Drugs & Supplements


Asthma

Today, there are many effective medicines to treat asthma. Most people with asthma need two kinds.

Quick-relief medicines — taken at the first sign of any asthma symptoms for immediate relief:

  • Short-acting inhaled beta2-agonists
  • Anticholinergics

Your doctor also may recommend you use these medicines before exercise for treatment of asthma. Quick-relief medicines can stop asthma symptoms, but they do not control airway inflammation that causes the symptoms. If you find that you need your quick-relief medicine to treat asthma symptoms more than twice a week, or two or more nights a month, then your asthma is not well controlled. Be sure to tell you doctor.

Long-term control medicines — taken every day to prevent symptoms and attacks:

  • Antileukotrienes or leukotriene modifiers
  • Cromolyn sodium and nedocromil
  • Inhaled corticosteroids
  • Long-acting inhaled beta2-agonists (never taken alone)
  • Methylxanthines
  • Oral corticosteroids
  • Immunomodulators

These medicines are taken every day even if you do not have symptoms. The most effective long-term control medicines reduce airway inflammation and help improve asthma control.

Your doctor will work with you to find the right medicine, or combination of medicines, to manage your asthma, and will adjust the type and amount based on your symptoms and control. The goal of asthma treatment is to have you feel your best with the least amount of medicine.

New HFA Inhalers

Your allergist can help you in many ways. The doctor can:

  • talk with you about which inhaler is the best for you. Right now, there are four to choose from.
  • make sure you are using your inhaler correctly and discuss whether a holding chamber – a device that holds the medicine and allows you to inhale slowly – might help.
  • review ways to help with the HFA inhaler’s cost.
  • update your treatment plan, and discuss your goals and how to reach them.
  • help you learn how to keep track of symptoms and make decisions about how much medicine to take.
  • make sure your asthma or COPD is being well managed and you aren’t using your quick-relief medicine too often to control your symptoms.

When you get a prescription for the new HFA inhaler, talk with your allergist about how you are feeling and make sure your disease is under control.

You should also talk with your allergist about when to use your inhaler. If you have asthma, take your quick-relief medicine at the first sign of symptoms. Your doctor may want you to use these medicines before exercise.

While it’s important to have a quick-relief inhaler, it isn’t something you should need to use all the time. If you have asthma and use your quick-relief inhaler to treat symptoms more than twice a week during the day, or two or more nights a month, then your asthma is not well controlled. Be sure to talk with your doctor.

There are many choices for the treatment of asthma including inhaled corticosteroids, other types of bronchodilators, other medications, and allergen immunotherapy. Together, you and your allergist can successfully control asthma.

Why You Should Consider Allergy Shots for Asthma

If you cannot avoid an allergic asthma trigger and you have asthma symptoms three days a week and more than two nights a month, you should consider allergy shots. Also known as immunotherapy, the shots are especially helpful when symptoms occur year-round or are not easily controlled by medicine.
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Allergies

When you cannot avoid allergens, there are many medicines that can help control allergy symptoms. Decongestants and antihistamines are the most common allergy medications. They help to reduce a stuffy nose, runny nose, sneezing and itching. Other medications work by preventing the release of the chemicals that cause allergic reactions. Corticosteroids are effective in treating inflammation in your nose.

An allergist will work with you to determine which medicines are best for you and how often and how much of them you should take—while eliminating or minimizing any side effects.

Allergy Shots

Allergy shots (immunotherapy) are sometimes recommended if you cannot avoid the allergen and your symptoms are hard to control. Allergy shots keep your body from over-reacting to the allergen. You will get regular injections of the allergen. Each dose is slightly larger than the last dose until a maximum dose is reached. These shots do not work for everybody and you will have to visit the doctor often.

Corticosteroids

Anti-inflammatory medications (corticosteroids) are available in many forms, including:

  • Creams and ointment for the skin
  • Eye drops
  • Nasal spray
  • Lung inhaler

Patients with severe allergic symptoms may be prescribed corticosteroid pills or injections for short periods of time.

