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People who are sniffling, sneezing and suffering because of summer allergies are caught in a terrible bind. Some popular antihistamines have the ability to affect the brain in an unpleasant way. In addition to causing drowsiness they may actually do damage when taken for long periods of time. One reader shared this concern:
Q. I recently heard that anticholinergic drugs can cause brain atrophy and may increase the risk for dementia.
What are the alternatives to anticholinergic drugs for the treatment of allergies? I am concerned since I have been using Benadryl and Claritin regularly for five years.
A. A new study shows that people who take anticholinergic (AC) drugs (including the antihistamines you’ve used) may experience changes in brain structure and function (JAMA Neurology, online April 18, 2016).
The researchers found “increased brain atrophy [shrinkage] and dysfunction and clinical decline” associated with the use of AC medications. We worry about this, particularly for older people who may be vulnerable to dementia.
There are a great many prescription and over-the-counter medications that contain ingredients with anticholinergic activity. Sadly, the labels of such medications rarely mention anything about this effect.
What Are Some Danger Signals with Allergy Remedies?
There are several classic symptoms that may tip you off that a medication might have anticholinergic activity. They include:
- Dry mouth, dry nose, dry eyes, dry skin, reduced sweating
- Constipation
- Drowsiness, dizziness, unsteadiness
- Headache, confusion, memory problems, disorientation
- Blurred vision, visual disturbances
- Urination challenges, difficulty emptying bladder
We have searched the medical literature to find anticholinergic drugs. Some are allergy remedies (antihistamines), while others are for treating overactive bladder or high blood pressure. Antidepressant medications can have AC activity as can drugs for diarrhea.
To our surprise, there was no easy-to-find list. Keep in mind that some medications have strong AC activity while others have relatively weak anticholinergic action. The real trouble occurs when someone is taking three of four different medicines that have some degree of AC activity. The end result can be a substantial anticholinergic “burden” as doctors have labeled this. Here is the list that we have compiled. We have no doubt it will keep growing as more medications are added.
Allergy Remedies with Low or No AC Activity:
An alternative antihistamine, fexofenadine (Allegra), is much less likely to have AC activity than Benadryl (European Journal of Pharmacology, Jan. 4, 2005). You may also want to consider a steroid nose spray such as budesonide (Rhinocort), fluticasone (Flonase) or triamcinolone (Nasacort). These products are now available over the counter but we would caution you not to use a corticosteroid nasal spray for long periods of time. Such products can cause nasal irritation, stinging or bleeding. Prolonged use may lead to systemic absorption and steroid complications such as glaucoma or cataracts.
What About Natural Allergy Remedies?
The best solution to allergy misery is to try to avoid the offending allergen. That means avoiding cats if they make your eyes itch or your nose run. Other things that can cause trouble include cleaning agents left on floors. When they dry the chemicals can circulate on dust particles and be inhaled and cause mischief. There are too many potential problems to list them all, but dust mites and pollen are big contributors to congestion and they are hard to avoid.
Vitamin C:
Most doctors pooh-pooh ascorbic acid and we have to admit that research has been surprisingly squishy with this vitamin. That said, there have been some studies suggesting that vitamin C may help reduce allergic symptoms and modulate the immune system. There is even some suggestion that vitamin C has a kind of antihistamine activity. (You can find references to this research in our allergy chapter in Best Choices from The People’s Pharmacy).
Stinging Nettle (Urtica Dioica):
This plant sounds uninviting and indeed if you run into it in the woods you would regret the interaction. Tiny hairs on the plant can cause a nasty rash and an itch that lasts for a very long time.
When it is swallowed in pill form there is some reason to believe nettle can help calm allergic symptoms. One study demonstrated that an Urtica dioica extract blocks the inflammatory pathways that produce allergic symptoms (Phytotherapy Research, July, 2008).
Should you wish to learn more about other ways to control allergic symptoms without experiencing anticholinergic complications, we have a whole chapter on allergy in our book, Best Choices from The People’s Pharmacy. You will also learn about butterbur (Petasities hydrides), NasalCrom (cromylyn sodium) and more details about corticosteroid nasal sprays.
And please don’t forget to check this link with a list of other anticholinergic drugs. Of course sometimes it is impossible to avoid all AC drugs and you will need to share the list of drugs with your physician before stopping any medication.
Ken
USA
H1 antagonists regarding anticholinergic activity, or lack of.
https://www.ncbi.nlm.nih.gov/pubmed/15627436
Tim D
near Seattle in the USA
I think fexofenadine HCL is the pill to take, and Zaditor eye drops (ketotifen) is the eyedrop to take. Neither is a vein constrictor, which might cause NAION, which is damage to the optic nerve. These medications should not cause the harm to the brain that anticholinergic drugs seem to cause.
