How Allergy Medications Affect Older Adults

Diphenhydramine is also part of a class of medications known as anticholinergics, which, in studies, have been linked to dementia. Researchers have found that longer-term use of anticholinergics — which block acetylcholine, a chemical messenger in the brain involved in learning and memory — is associated with roughly a 50 percent greater risk for dementia in adults.

It’s important to know that diphenhydramine is found in a number of combination medications that relieve allergy and cold-like symptoms (Sudafed PE Sinus Congestion Day + Night and Theraflu Nighttime Severe Cold & Cough, for example), so be sure to read the label carefully when shopping for relief.

Decongestants: Stuffy nose? Beware of decongestant pills, including phenylephrine (which the Food and Drug Administration determined is an ineffective ingredient when taken orally) and pseudoephedrine, which are often found in products such as Sudafed. This is especially true if you have high blood pressure or cardiovascular disease.

“Any decongestant will raise blood pressure, possibly causing an increase in heart arrhythmias,” says Dr. Kevin McGrath, an allergist in Wethersfield, Connecticut. People with glaucoma or hyperthyroidism should also avoid decongestants, according to the Mayo Clinic.

Taken too late in the day, decongestants can make it difficult to fall asleep. They can also lead to nervousness and a jittery or shaky feeling, McGrath says.

Combination medications: While usually found in cold medicines, phenylephrine and pseudoephedrine are also in some allergy products.

“Something I tell people to try to avoid in general are these multisymptom combination pills for allergies or colds that contain a lot of different ingredients,” Gilliam emphasizes.

Take, for instance, Claritin versus Claritin-D.

“Claritin-D is going to have a decongestant, pseudoephedrine, in it, which certainly has much more risk in older adults,” Gilliam says. “That can raise blood pressure, can raise heart rate.” Other combination medications to generally avoid include Zyrtec-D and Allegra-D.

“For the right person who is using it cautiously and with the doctor’s guidance, it can be helpful to reduce congestion,” she says. “But it certainly has those other side effects” — including raising blood pressure.

For these reasons, Gilliam generally advises buying single-ingredient medications. “Make sure you know what you’re taking,” she stresses. “Because there are just so many products, including multi-ingredient products, out there.”

Decongestant nasal sprays such as oxymetazoline (Afrin) or  phenylephrine, which is effective as a nasal spray, don’t carry the same risks as their pill counterparts, but you should limit their use, as they can cause rebound congestion or persistent stuffiness if used too often.  

Allergy medications to take instead

Nasal steroid sprays: These are the first-line treatment for people with seasonal allergies, and studies show they can be even more effective than oral antihistamines. Three that McGrath recommends are Nasacort (triamcinolone), Rhinocort (budesonide) and Flonase (fluticasone), which are all now available without a prescription as over-the-counter products.

To maximize effectiveness, use them correctly: Be sure to spray slightly toward the outside of the nostril.

“Use the right hand to spray up the left nostril and the left hand to spray up the right nostril,” McGrath says. “You do not want to spray into the middle of your nose, the septum, as this causes increased risk of nosebleeds and irritation.”

Certain over-the-counter oral antihistamines: If a nasal steroid spray isn’t enough, you can pair it with an over-the-counter antihistamine.

“The best choice for patients in general — and especially for seniors — is Allegra [fexofenadine],” McGrath says.

Side effects can include headache, indigestion, back pain, nausea and dry mouth, but this second-generation antihistamine avoids many of the issues seen with older antihistamines.

“Allegra has been shown not to cause sedation, memory problems or other issues associated with other antihistamines,” McGrath notes. “Also, Allegra has not been shown statistically to affect blood pressure unless patients are taking Allegra-D, which has the decongestant in it.”

If you don’t have Allegra on hand, McGrath suggests Xyzal (levocetirizine), which he says is less sedating than other brands.

“It is also more effective than Zyrtec [cetirizine] at half the dose,” he adds. “However, Zyrtec and Xyzal do penetrate the blood-brain barrier [and] can cause side effects such as sedation, memory loss and fatigue. Less so with Xyzal than Zyrtec.”

For those taking Claritin (loratadine), reported side effects can include headache, drowsiness that’s usually mild, dry mouth, fatigue and gastrointestinal issues such as nausea or diarrhea.

“Claritin is one of the least-effective second-generation antihistamines for adults,” McGrath says. “There are some rare patients that do very well with it.”

Allergy immunotherapy: These are regular injections over a period of time — generally three to five years — to prevent or reduce allergy attacks. Each allergy shot contains a minuscule amount of what you’re allergic to, to stimulate your immune system.

Over time, your doctor increases the dose of allergens in each shot to help get your body used to the allergens so that your symptoms diminish. While it’s normally thought of as a treatment for kids, it can be extremely effective in older adults too.

In fact, a study published in the Annals of Allergy, Asthma & Immunology found that immunotherapy reduced symptoms by 55 percent in adults ages 65 to 75 after three years of therapy and decreased the amount of medication patients needed to take by almost two-thirds.

Nondrug treatments: McGrath also recommends nondrug treatments, such as a nasal saline rinse or neti pot, to help flush allergens and irritants from your nose. (Use them before you spritz a nasal steroid spray to get the best effect.)

If you use a neti pot, remember to use distilled water, not tap water (unless you boil it first), to avoid the risk of a dangerous parasitic infection that can spread into the nose and possibly the brain.

Remember, too, that lifestyle steps can help. Keep windows closed during high-pollen periods and run the air conditioner in your home or car instead. If you spend time outside, remove your clothes when you come in and shower to rinse pollen from your skin and hair.

McGrath also recommends air purifiers with HEPA filters for areas where you spend a lot of time, like your bedroom or living room. These seem like small steps, but they may keep your symptoms at bay enough that you can avoid medication.

Drugs that can trigger asthma and allergy-like symptoms

Unfortunately, certain medications you may take to control other conditions, such as high blood pressure, can make asthma symptoms worse or trigger allergy-like symptoms in some people. These include:

Beta-blockers: Drugs such as labetalol or propranolol are often used to treat high blood pressure, heart disease and migraine. But they can also trigger asthma symptoms in people with asthma. Your doctor may elect to try a beta-blocker that is more selective for the heart than lungs and doesn’t worsen your respiratory symptoms.

ACE inhibitors: Drugs like lisinopril and enalapril, which are used for high blood pressure or heart disease, can cause a cough — including wheezing — in about 10 percent of patients, studies show. This usually resolves once you stop the medication, McGrath says. If you notice this symptom, talk to your doctor. You may be able to switch to a different class of medication.

NSAIDs: Over-the-counter pain relievers such as ibuprofen and naproxen can trigger symptoms in some people with asthma. Talk to your doctor if you are concerned; acetaminophen may be a better option.