Antihistamines

Antihistamines are available over-the-counter and by prescription. They are available in many forms, including:

  • Capsules and pills
  • Eye drops
  • Injection
  • Liquid
  • Nasal spray
Decongestants

Decongestants can help relieve a stuffy nose. Do not use decongestant nasal spray for more than several days, because they can cause a "rebound" effect and make the congestion worse. Decongestants in pill form do not cause this problem. People with high blood pressure, heart problems, or prostate enlargement should use decongestants with caution.

Other Medicines

Leukotriene inhibitors are medicines that block the substances that trigger allergies. Zafirlukast (Accolate) and montelukast (Singulair) are approved for people with asthma and indoor and outdoor allergies.
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COPD

Doctors use several basic groups of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed:

  • Bronchodilators. These medications — which usually come in an inhaler — relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day, or both.
  • Inhaled steroids. Inhaled corticosteroid medications can reduce airway inflammation and help you breathe better. But prolonged use of these medications can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes. They're usually reserved for people with moderate or severe COPD.
  • Antibiotics. Respiratory infections — such as acute bronchitis, pneumonia and influenza — can aggravate COPD symptoms. Antibiotics can help fight bacterial infections, but are recommended only when necessary.
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Chronic Cough

Determining the cause of chronic cough is crucial to effective treatment. In some cases, more than one underlying condition may be causing your chronic cough.

Medications used to treat chronic cough may include:

  • Antihistamines and decongestants. These drugs are standard treatment for allergies and postnasal drip.
  • Inhaled asthma drugs. The most effective treatments for asthma-related cough are inhaled medications that reduce inflammation and widen your airways.
  • Antibiotics. If a bacterial infection is causing your chronic cough, antibiotics will be prescribed.
  • Acid blockers. When lifestyle changes don't take care of acid reflux, you may be treated with medications that block acid production.
  • Cough suppressants. If the reason for your cough can't be determined, your doctor may prescribe a cough suppressant, especially if your cough is interfering with your sleep.

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Alpha-1 Antitrypsin Deficiency (AAT)

The most important health intervention for a person with alpha1-antitrypsin (AAT) deficiency is avoiding cigarette smoking. Smoking clearly advances the progression of emphysema in severely deficient individuals by as much as 15 years over their nonsmoking counterparts.

Airflow obstruction and symptoms resulting from alpha1-antitrypsin deficiency can be treated in a manner similar to emphysema. Bronchodilators may provide relief of some symptoms. Use antibiotics to treat bacterial complications, including pneumonia or purulent bronchitis. Neither bronchodilators nor antibiotics demonstrate any effect on disease progression. Likewise, corticosteroids may provide some short-term relief, but they have no proven long-term benefit in inhaled or oral preparations. Because of their long-term adverse effects, avoid oral steroids.

Prescribing oxygen may be a viable option if patients are hypoxemic at rest, with activity, or during sleep.

Replacement (or augmentation) therapy to slow the progression of emphysema may need to be considered. At present, IV augmentation therapy is the only FDA-approved treatment specific for alpha1-antitrypsin deficiency. It is most clearly indicated for patients with moderate degrees of airflow obstruction (FEV1 35-65% of predicted). Three preparations are available. Although purifications and/or preparations differ, all are equivalent, and none have been a cause of hepatitis or HIV infection. Each is approved at the same dose and administration, ie, 60 mg/kg/wk given IV.
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Primary Immune Deficiency

Treatments for primary immunodeficiency involve preventing and treating infections, boosting the immune system and treating the underlying cause of the immune problem. In some cases, primary immune disorders are linked to a serious illness, such as an autoimmune disorder or cancer, which also needs to be treated.

