How do antihistamines cause drowsiness. What are non-drowsy alternatives for allergy relief. How to minimize sedation from cold and flu medications. When should you consult an allergist for persistent symptoms.

Understanding Histamine and Antihistamines

Histamine plays a crucial role in our body’s immune response and wakefulness. When allergens or pathogens enter our system, histamine production increases to combat these threats. However, this can lead to uncomfortable symptoms like runny nose, sneezing, and itchy eyes. Antihistamines work by blocking histamine’s effects, providing relief from these symptoms.

Why do antihistamines often cause drowsiness? Histamine in the brain helps keep us alert and awake. When antihistamines cross the blood-brain barrier, they can interfere with this process, resulting in feelings of sleepiness.

First-Generation vs. Second-Generation Antihistamines

Antihistamines are broadly categorized into two groups:

• First-generation antihistamines (e.g., diphenhydramine/Benadryl速)
• Second-generation antihistamines (e.g., cetirizine/Zyrtec速, fexofenadine/Allegra速, loratadine/Claritin速)

First-generation antihistamines are more likely to cause drowsiness as they readily cross the blood-brain barrier. Second-generation antihistamines, often marketed as “non-drowsy,” generally cause less sedation and have longer-lasting effects.

Minimizing Drowsiness from Allergy Medications

If you’re struggling with antihistamine-induced drowsiness, consider these strategies:

1. Opt for second-generation antihistamines
2. Try nasal spray antihistamines (prescription only)
3. Use intranasal corticosteroids
4. Take antihistamines in the evening
5. Avoid alcohol when using antihistamines

Can you switch between different antihistamines? Yes, but it’s essential to check chemical ingredients and dosages before changing brands or generics. What works for one person may not work for another, so finding the right medication might require some trial and error.

The Role of Intranasal Corticosteroids in Allergy Management

Intranasal corticosteroids can be an effective alternative or complement to antihistamines. These medications work by reducing inflammation in the nasal passages, providing relief from allergy symptoms without causing drowsiness.

How long do intranasal corticosteroids take to work? Unlike antihistamines, which offer quick relief, intranasal corticosteroids may take a few days to reach full effectiveness. During this initial period, your doctor might recommend using an antihistamine alongside the corticosteroid.

Over-the-Counter vs. Prescription Intranasal Corticosteroids

Some intranasal corticosteroids are available over-the-counter, while others require a prescription. Consult with your healthcare provider to determine which option is best for your specific needs.

Cold and Flu Medications: Hidden Antihistamines

Many people are unaware that cold and flu medications often contain first-generation antihistamines. These are included because they are effective at treating cold symptoms and reducing nasal discharge. However, this also means these medications can cause significant drowsiness.

Why are some cold medicines labeled for nighttime use? Cold medicines containing sedating antihistamines are typically marketed for nighttime use due to their drowsiness-inducing effects. It’s crucial to take this labeling seriously, especially for medications containing highly sedating antihistamines like doxylamine.

Safe Usage of Cold and Flu Medications

To use cold and flu medications safely:

• Read labels carefully
• Follow recommended dosages
• Avoid combining multi-symptom medications with single-ingredient antihistamines
• Be cautious about daytime use of nighttime formulations

When to Consult an Allergist

While over-the-counter medications can provide relief for many allergy sufferers, there are instances when professional medical advice is necessary. Consider scheduling an appointment with a board-certified allergist if:

• Your allergy symptoms persist for more than two weeks
• Over-the-counter medications fail to adequately control your symptoms
• You experience significant side effects from allergy medications
• You’re unsure about what’s causing your allergic reactions

How can an allergist help? An allergist can provide a comprehensive diagnosis, identify your specific allergens, and develop a tailored treatment plan. This may include allergen immunotherapy or prescription medications that offer relief without causing drowsiness.

Alternative Treatments for Allergy Relief

If antihistamines or intranasal corticosteroids are causing unwanted side effects, there are other options available for managing allergies:

1. Allergen immunotherapy (allergy shots or sublingual tablets)
2. Leukotriene modifiers
3. Nasal irrigation (e.g., neti pot)
4. Environmental controls to reduce allergen exposure
5. Natural remedies (e.g., butterbur, stinging nettle)

How effective is allergen immunotherapy? Immunotherapy can provide long-lasting relief by gradually desensitizing your immune system to specific allergens. While it requires a significant time commitment, many patients find it highly effective in reducing or eliminating their allergy symptoms.

