Second generation antihistamines are highly selective for the H1 receptor. They do not cross the blood brain barrier or bind to cholinergic receptors, therefore they do not produce sedating or anticholinergic side effects (dry mouth, dry eyes, etc). Another advantage of the second-generation antihistamines is once or twice daily dosing, rather than every four to six hours, as with diphenhydramine. Some of the second generation antihistamines are available by prescription only; however, loratidine (Claritin and Ala-vert) and cetirizine (Zyrtec) are available over the counter.

Mast cell stabilizer

Intranasal cromolyn (Nasalcrom) is indicated for the prevention and treatment of rhinorrhea, nasal itching and sneezing due to allergies. The recommended dose is one spray in each nostril 3-to- 4 times daily. The maximum effectiveness of this product may not be seen for one to two weeks after initiation of therapy. Whenever possible, patients should start cromolyn prior to exposure to allergens. Adverse effects include sneezing, nasal stinging, irritation and burning.

Decongestants

Decongestants, approved for the treatment of nasal and sinus congestion, stimulate alpha-adrenergic receptors in smooth muscle resulting in constriction of the blood vessels within the nasal sinuses. Available products include both oral and intranasal formulations. Oral products, such as phenylephrine and pseudoephedrine, act indirectly and generally have a longer duration of action but slower onset. Intranasal dosage forms, including phenylephrine, nap-hazoline, tetrahydrozoline, oxymetazoline and xylometazoline, have direct action on alpha-adrenergic receptors and are often preferred to minimize systemic side effects. The use of intranasal formulations should be limited to three consecutive days to avoid rebound congestion. If extended use is necessary, some clinicians recommend cycling three days on and three days off therapy.

Patients commonly experience central nervous system (CNS) and cardiovascular side effects with oral agents. Although this

is also possible with nasal formulations, it typically only occurs with higher doses. CNS stimulation may cause insomnia, dizziness, anxiety, tremors and agitation. Cardiac effects can include elevation in blood pressure, rapid heart rate and palpitations. They should be used with caution in patients with a history of arrhythmias, coronary heart disease or hypertension. They should also be used with caution in patients with hyperthyroidism, glaucoma, diabetes or prostatic hypertrophy. Decongestants should not be used in patients who are taking tricyclic antidepressants or monoamine oxidase inhibitors, as they may • be put at risk for hypertensive crisis.

Under the Combat Methamphetamine Epidemic Act of 2005, controls were put into place for the sale and purchase of medications containing pseudoephedrine. The intent is to limit the sale of large quantities of the ingredient that are necessary for illegal manufacturing of methamphetamine. All nonliquid formulations of pseudoephedrine must be sold in blister packs or unit-dose packets or pouches. The act limits the amount of • pseudoephedrine a patient can purchase to 3. 6 grams in a single day and 9 grams in a month at a retail store. These products must be stored such that customers do not have direct access before the sale is made. Products may be displayed behind the pharmacy counter or in a locked cabinet that is located in an area to which customers have direct access. These new regulations require the patient to show a government- • issued photo identification, such as a driver’s license, and to sign a logbook. The store is mandated to keep a record of purchases of these products, including the product name, quantity sold, the name and address of purchaser, and the date and time of the sale for at least two years.

these medications not be used to treat infants and children under 2 years of age due to the risk of life-threatening side effects.

A review of the information pertaining to the safety of these agents in children ages 2 to 11 years is still under review. Until this review is complete, the FDA has made the following recommendations for parents:

• Check the “active ingredient” section of the DRUG FACTS label in order to better understand what ingredients are in the product and what symptom each ingredient is intended to treat.

Be careful giving more than one OTC cough-and-cold medicine to a child. Many OTC cough-and-cold medicines have more than one “active ingredient.” If two medicines have the same or similar ingredients, a child could get too much of an ingredient which may harm the child.

• Carefully follow the directions in the DRUG FACTS part of the label on how much medicine to give and how often to give it.

Only use the measuring spoons or cups that come with the medicine or those made specifically for measuring medications. Do not use common household spoons to measure medicines for children because household spoons come in different sizes.

• Choose OTC cough-and-cold medicines with childproof safety caps and store medicines out of the reach of children. Understand that OTC cough-and-cold medicines are intended only to treat symptoms. They do not cure the illness or shorten the length of time the child is sick.

• These medications should not be used to make the child sleepy.

The Food and Drug Administration has raised questions about the safety of OTC cough-and-cold product use in children. In particular, the FDA is concerned whether the benefits justify the potential risks associated with these medications, especially in children under 2 years of age. After a thorough review, the FDA has recommended that

Not all patients who complain of a runny or stuffy nose with rhinorrhea are suffering from an allergic reaction. However, for patients who are suffering from an allergy, there are many OTC options that may help them feel better. Patients who have questions or whose symptoms have not improved with treatment, should be referred to the pharmacist for counseling.