Managing infections
  • Antibiotics. Infections are typically treated with antibiotics. In cases where infections don't respond to standard medications, hospitalization and treatment with intravenous (IV) antibiotics may be necessary. Some people need to take antibiotics long term to prevent infections from occurring and to prevent permanent damage to the lungs and ears.
  • Treating symptoms. You may need medications to relieve symptoms caused by infections, such as ibuprofen for pain and fever, decongestants for sinus congestion, and expectorants to help clear

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Sinusitis

Treatments to relieve symptoms

Your doctor may recommend treatments to help relieve sinusitis symptoms. These include:

  • Saline nasal spray, which you spray into your nose several times a day to rinse your nasal passages.
  • Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flonase), budesonide (Rhinocort Aqua), triamcinolone (Nasacort AQ), mometasone (Nasonex) and beclomethasone (Beconase AQ).
  • Oral or injected corticosteroids. These medications are used to relieve inflammation from severe sinusitis, especially if you also have nasal polyps. Examples include prednisone and methylprednisolone. Oral corticosteroids can cause serious side effects when used long term, so they're used only to treat severe asthma symptoms.
  • Decongestants. These medications are available in over-the-counter (OTC) and prescription liquids, tablets and nasal sprays. Examples of OTC oral decongestants include Sudafed and Actifed. An example of an OTC nasal spray is oxymetazoline (Afrin). These medications are generally taken for a few days at most; otherwise they can cause the return of more severe congestion (rebound congestion).
  • Over-the-counter pain relievers such as aspirin, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). Because of the risk of Reye's syndrome — a potentially life-threatening illness — never give aspirin to anyone younger than age 18.
  • Aspirin desensitization treatment if you have reactions to aspirin that cause sinusitis. However, this treatment can have serious complications such as intestinal bleeding or severe asthma attacks.
Antibiotics

Antibiotics are sometimes necessary for sinusitis if you have a bacterial infection. However, chronic sinusitis is usually caused by something other than bacteria, so antibiotics usually won't help.

Antibiotics used to treat chronic sinusitis caused by a bacterial infection include amoxicillin (Amoxil, others), doxycycline (Doryx, Monodox, others) or the combination drug trimethoprim-sulfamethoxazole (Bactrim, Septra, others). If the infection doesn't subside or if the sinusitis comes back, your doctor may try a different antibiotic.

If your doctor does prescribe antibiotics, it's critical to take the entire course of medication. Generally, this means you'll need to take them for 10 to 14 days or even longer — even after your symptoms get better. If you stop taking them early, your symptoms may come back.

Immunotherapy

If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens may help treat the condition.
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Recurring Ear Infection

Antibiotic therapy

Your doctor may recommend antibiotic treatment for an ear infection in the following situations:

  • Children under 6 months old with a probable diagnosis of ear infection
  • Children 6 months to 2 years old with a certain diagnosis of ear infection
  • Anyone with a probable ear infection and moderate to severe ear pain
  • Anyone with a probable ear infection and a fever over 102.2 F (39 C) or higher

Even after symptoms have improved, be sure to use all of the antibiotic pills as directed. Failing to do so can result in recurring infection and resistance of bacteria to antibiotic medications. Talk to your doctor or pharmacist about what to do if you accidentally skip a dose.

Treating pain

Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:

  • A warm compress. Placing a warm, moist washcloth over the affected ear may lessen pain.
  • Pain medication. Your doctor may advise the use of over-the-counter acetaminophen (Tylenol, others) or ibuprofen (Motrin, Advil, others) to relieve pain. Use the drugs as directed on the label. Because aspirin has been linked with Reye's syndrome, use caution when giving aspirin to children or teenagers. Although aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.
  • Eardrops. Prescription eardrops such as antipyrine-benzocaine (Aurodex) may provide additional pain relief. To administer drops to your child, warm the bottle by placing it in warm water. Put the recommended dose in your child's ear while he or she lies on a flat surface with the infected ear facing up. Benzocaine has been linked to a rare but serious, sometimes deadly, condition that decreases the amount of oxygen that the blood can carry. Don't use benzocaine in children younger than age 2 without supervision from a health care professional, as this age group has been the most affected. If you're an adult, never use more than the recommended dose of benzocaine and consider talking with your doctor.