The Importance of Allergy Prevention

While medications can help manage allergy symptoms, prevention is often the most effective strategy. Understanding your specific allergens and taking steps to minimize exposure can significantly reduce your reliance on medications.

Common Allergen Avoidance Strategies

• Use air purifiers with HEPA filters
• Regularly clean and vacuum your living space
• Keep windows closed during high pollen days
• Shower and change clothes after spending time outdoors
• Use allergen-proof bedding covers
• Keep pets out of bedrooms if you’re allergic to animal dander

Can lifestyle changes really make a difference in allergy management? Absolutely. Many allergy sufferers find that combining medication with allergen avoidance strategies provides the most comprehensive relief from symptoms.

The Future of Allergy Treatment

As our understanding of allergies and the immune system continues to grow, new treatments are constantly being developed. Some promising areas of research include:

• Biologics targeting specific immune pathways
• Gene therapy to modify allergic responses
• Improved allergen immunotherapy techniques
• Novel drug delivery systems for more targeted treatment

What can we expect from future allergy treatments? While it’s difficult to predict specific breakthroughs, the trend is moving towards more personalized and targeted therapies that offer better efficacy with fewer side effects.

Emerging Technologies in Allergy Management

Technology is also playing an increasingly important role in allergy management:

1. Smartphone apps for tracking symptoms and pollen levels
2. Wearable devices that monitor environmental allergens
3. AI-powered systems for predicting allergy flare-ups
4. Telemedicine platforms for remote allergy consultations

How can technology improve allergy care? These tools can help patients and healthcare providers better understand individual allergy patterns, leading to more effective prevention and treatment strategies.

Navigating Allergy Season: Tips for Success

Allergy seasons can be particularly challenging for those sensitive to environmental allergens. Here are some strategies to help you navigate these difficult periods:

• Start allergy medications before symptoms begin
• Monitor local pollen forecasts
• Plan outdoor activities for times when pollen counts are lower
• Wear sunglasses and a wide-brimmed hat when outdoors
• Use a clothes dryer rather than hanging laundry outside
• Consider a vacation to a low-allergen area during peak allergy season

Is it possible to build tolerance to allergens over time? While some people may experience a natural reduction in allergy symptoms as they age, others may find their allergies worsen. Allergen immunotherapy remains the most reliable way to build long-term tolerance to specific allergens.

Seasonal vs. Perennial Allergies

Understanding whether your allergies are seasonal or perennial can help in developing an effective management strategy:

• Seasonal allergies: Typically caused by pollen from trees, grasses, or weeds
• Perennial allergies: Year-round allergies often triggered by dust mites, pet dander, or mold

How does treatment differ for seasonal and perennial allergies? While the medications used may be similar, the timing and duration of treatment can vary. Seasonal allergy sufferers may only need to take medications during specific times of the year, while those with perennial allergies might require year-round management.

The Impact of Climate Change on Allergies

Climate change is having a significant impact on allergy patterns worldwide. Some of the observed effects include:

• Longer and more intense allergy seasons
• Changes in plant distribution, introducing new allergens to different regions
• Increased pollen production due to higher CO2 levels
• More frequent extreme weather events that can affect allergen levels

How can we adapt to changing allergy patterns? Staying informed about local allergen trends, working closely with healthcare providers, and being flexible in treatment approaches will be crucial as allergy patterns continue to evolve.

The Role of Air Quality in Allergy Management

Air quality plays a significant role in allergy symptoms, particularly for those sensitive to environmental pollutants. Consider these factors:

1. Monitor air quality indexes in your area
2. Use air purifiers in your home, especially in bedrooms
3. Avoid outdoor exercise on days with poor air quality
4. Support initiatives to improve local air quality

Can improving indoor air quality significantly reduce allergy symptoms? For many people, especially those with perennial allergies, improving indoor air quality can lead to a noticeable reduction in symptoms and reliance on medications.