Elisec
Seattle
I’m all for trying a non-drug remedy first. What about nasal rinsing? This method of cleansing the nasal passages using a saline solution uses no drugs and has been around in Neti pot form for a very long time. It seems to give my spouse relief from seasonal allergies including post nasal drip without the use of drugs with all their potential side effects. Not only that, but the cost of a nasal irrigator and the saline packets (you can use plain salt too) is very affordable compared to any drug.
Wynter
California
I have developed allergies at middle age. I was tested, and most of my allerges I cannot prevent coming into contact with. I have a family history of Alzheimer’s, and all antihistamines knock me flat out, even the non-drowsy variety. I was taking Flonase for years, at the instructions of my doctor, but suddenly they started aggravating my varicose veins. I found whenever I took the steroid, shorly therafter my veins would feel irritated. After seeing the doctor, I learned some people respond that way to steroids. Just Peachy.
I have tried the allergy shots (I was allergic badly to the first one).
I get mild relief from itchiness in the morning from Quercetin Bromelin supplement, but nothing really helps the rhinitis. I’ve tried many of the natural remedies but get zero relief from them.
I’m feeling kind of like I have fallen through the cracks of the medicinal world, since if you can’t take steroids or antihistamines you’re kind of struck.
I’m doing the Nasalcrom right now, but it really doesn’t seem half as effective as steroids.
Jenny
Us
If you haven’t considered it yet- toxic molds have very harmful effects on the immune system. I bought a house that unknowingly had stachybotrys in the attic. I developed all kinds of allergies to many things. It’s taken several years but I am improving. The documentary MOLDY is a great resource if anyone is having health problems that doctors just haven’t been able to figure out.
NANCY
Cleburne, TX
I am surprised you did not mention the OTC drug, NasalCrom (Cromalyn Sodium), as helpful solution to seasonal allergies, in this article. You covered it in your April 11, 2017 issue, and I have started using it, with great results. Have been suffering w a runny nose for months. This product has been a “miracle worker” for me.
NancyM
Kevin
Savannah
I have been using AllerDrops through Dr. Michael Morris for the past two years and it has been completely effective. First, you have blood drawn to find out what you are allergic to, both environmental and foods. The doctor uses that info to formulate a custom solution just for you. You get one vial each month, and you simply put three drops under your tongue each day. The solution is very weak to begin with, getting stronger each month, naturally building up your own immunity to each allergen. The treatment is not covered by insurance yet, but only costs $42 per month. I live in Savannah, GA and the pollen each spring and fall is enormous! Since starting this treatment, I have gone from extreme suffering to completely unaffected. Even when I get covered in pollen while mowing the lawn, (I was very allergic to grasses and some trees, too) I barely sniffle, and then only for a few minutes afterwards. My wife has enjoyed the same results. Some people are cured after a year or two and no longer need the drops. I highly recommend contacting Dr. Morris for more info.
Kevin
I forgot to mention the treatment is available through the mail to anyone. No doctor visits required except to have blood drawn.
Ashley
Illinois
I agree with using allergy drops. My daughter had personality changes with all different kinds of allergy meds and that’s why we choose to try the Allergy drops. They are similar to allergy shots and just as effective, but instead it’s done at home three times a day instead of in the office. Within three weeks I noticed an improvement in my daughter’s allergies. It will be a year this August and she has no symptoms. I cannot be happier. In order for the results to be permanent, we have to do this for three to five years, but I think it’s worth it not to have to take any more meds with side effects. Also, we use a different brand of allergy drops than the above comment, but I’m sure they are just as effective. We use AllergyChoices (you can find a provider on their website). I want to spread the word because there are too many side effects to those other drugs and allergies can be controlled if not cured with drops or even shots if you don’t mind getting them in an office a couple times a week. Good luck to everyone!
Wendy
Gig Harbor, WA
I find this very disturbing. I have been taking antihistamines for decades! I suddenly developed serious allergies when I was in 7th grade. There were a series of conditions that preceded this bout of constant running nose, sneezing and stuffed up nose. It all began with plaque psoriasis that was on my eyelids when I was born that then showed up on my legs with a large patch on my right shin and another just below the left kneecap. I seem to remember that the doctor put me on a sulfa cream in an attempt to curb the spreading of the plaque which seemed to work.
When I was in about 5th or 6th grade the psoriasis started to disappear, but in it’s place I developed boils. I had one on my shin which was very painful. I had another under the nail of the ring finger of my left hand. The doctor had to remove the nail which was a horrible experience.