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Migraines

A variety of drugs have been specifically designed to treat migraines. In addition, some drugs commonly used to treat other conditions also may help relieve or prevent migraines. Medications used to combat migraines fall into two broad categories:

  • Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun.
  • Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines.
Pain-relieving medications

For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine. It may help if you rest or sleep in a dark room after taking them:

  • Pain relievers. These medications, such as ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) may help relieve mild migraines. Drugs marketed specifically for migraines, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraine pain but aren't effective alone for severe migraines. If taken too often or for long periods of time, these medications can lead to ulcers, gastrointestinal bleeding and rebound headaches. The prescription pain reliever indomethacin may help thwart a migraine headache and is available in suppository form, which may be helpful if you're nauseous.
  • Triptans. For many people with migraine attacks, triptans are the drug of choice. They are effective in relieving the pain, nausea, and sensitivity to light and sound that are associated with migraines. Medications include sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), zolmitriptan (Zomig), frovatriptan (Frova) and eletriptan (Relpax). Side effects of triptans include nausea, dizziness and muscle weakness. They aren't recommended for people at risk for strokes and heart attacks. A single-tablet combination of sumatriptan and naproxen sodium (Treximet) has proved more effective in relieving migraine symptoms than either medication on its own.
  • Ergot. Ergotamine and caffeine combination drugs (Migergot, Cafergot) are much less expensive, but also less effective, than triptans. They seem most effective in those whose pain lasts for more than 48 hours. Dihydroergotamine (D.H.E. 45, Migranal) is an ergot derivative that is more effective and has fewer side effects than ergotamine. It's also available as a nasal spray and in injection form.
  • Anti-nausea medications. Because migraines are often accompanied by nausea, with or without vomiting, medication for nausea is appropriate and is usually combined with other medications. Frequently prescribed medications are metoclopramide (Reglan) or prochlorperazine (Compro).
  • Opiates. Medications containing narcotics, particularly codeine, are sometimes used to treat migraine headache pain when people can't take triptans or ergot. Narcotics are habit-forming and are usually used only as a last resort.
  • Dexamethasone. This corticosteroid may be used in conjunction with other medication to improve pain relief. Because of the risk of steroid toxicity, dexamethasone should not be used frequently.
Preventive medications

In most cases, preventive medications don't eliminate headaches completely, and some cause serious side effects. If you have had good results from preventive medicine and have been migraine-free for six months to a year, your doctor may recommend tapering off the medication to see if your migraines return without it.

For best results, take these medications as your doctor recommends:

  • Cardiovascular drugs. Beta blockers — commonly used to treat high blood pressure and coronary artery disease — can reduce the frequency and severity of migraines. The beta blocker propranolol (Inderal La, Innopran XL, others) has proved effective for preventing migraines. Calcium channel blockers, another class of cardiovascular drugs, especially verapamil (Calan, Verelan, others), also may be helpful in preventing migraines and relieving symptoms from aura. In addition, the antihypertensive medication lisinopril (Zestril) has been found useful in reducing the length and severity of migraines. Researchers don't understand exactly why these cardiovascular drugs prevent migraine attacks. Side effects can include dizziness, drowsiness or lightheadedness.
  • Antidepressants. Certain antidepressants are good at helping to prevent some types of headaches, including migraines. Tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil) are often prescribed for migraine prevention. Tricyclic antidepressants may reduce migraine headaches by affecting the level of serotonin and other brain chemicals, though amitriptyline is the only one proved to be effective for migraine headaches. You don't have to have depression to benefit from these drugs. Other classes of antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) haven't been proved as effective for migraine headache prevention. However, preliminary research suggests that one SNRI, venlafaxine (Effexor, Venlafaxine HCL), may be helpful in preventing migraines.
  • Anti-seizure drugs. Some anti-seizure drugs, such as valproate (Depacon), topiramate (Topamax) and gabapentin (Neurontin), seem to reduce the frequency of migraines. Lamotrigine (Lamictal) may be helpful if you have migraines with aura. In high doses, however, these anti-seizure drugs may cause side effects, such as nausea and vomiting, diarrhea, cramps, hair loss, and dizziness.
  • Cyproheptadine. This antihistamine specifically affects serotonin activity. Doctors sometimes give it to children as a preventive measure.
  • Botulinum toxin type A (Botox). The FDA has approved botulinum toxin type A for treatment of chronic migraine headaches in adults. During this procedure, injections are made in muscles of the forehead and neck. When this is effective, the treatment typically needs to be repeated every 12 weeks.