Allergies and Mental Health

The impact of allergies extends beyond physical symptoms. Many allergy sufferers experience:

• Decreased quality of life
• Sleep disturbances
• Increased stress and anxiety
• Difficulty concentrating
• Social isolation during peak allergy seasons

How can we address the mental health aspects of living with allergies? Holistic allergy management should consider both physical and mental well-being. This might include stress reduction techniques, counseling, or support groups for allergy sufferers.

The Connection Between Allergies and Other Health Conditions

Allergies often coexist with other health conditions, including:

• Asthma
• Eczema
• Sinusitis
• Migraines
• Autoimmune disorders

Why is it important to consider these connections? Understanding the relationship between allergies and other health conditions can lead to more comprehensive and effective treatment strategies. For example, managing allergies effectively can often lead to improvements in asthma control.

Empowering Patients: Taking Control of Your Allergy Management

Effective allergy management requires active participation from patients. Here are some ways to take control of your allergy care:

1. Keep a detailed symptom diary
2. Educate yourself about your specific allergens and triggers
3. Communicate openly with your healthcare providers
4. Stay informed about new treatment options
5. Advocate for yourself in medical settings
6. Join allergy support groups or online communities

How can patient empowerment improve allergy outcomes? When patients are actively involved in their care, they’re more likely to adhere to treatment plans, recognize early warning signs of symptom flare-ups, and make informed decisions about their health.

The Role of Diet in Allergy Management

While diet primarily affects food allergies, some evidence suggests that certain dietary choices can impact environmental allergy symptoms as well. Consider these dietary approaches:

• Anti-inflammatory diets rich in fruits, vegetables, and omega-3 fatty acids
• Probiotic-rich foods to support gut health and immune function
• Avoiding foods that may cross-react with your known allergens
• Staying well-hydrated to help thin mucus secretions

Can dietary changes alone manage allergy symptoms? While diet can play a supportive role in allergy management, it’s typically not sufficient as a standalone treatment for environmental allergies. However, a healthy diet can contribute to overall well-being and potentially enhance the effectiveness of other allergy treatments.

When Allergy or Cold Medication Makes You Drowsy

Tips for Staying Alert

By Purvi Parikh, MD

In treating allergies or a cold with antihistamines, you may experience drowsiness, a common side effect of the medication.

How does this happen? Histamine is a chemical produced by the immune system to fight off allergens and germs. When there is a threat of allergies or infection (such as the common cold), histamine is even more active. In its search-and-destroy process, it can cause allergy or cold symptoms such as runny nose, coughing, sneezing and itch eyes. Antihistamine medications relieve these symptoms by blocking the unwanted effects of histamine.

Unrelated to the immune system, histamine is also produced in the brain, where it plays an important part in feeling awake. Antihistamines used to treat respiratory symptoms can get into the brain and interrupt this work, making you feel drowsy.

What can you do about drowsiness from allergy medicines?

Some antihistamines are less likely to cause drowsiness than others. Reactions vary considerably from one person to another. What relieves your symptoms without making you sleepy may be different from what works for someone else.

When you find one that works for you, stick with it – check chemical ingredients and dosages before changing brands or generics. On the other hand, if one doesn’t work for you, try another type.

Does diphenhydramine (Benadryl®) make you sleepy? First-generation antihistamines such as diphenhydramine (Benadryl®) usually cause drowsiness because they are less likely to affect the histamine produced in the brain or have other unwanted effects in the brain. Currently, there is no non-drowsy Benadryl® on the market.

Non-drowsy allergy medicines do exist. Newer, second-generation antihistamines such as cetirizine (Zyrtec®), fexofenadine (Allegra®) and loratadine (Claritin®) – marketed as “nonsedating” – usually cause less drowsiness. An added benefit is that second-generation antihistamines last longer than Benadryl. Allegra is generally the least sedating.

Nasal spray antihistamines are also somewhat less likely to make you sleepy, since they target nasal passages directly rather than sending medicine throughout your body in the bloodstream. These are available only by prescription.

Regular use of an intranasal corticosteroid is not only safe but also an effective way to reduce use of antihistamines. They take a few days to start working, so you need to be patient. Ask your doctor or pharmacist about using an antihistamine with an intranasal corticosteroid the first few days. Some intranasal corticosteroids are available over-the-counter, while others are available as prescription medication.

