Spring has barely sprung, but in most of the country, spring allergy season — triggered by the first stirrings of tree pollen — is well under way.
You can tell by the sniffles and sneezes of the afflicted. But you can also tell by the ads: TV spots selling remedies for drippy, congested noses, itchy eyes and other symptoms are in heavy rotation.
New this year: ads for Flonase, a nasal steroid spray from GlaxoSmithKline that just became available over the counter. It joins Sanofi’s Nasacort, a spray in the same class that went from prescription to over-the-counter status a year ago. And they both sit on store shelves next to antihistamines such as Claritin, Allegra and Zyrtec that were prescription drugs just a few years ago. Older over-the-counter antihistamines, such as Benadryl, and decongestants, such as Sudafed and Afrin, remain available as well.
Don’t expect the ads to help you sort out what might work best for you. Here’s what some top allergists say you need to know about these non-prescription options.
Believe (some of) the hype about the newly-accessible steroid nasal sprays.
These drugs work by fighting inflammation and they are in the “single most effective drug class” for treating nasal allergies, according to the American College of Allergy, Asthma & Immunology. Other expert groups have made similar statements. “These are first-line treatments” that can prevent allergy symptoms, not just treat them, says Jackie Eghrari-Sabet, an allergist in Gaithersburg, Md.
But that does not mean they work for everyone, says James Sublett, a Louisville allergist and president of the allergy group. People with mild to moderate symptoms have the best chance of full relief, he says.
Possible side effects include nasal irritation and nose bleeds. Labels caution that some children using the sprays may experience slower growth, so a doctor should be consulted if a child needs them for more than two months.
Expect to pay more.
When prescription drugs are first available over the counter, most consumers end up paying more, because their insurers no longer cover the cost. The non-prescription steroid nasal sprays are selling for about $17 to $23 for a one-month supply (at the typical two-squirts per nostril adult starting dose). Worth knowing: so far, insurers have continued to pay for similar prescription sprays, Eghrari-Sabet says. The various sprays have never been studied head to head, so it’s impossible to say whether they vary in effectiveness, she says.
There’s a right way to use these sprays.
They should be used daily during your vulnerable season or seasons, ideally starting before symptoms do, Eghrari-Sabet says. The idea is “to turn an army of inflammatory cells around before they recruit more soldiers,” she says.
It’s also important to administer the sprays correctly, so that they end up inside your nasal passages, not just your nose, where they might cause irritation, Sublett says. Packages contain instructions, and Sublett has an added tip: bend over and look at your toes while holding the bottle up and squirting.
Antihistamines still have a role.
These drugs target histamine. That’s a chemical your body releases, causing sneezing, a runny nose and itchy eyes, when you come in contact with allergy-triggering substances. Antihistamines work faster than the steroid sprays, which can take a week or so to reach full effectiveness. They also can be cheaper, because they are available in store-brand versions. For example, Walmart sells Equate loratadine tablets (the same active ingredient as Claritin) for about $7 for 60 24-hour doses
Antihistamines make perfect sense for someone who suffers a few sneezy days each season and doesn’t want to use a spray for weeks or months, Eghrari-Sabet says. Look for one that does not make you sleepy, Sublett says. It’s a myth, he adds, that older, sedating antihistamines, such as Benadryl, are extra effective against nasal allergies.
Be careful with decongestants.
Decongestants such as Sudafed work by shrinking swollen blood vessels in the nose. They can raise blood pressure and cause jitters, and some people are more susceptible than others. Some decongestant sprays such as Afrin — unlike the steroid nasal sprays — can be used for just few days at a time, because they otherwise cause rebound symptoms.
So use these medications sparingly, Sublett says.
Keep your medical providers in the loop.
Over-the-counter treatments should not take the place of professional care — especially if you have never been formally diagnosed with allergies, if you have additional medical problems or if your symptoms persist or worsen, Eghrari-Sabet and Sublett say. An allergist can test you to find out what’s causing your symptoms and offer additional treatments. Those include allergy shots and, for a few patients who qualify, newer immunotherapy pills that desensitize people to grass and ragweed pollens.
Also important to remember: While medications can be helpful, the first rule of allergy control is to avoid the substances that make you sniffle and sneeze. If you are allergic to mold spores or to pollen from trees, grasses or ragweed, that means knowing when levels are high (by checking pollen.com or the National Allergy Bureau) and then taking steps such as these recommended by the American Academy of Allergy, Asthma and & Immunology:
• Keep windows closed at home and in your car.
• Use air conditioning if possible.
• Try to stay indoors, and avoid mowing lawns or raking leaves.
• If you need to be outside for a long period, wear a pollen mask.
• After time outside, take a shower, shampoo your hair and change clothes.