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Uncontrolled Itching

Dermatitis treatment varies, depending on the cause. Using corticosteroid creams, applying wet compresses and avoiding irritants are the cornerstones of most dermatitis treatment plans. To minimize side effects, such as thin skin, and to increase effectiveness, topical corticosteroids are generally used only short term until rashes are under control.

For some types of dermatitis, nonsteroidal medications may help relieve signs and symptoms. And for all types of dermatitis, occasional use of over-the-counter oral antihistamines can reduce itching.

Contact Dermatitis

Treatment consists primarily of identifying the cause of the rash and then avoiding it.

Treatment options include:

  • Creams containing hydrocortisone
  • Other, stronger steroidal creams
  • Cool, wet compresses on the affected area
Neurodermatitis

Getting you to stop scratching and to avoid further aggravating your skin are the treatment objectives.

Treatment options include:

  • Covering the affected area to prevent you from scratching it
  • Hydrocortisone and similar lotions and creams
  • Wet compresses
  • In some cases, antidepressants or anti-anxiety medications

In addition, counseling can help you learn how your emotions and behaviors can fuel — or prevent — itching and scratching.

Seborrheic dermatitis

Medicated shampoos are usually the first treatment choice.

Treatment options include:

  • Warm mineral or olive oil to remove scales
  • Shampoos that contain tar, salicylic acid or ketoconazole as the active ingredient
  • Topical hydrocortisone creams and lotions
Stasis dermatitis

Treatment consists of correcting the condition that causes fluid to accumulate in your legs or ankles for extended periods.

Treatment options include:

  • Wearing elastic support hose
  • Having varicose vein surgery
  • Using wet dressings to soften the thickened yet fragile skin and to control infection
Atopic dermatitis

In addition to relieving redness and itching, treatments for this condition are aimed at healing infection-prone cracks in your skin.

Treatment options include:

  • Hydrocortisone-containing lotions
  • Wet dressings with mildly astringent properties
  • Immunosuppressant topical medications, such as tacrolimus (Protopic) and pimecrolimus (Elidel)

In addition, light therapy, which involves exposing your skin to controlled amounts of natural or artificial light, may be used to help prevent recurrences of atopic dermatitis.

Perioral dermatitis

In general, doctors try to avoid treating this condition with strong corticosteroids. When these potent medications are stopped, perioral dermatitis may return and even worsen.

Treatment options include:

  • The oral antibiotic tetracycline, sometimes taken for several months
  • A mild corticosteroid cream

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Contact Dermatitis (Poison Ivy/Oak/Sumac)

  • Avoiding the irritant or allergen. The key to avoidance involves identifying what's causing your symptoms and then eliminating your exposure to the culprit. It may take two to four weeks for your skin reaction to clear up.
  • Applying anti-itch creams or wet compresses. In mild to moderate cases, self-care measures, such as using over-the-counter creams containing hydrocortisone or applying wet dressings, can help relieve redness and itching. If over-the-counter steroid creams don't relieve your symptoms, your doctor may prescribe a higher-strength cream.
  • Using oral medications. In severe cases, your doctor may prescribe oral corticosteroids to reduce inflammation, or recommend antihistamines to relieve intense itching.

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Skin Rashes

Most rashes are not dangerous to a person or people in the vicinity (unless they are part of an infectious disease such as chickenpox). Many rashes last a while and get better on their own. It is therefore not unreasonable to treat symptoms like itchy and/or dry skin for a few days to see whether the condition gets milder and goes away.