To avoid daytime drowsiness, take an antihistamine in the evening rather than in the morning. It may help you sleep, with drowsy effects wearing off by the next morning. Be aware that drowsiness can last longer than you might expect – and that some antihistamines can cause vivid dreams.

Don’t drink alcohol when taking antihistamines, as it will increase the sedation.

What about antihistamines in cold and flu medications?

What many people may not know is that cold and flu medicines marketed to treat runny nose and sneezing usually include first-generation antihistamines – the more sedating types. That’s because they are often better at treating cold symptoms and drying up runny nose than the newer types.

Because of their sedating effect, cold medicines with antihistamines are labeled for nighttime use. Take this labeling seriously, as some include medications like doxylamine that are more sedating than others. Check labels for dosages as well, as these may vary, even within brands.

More is not better – read labels carefully and take only as recommended. Don’t supplement a multi-symptom cold medication with another single-ingredient antihistamine.

Be smart, be aware of allergy medication side effects

Smart use of allergy medications – knowing how they treat symptoms of an allergic reaction, being aware of potential unwanted side effects and, most important, monitoring their effect on you and your health – is just one step toward controlling allergy and cold symptoms. Even more important: knowing what you are allergic to and taking steps to prevent or reduce exposure.

If your allergy symptoms tend to last longer than two weeks or are not adequately controlled with over-the-counter medications, schedule an appointment with a board-certified allergist for a full diagnosis.

Antihistamines and intranasal corticosteroids are intended for symptom relief. If antihistamines or intranasal corticosteroids are causing side effects such as drowsiness or other problems, there are other treatment options your doctor can offer for relief from allergic reactions. These options include allergen immunotherapy and non-drowsy allergy medicines like second-generation antihistamines or nasal sprays.

Reviewed by:
Dennis Williams, PharmD, is an Associate Professor at the University of North Carolina Eshelman School of Pharmacy. He practices at UNC Medical Center with the pulmonary medicine medical service. He has served as a member of the National Asthma Education Program Coordinating Committee and the National Asthma Educator Certification Board. He serves on Allergy & Asthma Network’s Board of Directors.

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Product Information

• Adults and children 12 years of age and over:
• Take one 180 mg tablet with water once a day; do not take more than 1 tablet in 24 hours.
• Children under 12 years of age: do not use.
• Adults 65 years of age and older: ask a doctor.
• Consumers with kidney disease: ask a doctor.

 

Do not use if you have ever had an allergic reaction to this product or any of its ingredients.

Ask a doctor before use if you have kidney disease. Your doctor should determine if you need a different dose.

When using this product:

• do not take more than directed
• do not take at the same time as aluminum or magnesium antacids
• do not take with fruit juices (see Directions)

Stop use and ask a doctor if an allergic reaction to this product occurs. Seek medical help right away.

If pregnant or breastfeeding, ask a health professional before use.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center right away.

For 30 count or larger count sizes:

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For 15 count or smaller count sizes:

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Ingredients

Active Ingredients

Fexofenadine HCl 180 mg (in each tablet)

An antihistamine that works to relieve allergy symptoms of sneezing, runny nose, itchy/watery eyes, and itchy nose or throat due to hay fever or other upper respiratory allergies.

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Get tips for managing indoor and outdoor allergies

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What and how to treat allergies?

With various allergic symptoms – runny nose, conjunctivitis, urticaria, etc. – we, of course, resort to the help of antihistamines. But at the same time, we rarely think about their features: for example, to which generation this or that remedy belongs, what side effects it has. And it should.

Determining the diagnosis

Let’s start with what is currently known two generations of antihistamines . The first antihistamines began to be used in the 40-50s of the last century. These drugs initially had a number of serious side effects, which, however, did not prevent them from “gaining popularity” – the work on their creation was even awarded the Nobel Prize! ²
Meanwhile, medicine was advancing. In the 1980s, 2nd generation antihistamines appeared. They acted faster, more efficiently and were deprived of a number of side effects. But, nevertheless, many representatives of first-generation antihistamines continue to be widely used, and this despite the fact that reports of undesirable consequences of their use appeared almost 60 years ago! ¹
To this day, we continue to treat allergies with outdated remedies. Out of ignorance or “out of habit” – it doesn’t matter! Agree, if there are more modern and safe drugs, it is unreasonable to use their less successful predecessors, which can harm the health of you and your children.
Still in doubt? Let’s talk in more detail about the dangers of first-generation antihistamines, what advantages second-generation drugs have over them, and which of their representatives should be remembered.

