane-stabilizing abilities. Decreasing caffeine, increasing sleep, and decreasing stress helps. Antihistamines can also be used in conjunction with topical steroid ointment for severe contact dermatitis which is common around eyelids. The skin around the eyelid is very thin and commonly comes into contact with lotions, makeup, and soaps or detergents to which the patient may be allergic. Also, a person often has his/her hands around the face and eyes, so products that may be on the hands can be transferred to the periorbital area. An antihistamine will help relieve the symptoms of itching.

Contact dermatitis

OTC Allergy Medications

A plethera of allergy medications are available over the counter. Some popular ones include:

• Loratadine (the generic of Claritin, Alavert, etc.)
  • Nondrowsy, easy dose
  • Breakthrough of symptoms?
  • Adverse reactions include headache, dry mouth, nervousness
• Claritin-D12 (5 mg BID), Claritin-D24 (10 mg QD)
  • Nondrowsy
  • Claritin D large pill, difficult to swallow. For the patient who has problems swallowing pills, Claritin Reditabs dissolve under the tongue--but are expensive.