Spring allergies are here! How to treat them best

Adapted from Dr. Roy’s blog post

Ah, spring. Birds are tweeting, the flowers are blooming, there’s a layer of yellow dust all over my car, and just about everyone is sneezing and stuffy. Fortunately, there are some great medicines out there to help reduce the symptoms of spring allergies, and most of them are inexpensive and over-the-counter. Here’s an updated guide to help you pick the medicines that are best to relieve your family’s suffering.

But first: before medications, remember non-medical approaches. People with allergies should shower and wash hair after being outside (though it’s not practical or good to just stay inside all spring!) You can also use nasal saline washes to help reduce pollen exposures.

Antihistamines are very effective for sneezing, drippy noses, and itchy noses and eyes. The old standard is Benadryl (diphenhydramine), which works well—but it’s sedating and only lasts six hours. It’s better to use a more-modern, less-sedating antihistamine like Zyrtec (cetirizine), Claritin (loratidine), or Allergra (fexofenidine.) All of these are OTC and have cheap generics. They work taken as-needed, or can be taken every day. Antihistamines don’t relieve congested or stuffy noses—for those symptoms, a nasal steroid spray (see below) is far superior.

There are a just a few differences between the modern OTC antihistamines. All are FDA approved down to age 2, though we sometimes use them in younger children. They all come in syrups, pills, or melty-tabs. Zyrtec is the most sedating of the three (though far less than Benadryl). Zyrtec and Claritin are once a day, while Allegra, for children, has to be taken twice a day. A 2017 study showed that Zyrtec is marginally more effective than Claritin, so I’ve been recommending that one first.

Decongestants work, too, but only for a few days—they will lose their punch quickly if taken regularly. Still, for use here and there on the worst days, they can help. The best of the bunch is old-fashioned pseudoephedrine (often sold as generics or brand-name Sudafed), available OTC but hidden behind the counter. Don’t buy the OTC stuff on the shelf (phenylephrine), which isn’t absorbed well. Ask the pharmacist to give you the good stuff hidden in back.

Nasal Steroid Sprays include a huge and dizzying array of choices now. OTC Nasacort, Flonase, Rhinocort, Clarispray, Sensimist, and many generics are available. Many of the brands contain the identical ingredient, sold under different names for marketing purposes. All of these products are essentially the same. They all work really well, especially for congestion or stuffiness (which antihistamines do not treat.) They can be used as needed, but work even better if used regularly every single day for allergy season.

Some minor distinctions: Nasacort is approved down to age 2, Flonase to 4, and Rhinocort to 6, though there’s no reason to think any are more or less safe for children. Flonase is scented (kind of an odd, flowery scent, which seems weird in an allergy medicine), and seems to be a little more burny to some people than the others. My personal favorite is Nasacort.

Nasal oxymetazolone (brands like Afrin) are best avoided. Sure, they work—they actually work great—but after just a few days your nose will become addicted, and you’ll need more frequent squirts to get through the day. Just say no. Steroid nasal sprays are much safer than OTC Afrin.

Eye allergy medications include the oral antihistamines, above; and the topical nasal spray steroids can help with eye symptoms, too. But if you really want to help allergic eyes, go with an eye drop. The best of the OTCs is Zaditor.

Bottom line: for mild eye or nose symptoms, a simple oral antihistamine is probably the best first line. For more severe symptoms OR symptoms dominated by clogging and stuffiness, use a steroid nasal spray. You can also use both, in combination, an antihistamine PLUS a steroid spray, for really problematic symptoms. Please come see us if you have any other questions, or if these tips aren’t helping.

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Help Dr. Roy & Son fight childhood cancer

In a few weeks, my son Daniel and I will be getting out heads shaved — a silly stunt, yes, but it helps draw attention to childhood cancer. We’ve actually made great strides in the treatment of cancer in children, but more research dollars are needed. The St. Baldrick’s charity helps raise money to support the fight! If you’d like to contribute, please visit our team page. Believe me, both of us really need a haircut, and the fight against childhood cancer could use your help!

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Send your doc or our staff a message via the portal

Our portal is “open for business” 24/7 — so if you’ve got a question, you can send it in anytime! Watch this short video to see how.

Portal messages sent to staff are typically answered the next business day. You can also send a message directly to any of our doctors — but keep in mind that every doctor doesn’t work every day, so messages like these won’t typically be seen until the next day your doctor is in the office. Portal messages are for routine questions and followups, not for time-sensitive or urgent matters.

We also use portal messages like these to send you routine, normal lab results. You’ll get a notification any time there’s a portal message or response waiting for you.

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It’s easy to schedule an appointment online via our portal

It’s now easier than ever to schedule your appointment via the portal! Here’s a video demonstration. Portal scheduling is most useful for ordinary sick visits within the next few days, quick nurse visits for vaccines, or well check ups for children 11 and under (currently you can’t schedule well checks for older children on the portal, but we’re working on that!)

If you can’t find a slot that fits your needs, or you think the appointment needs extra time or is complicated for any reason, please give us a call. It’s also best to call if you need an appointment quick, within a few hours — in that case, we can sometimes shift things around to fit you in. As always, when you call there’s no phone tree, and it’s easy to get a receptionist on the line to help with appointment scheduling or anything else!

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Elderberry extract for colds and flu

Wow — we’re getting dozens of questions about elderberry and elderberry extracts to help treat cold and flu symptoms. It is “the thing” flying around Facebook! Should you try it? Here’s what we know:

  • There are zero studies of any elderberry product to help with cold or flu symptoms in children.
  • There is one small study, from 2004, of elderberry for adults with flu. It showed a very strong positive effect. But the study was funded by a company that makes and sells elderberry syrup, and it was never repeated.
  • Elderberry products seem to be quite safe. I suppose as with anything there’s a risk of allergic reactions, but in ordinary amounts I don’t think these elderberry products are likely to cause any harm.
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