Nonprescription (over-the-counter) remedies include

  • Anti-itch creams containing camphor, menthol, pramoxine (Itch-X, Sarna Sensitive), or diphenhydramine (Benadryl);
  • Antihistamines like diphenhydramine, chlorpheniramine (Chlor-Trimeton), or loratadine (Claritin, Claritin RediTabs, Alavert); and cetirizine (Zyrtec);
  • Moisturizing lotions.

If these measures do not help, or if the rash persists or becomes more widespread, a consultation with a general physician or dermatologist is advisable.

There are many, many other types of rashes that we have not covered in this article. So, it is especially important, if you have any questions about the cause or treatment of a rash, to contact your doctor. This article, as the title indicates, is just an introduction to common skin rashes.
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Urticaria (Chronic Hives)

Oral antihistamines

These medications block the symptom-producing release of histamine, controlling symptoms for the majority of people with chronic hives — but they do not treat the underlying cause of the rash. Antihistamines are divided into two categories — older, first-generation drugs and newer, second-generation medications. Each category includes nonprescription and prescription drugs. A combination of antihistamines may work best.

Second-generation, newer antihistamines. Your doctor may have you start with newer, nonsedating or low-sedating antihistamines because they are generally as effective and better tolerated than first-generation antihistamines. Examples include:

  • Loratadine (Claritin, Alavert)
  • Fexofenadine (Allegra)
  • Cetirizine (Zyrtec)
  • Levocetirizine (Xyzal)
  • Desloratadine (Clarinex)

First-generation, older antihistamines. If a nonsedating antihistamine doesn't work, your doctor may recommend taking a first-generation antihistamine. These antihistamines can make you drowsy and impair your ability to drive or perform other tasks that require physical coordination. For that reason, your doctor may recommend that you take this type of antihistamine before bedtime and switch to a second-generation drug during the daytime. This class of antihistamines includes:

  • Hydroxyzine (Vistaril)
  • Diphenhydramine (Benadryl)
  • Chlorpheniramine (Chlor-Trimeton)

Check with your doctor before taking any of these medications if you're pregnant or breast-feeding, have a chronic medical condition, or are taking any other medications.

Other medications

If antihistamines alone don't relieve your symptoms, other possible treatments include:

  • H-2 antagonists. These medications, such as cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid) and famotidine (Pepcid AC), can be used along with antihistamines. Some common side effects from this class of medications range from gastrointestinal problems to headache.
  • Oral corticosteroids. Oral corticosteroids, such as prednisone, can help lessen swelling, redness and itching — but are usually used only a short term for severe hives or angioedema because they can cause serious side effects. Topical corticosteroids usually aren't effective for chronic hives. Corticosteroids can weaken your immune system, making it easier for you to get an infection or worsening an existing infection you already have.
  • Tricyclic antidepressants. The tricyclic antidepressant doxepin (Zonalon) has antihistamine properties and can help relieve itching. Doxepin may cause dizziness or drowsiness.

Other medications are still being studied to determine whether they may be useful for treating chronic hives. These include:

  • Leukotriene modifiers. Montelukast (Singulair) and zafirlukast (Accolate) are asthma medications that may be helpful when used along with antihistamines. Side effects of these drugs may include behavior and mood changes.
  • Cyclosporine. This immune system suppressant can help with symptoms, but it can cause serious side effects and needs to be monitored carefully. The Food and Drug Administration warns that taking cyclosporine (Gengraf, Neoral, others) puts you at greater risk of opportunistic infections, such as the activation of a previous infection.

Omalizumab (Xolair). This medication is normally given by injection to treat allergic asthma. It may help people who have chronic hives caused by an autoimmune response that haven't been helped by antihistamines. Only very small studies have been completed, so more clinical trials are needed.
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Angioedema

Antihistamines

Antihistamines are divided into older, first-generation drugs and newer, second-generation medications based on their chemistry and associated side effects. Each category includes nonprescription and prescription drugs.