Diagnosis established

“Search and neutralize” ²
Imagine: an allergen enters the body, an allergic reaction begins, during which histamine is released. By binding to receptors, this substance causes swelling, redness of the skin, bronchospasm, difficulty in nasal breathing, so it is very important to block its action, stop the inflammatory reaction.
Histamine receptors are found in blood vessels, smooth muscles, the heart, tissues of the central nervous system, epithelium, and also in the brain. ⁷ In order to relieve allergy symptoms, it is enough to act on peripheral receptors. However, first-generation antihistamines also block receptors in the brain, resulting in a number of side effects:
– They act on the central nervous system, and therefore cause sedation – drowsiness, inhibition of reactions .
– Their action is not stable and durable, which makes it necessary to use high doses several times a day (up to 4-6 times) of these drugs. ( And this despite the fact that the therapeutic concentration is reached only after 2 hours! ³ ) As a result, when using these drugs, there is a possibility of a whole range of side effects: drowsiness, dizziness, lethargy, impaired coordination, inability to concentrate.
– They do not have selectivity (“targeting” action on histamine receptors), they also block other types of receptors, which can cause tachycardia, dryness of the nasopharynx and oral cavity, urinary retention, constipation, and visual impairment. The condition of bronchial asthma may even be aggravated (sputum viscosity increases) and cardiac arrhythmia may occur as a result of toxic effects on the heart. ¹
– May be addictive, and with prolonged (more than 7-10 days) use, the therapeutic activity of the drug decreases.
It is clear that in diseases such as bronchial asthma, chronic urticaria and perennial allergic rhinitis, requiring long-term use of antihistamines, the use of first-generation drugs is highly undesirable. ²
Mistakes we make ¹
Perhaps the biggest mistake of using 1st generation drugs is that many mothers give these drugs to babies before bed at night, hoping that the sedative effect will contribute to a deeper sleep of the child.
In the course of recent studies of the effect of 1st generation antihistamines on the functioning of the brain, it was proved that they cause unnatural sleep, disrupt the course of sleep phases! ¹ The onset of REM sleep (necessary for memory formation and brain development) is delayed, its duration is reduced. The use of first-generation antihistamines often leads to daytime sleepiness, reduced daytime activity, and impaired brain function, which is especially dangerous when they are used in children.

It has also been proven that 1st generation drugs contribute to a significant decrease in the ability of schoolchildren to learn, impaired concentration and memory.
With the regular use of such funds, cognitive functions (the ability of the brain to perceive and process information) are seriously affected, and therefore there is a threat to the full intellectual development of the child.

A special study was conducted in the UK with 1,834 teenage students taking exams. Among the students were those who suffered from allergic rhinitis. They were divided into two groups – those who were not treated with anything, and those who took first-generation antihistamines. For the former, the probability of “failing” the exam was 40%, for the latter – 70%. ¹
In general, it becomes clear why many developed countries are raising the issue of limiting the use of first-generation antihistamines without a prescription. ²
So, if you see one of the following substances on the package or in the instructions, know that you have a 1st generation antihistamine in your hands: Diphenhydramine, chloropyramine, promethazine, dimethindene, clemastine, mebhydrolin, etc. . ²

New generation chooses… ^2.3
What kind of allergy medications do we, modern people, need? Well, of course, those that:
– act quickly and efficiently;
– in therapeutic doses, they practically do not have a sedative effect;
– work even at a high concentration of histamine in the blood, without harming the body;
– suitable for the treatment of most allergic diseases, including chronic forms;
– practically do not affect the ability of children to learn and concentrate;
– contribute to improving the quality of life against the background of the current allergic disease.
It is these qualities that second-generation antihistamines have. These drugs include cetirizine (Zodak®), levocetirizine (Zodak Express®), and fexofenadine (Allegra).
These drugs can also be taken by children. Zodak® in the form of drops can be used in children from 6 months. ⁴ A Zodak® and Zodak Express® tablets are approved for use from 6 years of age.