Best medications for really bad allergies.

Allergies & Medications

• QUESTION: Hi Gene, Progressively over the last 3 years my mental health (depression & anxiety) seems to be declining as well as an increase in allergies.  I am a 31 year old female. I have chronic swollen turbinates and post-nasal drip w/ sore throat and swollen glands in throat.  I never have the typical sneezing, itchy eyes and throat.  Mine always feels like significant sinus pressure.  Last year the only time I felt decent was during the winter.  Assuming that my allergies could be playing some role in the mental health arena, my psychiatrist sent me for allergy testing. Results: mild allergy to cats (I have 3 indoor, 1 which is fairly new to our home), mild allergy to cockroaches, bermuda grass, timothy grass & dust mites.  I live in the Southern US. My psychiatrist currently has me on Lexapro, Wellbutrin XL, Lamictal and then Klonopin low dose as needed.  I've been taking Claritin 12 hour reditabs and my ENT started allergy shots about 6 weeks ago.  I swear my allergies have been worse and intensifying since beginning the shots but he tells me it doesn't work like that??  Well if not, could any of the medications I'm taking cause an increase in upper respiratory symptoms? I'm miserable, and have been off and on for the last 3 years.  I'm grasping at straws, just wanting to feel better. ANSWER: Wendy... Whew! For having gone through so much, you have given me a remarkably concise summary of you history. Just one thing is missing, and that is you phychiatric diagnosis for these medications, and additionally the extent and nature of your seizures. This is not a medication regimen for simple 'chronic sinusitis' depression. There are particular attachments to side effects that could add to your symptoms. We need to see which came first, the chicken or the egg. Can you add a little backround here. I can see why you are reacting, and I acknowledge the ability of chronic sinusitis to add to chronic fatigue and depression. Help me with a little additional information before we dig in. Cheers, Gene ---------- FOLLOW-UP ---------- QUESTION: Sure!  I do not have seizures.  The Lamictal was just added about 2 weeks ago when my psychiatrist decided he thinks instead of depression that isn't responding, I have Bipolar II. I didn't have any difficulties with these so-called allergies or the severe depression/fatigue prior to my OBGYN telling me to discontinue the Lexapro prior to trying to conceive our second child.  Once I got off the Lexapro, nothing has been the same since.  (Not even sure if this is relevant).  But this happened 3 years ago.  Due to the problems I've had since, we have put off trying to conceive. I was on Lexapro for years for both anxiety and depression, both manageable and not causing problems in my life as long as I took the SSRI.  Then once I got back on it, it never seemed to work right again and it seemed that over about a year I was spiraling into a deeper depression.  But my anxiety was also increasing.  My OBYGN tried Wellbutrin XL instead of Lexapro but that wasn't a good fit alone.  So back to the Lexapro since I felt "okay" on it.  While I was on the Wellbutrin XL that time I had to visit an allergist because I was absolutely miserable with upper respiratory symptoms, but I was told there was no connection to the medication.  In hindsight, when the WBXL was discontinued my URI symptoms resolved.  Could have been coincidental and relevant to the time of year - late summer or early fall.  It took a Medrol Dose Pak and I was good to go. In March of this year, I had an out of the blue panic attack(s) that seemed to last for weeks.  My depression & anxiety hit an all-time high.  My psychiatrist has been working with me since this incident trying to find a combination of medications that will help, and so far I haven't responded well.  Xanax first which wasn't much help and then Klonopin. The Lexapro was increased to 20mg, and after no good response Wellbutrin XL 150 was added.  I will feel okay for a couple of weeks and then plummit into a depresson again.  This last time is when he dx. the Bipolar II after he thinks I was hypomanic prior to this last depression. I hope this information helps in some way.  I'm so confused at this point from lack of help and information from my doctors that I'm not even sure what pieces of information are relevant or not.  I've worried about my health so much over the past two years that I've gone from 155 lbs to 118 lbs.  I just want to feel better but I do not know which direction to turn since I'm not exactly sure what is going on or if one thing might be causing the other.  Thanks! ANSWER: Wendy... I can be relevant on all issues (allergies/environment/immunology), but cannot make accurate suggestions regarding clinical evaluations, or issues of Dr/Patient phychiatric treatments. I'm sure that you can understand these reasons. Both the Lamictal and the Wellbutrin can cause a good deal of rhinitis. I'm not sure that these contributed symptoms can be addressed. They are just a biproduct. When these tissues become dry and irritated they are suseptible to irritation and response to outside allergens, dust etc. We can look at this with reference to your indoor surroundings also. (Your home description: carpeting, drapes, plants, lighting fixtures, HVAC system, etc). There is a good deal of history here for you. Ask specific questions about your rhinitis and we'll go from there. Cheers, Gene ---------- FOLLOW-UP ---------- QUESTION: Of course I understand. :-)  If this is medication related, what are the best ways to keep the tissues moist?  I assume that keeping the tissues moist will help with the response to allergens?  Even if it isn't medication related, what can I do in my home to assist in keeping the tissues moist?  Would a vaporizer or humidifier be of benefit? Our home is just over 2000 sq ft. I'd say atleast half of the house is carpeted. I understand from my ENT that carpet is bad, but when we purchased this home in 2009 we replaced all of the carpet so it wouldn't be cost efficient to rip it up and replace it just yet.  I do not have any drapes.  No indoor plants due to our inside cats.  Lighting fixtures...I'm not exactly sure what you mean but the bedrooms and main living room have lighted ceiling fans.  My husband has installed compact fluorescent bulbs in all fixtures.  I'm no expert in describing my HVAC system...ha.  All I know is that we have central heat & air...the heat is gas.

• Answer:

  Yes, there are two things I would recommend that may be of help. The first is a product called Nasonex. It is a prescription nasal steroid (topical only) that reduces inflammation in the nares. This product is used twice daily. The second is an over the counter product called Ocean (Normal Saline nasal douche. You can use this product three times daily to 'wash' your sinuses if you are reacting to allergens. Most important before bed and when arising in the am. I have found the combination of these two medications very effective. Evaluate at least two to three weeks before you make evaluations as to their effectiveness. The Nasonex requires that much time (and twice daily use) to see results. If you live in the South, I don't need to warn you about the use of humidifiers (all negative), and you already probably have adequate humidity. Try them and we can go from there. If you are already using Nasonex, then let me know. Cheers, Gene PS...Two additional comments re: your home/illness. Comment on Can Lights is environmental. Can lights are notorious for letting the air between the attic and home exchange/mix. This can be very problematic for those who suffer allergies when this exchange is in the master BR. I always suggest sealing or removing can lights in the bedrooms. The use of a quality HEPA filter on your side of the bed may be of help. There are only two brands I recommend. IQ Air and Austin. You can check them out on the web.