We congratulate this story for its thorough and nuanced discussion of the costs of different allergy medications — a rarity in health news today. But if a story is going to call certain medications “the single most effective drug class for treating nasal allergies,” then we’d like to see that statement backed up with evidence and a quantification of the benefits. It’s also problematic for this story to rely on a source with extensive ties to pharmaceutical companies that make allergy drugs without alerting readers to these relationships. We’re glad that a second independent expert was consulted to help deliver an evaluation of the comparative benefits.
March is the beginning of spring and allergy season. It is estimated that 50 million people in the US, or 30 percent of adults, are affected by nasal allergies. There are a variety of treatment options, such as antihistamines and decongestants, as well as nasal steroid sprays, which are becoming available over the counter. With more drugs to choose from at the pharmacy, consumers need accurate reporting on these treatments to make informed decisions when buying allergy treatments.
The story goes above and beyond our standard here. There is a whole section on costs, which tells consumers to “expect to pay more.” Insurers will no longer cover the cost, the article says, so expect to shell out $17 to $23 for a one-month supply of non-prescription steroid nasal spray. The story also discusses the costs of antihistamines and says store-brand versions are a cheaper alternative to steroid sprays. An example is Walmart’s Equate loratadine tablets, which cost $7 for 60 24-hour doses.
The story claims steroid nasal sprays are the “single most effective drug class for treating nasal allergies” — a quote that is attributed to the American College of Allergy, Asthma & Immunology’s website. But this statement is not backed up with any quantitative data. How effective are these treatments? And how do they compare to other alternatives out there, like antihistamines and decongestants? How many patients put on this treatment would report experiencing a benefit? The story acknowledges that these sprays won’t work for everyone, but it wouldve been better to provide an estimate. There are several Cochrane reviews (meta-analyses based on multiple studies) on this topic, such as this one and this one, that could’ve been used to help quantify the story’s claims.
The story goes into the side effects of steroid nasal sprays, antihistamines and decongestants. Although none of these harms are quantified, we’ll give the story the benefit of the doubt.
The line that caught our attention was: “Labels caution that some children using the sprays may experience slower growth.” What kind of slower growth (mentally vs. physically)? How many children encountered this side effect? And is it worth the risk to ever use a steroid nasal spray? A few figures here would have been helpful to put this in perspective, because “slower growth” sounds like one of the more serious harms that someone could experience.
We give the story credit for quoting reputable organizations and expert groups, as well as allergists, regarding the relative merits of these treatments. However, the story did not provide any evidence to back up their claims. The reader has no idea if these claims are based on big clinical trials or small case series. Here’s the only comment that touches upon evidence: “The various sprays have never been studied head to head, so it’s impossible to say whether they vary in effectiveness.”
While that statement may well be true, many placebo-controlled trials have been conducted on these treatments, and those trials could’ve been cited to give readers an accurate reflection of the evidence base on this topic.
While there was no overt disease mongering, the story suggests that anyone who has allergies needs to see an allergist, which is not accurate and might be said to constitute a sort of “specialty service mongering.” In the majority of cases, the appropriate care setting is primary care. Inappropriate specialty care is a major contributor to rising health care costs.
There were some obvious conflicts of interest with one of the expert sources quoted in this story.
Dr. James Sublett is not only a Louisville allergist and president of the American College of Allergy, Asthma & Immunology, but he is also a “speaker for numerous pharmaceutical and medical device companies,” says his profile on the digital media company Everyday Health. A bit more digging finds that Sublett “has received payment for lectures from GlaxoSmithKline, Merck, Sunovion, and Teva and has stock/stock options with AllergyZone LLC,” according to disclosure statement for a 2013 study on cockroaches in The Journal of Allergy and Clinical Immunology.
We believe such conflicts of interests are troubling and should be disclosed, especially when the first product mentioned by the story includes a nasal steroid spray from GlaxoSmithKline – the same pharmaceutical company that engages Sublett as a speaker. That, together with the lead quote from the allergy group (where Sublett is president) claiming steroid nasal sprays are the “single most effective drug class,” throws the story somewhat off balance. We’re glad a second, seemingly independent expert was also consulted for her opinion.
The article did a great job comparing the various over-the-counter alternatives out there, from steroid nasal sprays like Flonase to antihistamines like Claritin to decongestants like Sudafed.
All these drugs are available over the counter, which the article mentions early in the story.
Nasal steroids are not a new concept: They have been developed since at least the 1950s and have been tested in lab and clinical trials since the 1990s.
What is new about Flonase is that it’s now available over the counter, after the US Food and Drug Administration approved its use without a prescription last July, according to media reports at the time.
Since this fact is clear early in the story, we give it a satisfactory rating.
The story includes enough original reporting that we can be sure it’s not based on a press release.