Hay fever
- Thread starter dr_john
- Start date
I get by usually with Cetirizine but sometimes this isn't enough! Today is one of those days 
Also as someone said above the Zed is usually a bit of a safe haven for me being a coupe with always at every service a new filter!
Wondered if the Prof knew of what the next steps should be with someone who has cold urticaria as my other half has started with in the last two years to become very affected by this and all anti histimine medication given (ranitidine) is proving not to work.
Thanks in advance although I realise not strictly hayfever.
Also as someone said above the Zed is usually a bit of a safe haven for me being a coupe with always at every service a new filter!
Wondered if the Prof knew of what the next steps should be with someone who has cold urticaria as my other half has started with in the last two years to become very affected by this and all anti histimine medication given (ranitidine) is proving not to work.
Thanks in advance although I realise not strictly hayfever.
Mad Professor
Active member
AlfaScozzesi said:I get by usually with Cetirizine but sometimes this isn't enough! Today is one of those days
Also as someone said above the Zed is usually a bit of a safe haven for me being a coupe with always at every service a new filter!
Wondered if the Prof knew of what the next steps should be with someone who has cold urticaria as my other half has started with in the last two years to become very affected by this and all anti histimine medication given (ranitidine) is proving not to work.
Thanks in advance although I realise not strictly hayfever.
So for urticaria the next step is a higher dose of oral fexfenadine ie 180mg twice daily and then add in oral montelukast 10mg daily - low dose tricyclic antidepressants like amitriptyline or doxepin sometimes works especially at night as they also have sedative effects .
Failing that we're talking stepping up to the S54 variant of therapy like anti-IgE [xolair] injections monthly which are highly effective but hideously expensive ,so really last resort -i would suggest you get her referred to a dermatologist for a proper opinion in the first instance .
Mad Professor said:AlfaScozzesi said:I get by usually with Cetirizine but sometimes this isn't enough! Today is one of those days
Also as someone said above the Zed is usually a bit of a safe haven for me being a coupe with always at every service a new filter!
Wondered if the Prof knew of what the next steps should be with someone who has cold urticaria as my other half has started with in the last two years to become very affected by this and all anti histimine medication given (ranitidine) is proving not to work.
Thanks in advance although I realise not strictly hayfever.
So for urticaria the next step is a higher dose of oral fexfenadine ie 180mg twice daily and then add in oral montelukast 10mg daily - low dose tricyclic antidepressants like amitriptyline or doxepin sometimes works especially at night as they also have sedative effects .
Failing that we're talking stepping up to the S54 variant of therapy like anti-IgE [xolair] injections monthly which are highly effective but hideously expensive ,so really last resort -i would suggest you get her referred to a dermatologist for a proper opinion in the first instance .
Thanks for this prof (bet nobody thought your were a real prof before this
)Above and beyond
Mad Professor
Active member
Benadryl is acrivastine a sedative old school short duration 1st gen oral antihistamine -ie an antiallergy drug -think of that if you will as being like a 1600 xflow -not even a flowed /ported xflow with cast iron pistons and crank and no verniers .Benadryl plus also has a decongestant oral pseudoephedrine which shrinks the blood vessels in the nasal mucosa -not a good idea to take on a regular basis as like nasal otrivine spray you rapidly become tolerant to it and then also develop rebound worsening of congestion .Also if you have high blood pressure taking pseudoephedrine isnt a smart idea as it will put up your blood pressure by constricting blood vessels eslewhere -not something i would ever use . Think of oral pseudoephedrine as an SU carb rather than multipoint fuel injection if you will .Molinites said:
So the reason that benadryl plus works for you is clearly the decongenstant -that ok to take occasionally for relief but not on a regualr basis IMHO .The equivalent nasal spray would be otrivine which works on the same alpha1 receptor as psueodephedrine to constrict the blood vessels in the nose .However if you take otrivine on its own on a regular basis after a few days you develope the same tolerance and rebound as you get with pseudoehedrine -this is becasue the body is clever and rapidly adapts by reducing the number of available alpha receptors .
However what our published research has shown is that if you take the otrivine with a nasal steroid spray like beclometasone [Beconase ] it mitigates the tolerance as it has synergistic effect on the alpha 1 receptor . So the equivalent for you would be to take otrivine spray 1 squirt first ,wait 5-10 min for the decongenstant effect to kick in and then follow that by taking the Beconase spray as a chaser -but only take the combination once a day -that could be increased to 2 squirts of each once daily if required .That would ok to take on a regular basis -although i usually tell my patients to stop the otrivine after 1-2 weeks and then continue on the Beconase alone -ie it takes that long for the beconase to fully kick in .
Hope that helps
Mad Professor
Active member
NickDE said:Mad Professor said:
It's a shame we are talking about hayfever, and not engine modifications. Just imagine a N52 fitted with twin turbinates and steroid injection
v funny
Thank you so much for your advice, explanation and time, as put beautifully by another - above and beyond. I have tried Boots own pseudoephedrine and Beconase Nasal Spray without the success of Benadryl Plus, I will definitely try Otrivine and Beconase and follow your advice. Thanks
I used to live out in the middle of nowhere surrounded by trees and fields. Some years my hay fever was that bad that my eyes used to puff up like I'd been in 5 rounds with Mike Tyson.
From May to July I was pretty much house bound which for a 10 - 16 year old was pretty depressing.
One year I was prescribed kenalog - had the injection at the start of May and didn't have a sniff for the rest of the year,
Probably had this 4 / 5 years on the trot until the NHS stopped using it. Only option after that was to go private.
I think (from reading the web) some people still have it but it does come with warnings.
From May to July I was pretty much house bound which for a 10 - 16 year old was pretty depressing.
One year I was prescribed kenalog - had the injection at the start of May and didn't have a sniff for the rest of the year,
Probably had this 4 / 5 years on the trot until the NHS stopped using it. Only option after that was to go private.
I think (from reading the web) some people still have it but it does come with warnings.
Mad Professor
Active member
Its not a good idea to get Kenalog -intramuscular slow release depot steroid -triamcinolone acetonideDPG said:
You may as well be taking oral steroid tablets [ie oral prednisolone] as taking Kenalog
While i might in occcasional very severe cases prescribe a short 1 -2 week course of oral prednisolone during peak pollen season eg for people doing exams -kenalog is not something i like to use because the side effects are unnacceptable cf safer modern treatments for hay fever -ie i have never had to resort to this .Its what my fathers generation when he was a GP used to use when they didn't have any other effective options and knew no better -now we do . Long term adverse effects include: adrenal suppression ,osteoporosis ,cataracts ,glaucoma ,hypertension ,muscle wasting,skin thinning ,diabetes ,weight gain ,raised cholesterol .Thats why I never use it . If you were going private then whoever prescribed it for you would i presume have warned you about these potential side effects .