Second-generation, newer antihistamines. Doctors generally recommend starting treatment with these newer, second-generation drugs. For most people, these drugs are less likely to cause drowsiness or reduce your reaction time while you're driving or performing other mentally or physically demanding tasks.

Nonprescription second-generation antihistamines include:

  • Loratadine (Claritin, Alavert)
  • Cetirizine (Zyrtec)

Prescription second-generation antihistamines include:

  • Desloratadine (Clarinex)
  • Fexofenadine (Allegra)
  • Levocetirizine (Xyzal)

First-generation, older antihistamines. These medications tend to make you drowsy and respond more slowly than usual while driving or performing other tasks requiring physical coordination. In addition, they may cause dry mouth, blurred or double vision, constipation or difficulty passing urine. But they may be more helpful than second-generation antihistamines for some people with hives or angioedema, especially if your symptoms are severe or involve significant swelling of your face, tongue or throat. They may also be helpful taken at bedtime if your symptoms disturb your sleep.

Nonprescription first-generation antihistamines include:

  • Diphenhydramine (Benadryl, others)
  • Chlorpheniramine (Chlor-Trimeton, others)

Prescription first-generation antihistamines include:

  • Hydroxyzine (Vistaril)
Treatment for hereditary angioedema

Antihistamines and oral corticosteroid medications — although useful in treating hives and acute angioedema — are often ineffective in treating hereditary angioedema. Medications used to treat hereditary angioedema on a long-term basis include certain androgens (male hormones), such as danazol, that help regulate levels of blood proteins.

The Food and Drug Administration (FDA) has also approved certain treatments targeting specific blood proteins that function abnormally in hereditary angioedema. These medications include:

  • Cinryze and Berinert, two treatments derived from donated human blood plasma. Both drugs provide C1 esterase inhibitor, a blood protein that's inadequate or defective in hereditary angioedema. Cinryze is approved as a therapy to prevent hereditary angioedema attacks in adults and adolescents. It's taken as an injection by vein every few days and can be self-administered after training by a health professional. Berinert is approved to treat acute hereditary angioedema attacks affecting the face and abdomen while the attacks are under way. Berinert also is taken as an injection by vein, but it must be given by a health professional.
  • Ecallantide (Kalbitor) is a protein derived from yeast. It blocks the activity of a blood protein called kallikrein, which is involved in hereditary angioedema. It's approved for adolescents and adults as a treatment to counter the effects of acute hereditary angioedema attacks on all body areas. Ecallantide is taken as an injection under the skin (subcutaneous) that must be given by a health care professional.
Emergency situations

For a severe attack of hives or angioedema, you may need a trip to the emergency room and an emergency injection of adrenaline (epinephrine). If you have had a serious attack or your attacks recur, despite treatment, your doctor may prescribe — and instruct you how to use — adrenaline to carry with you for use in emergency situations.
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Insect Allergies (Bee Sting)

Epinephrine autoinjector

If you're allergic to bee stings, your doctor will likely prescribe an emergency epinephrine autoinjector (EpiPen, Twinject). You'll need to carry it with you at all times. An autoinjector is a combined syringe and concealed needle that injects a single dose of medication when pressed against your thigh. Always be sure to replace epinephrine before its expiration date, or it may not work properly.

Be sure you know how to use the autoinjector. Also, make sure the people closest to you know how to administer the drug — if they're with you in an anaphylactic emergency, they could save your life. Medical personnel called in to respond to a severe anaphylactic reaction also may give you an epinephrine injection or another medication.

You might also consider wearing an alert bracelet that identifies your allergy to bee or other insect stings.

Allergy shots

Bee and other insect stings are a common cause of anaphylaxis. If you've had a serious reaction to a bee sting or you've been swarmed by bees, your doctor will likely refer you to an allergy specialist (allergist) for allergy shots (immunotherapy). These shots are generally given on a regular basis for a few years and can reduce or completely eliminate your allergic response to bee venom.
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