This one culminated with a serious allergy attack where my nose ran non-stop to start. Of course this happen on the day I had to take a very important test! I had to get permission to go to the rest-room to get more and more tissue to take back to my desk. I have never had an event like that since that fateful day. Thankfully I did well on the test
But, my misery was not over. the runny nose terminated and the sneezing began with itchy eyes. I was miserable. That was when I began my ritual of taking antihistamines. It was approximately 1964. I was 12-yrs old. I am now 65. That is 53 years of taking all different brands of antihistamines on a pretty regular basis. My mother and maternal great grand-mother died with advanced dementia complicated with undiagnosed bi-polar depression and stroke. My father died of Alzheimer’s.
So, to say I am VERY concerned is an understatement now that this information has come out. Do I stop antihistamines cold turkey to stop the process of potential brain damage? This news really is disturbing . . more research need to be done before I feel doomed to not breathing with a runny nose and itching eyes in order to try and save my brain!
Wayne
California
Wayne
One of the best solutions to allergies is Allerphase. It has almost cured me of allergies.
Celeste
The British Medical Journal (BMJ) published a study showing that the extract of the Butterbur plant worked as effectively to prevent allergic rhinitis as Cetirizine (aka Zyrtec) back in 2002. Since it’s become widely available in the past few years, I’ve been taking it instead of Stinging Nettles for my hay fever (making sure to take a remedy that is marked “PA – pyrrolizidine alkaloid – free”), having found it to be even more effective. One word of caution about Butterbur is that it can cause allergic reactions in people who are allergic to ragweed, chrysanthemums, daisies, and marigolds.
In addition, I start taking quercetin about a month before allergy season starts. For itchy eyes, I’ve found great relief with hydrosol of Green Myrtle – I soak a cotton swab in cold water, squeeze out the excess, and spray about 12 squirts of the hydrosol on it, then wipe my eyes. Lastly, I find combination homeopathic remedies for allergies and hay fever to work quite well, too.
Kat
Central Florida
I am basically allergic to Florida, where I live, so have tried everything under the sun to control my allergies (I’m 67). Tried stinging nettle for awhile, but that made things worse for me, so I’m back to saline spray, quercetin, butterbur, pine bark tablets, and Nasacort as a daily regimen to keep my allergies somewhat under control. Everyone is different, so there is no one-size-fits-all approach.
Marlene C.
Mount Dora, FL
I have been an allergy sufferer for decades, but have found SIGNIFICANT RELIEF
by using Olive Leaf Extract nasal spray. All natural and very effective. PLUS no side effects.
Valerie
MI
Which brand do you use? I’d love to give it a try!
Jean
Sacramento, CA
I have been taking Butterbur for two years for spring allergies and it has worked as well as any over-the-counter meds I’ve taken in the past. Butterbur is used throughout Europe for allergies and is reportedly as effective as the common drugs we use in the U.S., but there are absolutely no side effects. I will never go back to taking the usual allergy meds.
Terry Graedon
It’s always a bit risky to assume there are no side effects. That seems to be the case for you (and that is great), but others sometimes have digestive complaints or allergic reactions.
rick
By using antihistamines you are actually inhibiting the ability of your immune system to adapt. At the first sign of an allergic reaction its off to the Doctor to get your child’s prescription for antihistamines or steroids by doing so you in all probability are causing you child a life time of pain and suffering. The obvious is the parent that smokes , rather than stop smoking to remove the stimulus for the allergy they feed their child antihistamines with a little luck the child may adapt but in essence what you are doing is creating an auto immune disease from both the smoke and the toxicity of the medications.
Netra
Frederick, Maryland
My daughter is allergic to just about everything outside & inside. I had her on Flonase, then we tried some other one. She absolutely hated taking it, so I’m recently into the All Natural things now. I seen someone say they use 100% PURE SALINE SPRAY. I grabbed a bottle and tried it on her. When I say she was totally stuffy, she was just breathing thru her mouth. She sprayed the SALINE and it dried her up and cleared her out!!! You can use it up to 8x a day if needed. I’ll never go back to those nasty nose sprays again!!!!
Cindy
CA
Stinging Nettle {I use capsules} works for me. I work outside and am often immersed in pollen. It works for my 101 year old mother-in-law. Her constant post nasal drip has ceased. Her caregiver asked me to get her a bottle because she noticed the improvement.
Stephanie
Colorado
About 30 years ago I had allergies and asthma. I took two stinging Nettles twice per day for three months and my allergies and asthma were gone.
So I made sure I never skipped taking my vitamins/minerals and antioxidants. I still am allergy free at 67 years old.
Jan
Houston ,TX
I take about a tablespoon of Bragg’s apple cider vinegar in 2 oz. of water & then chase it with more water (probably should mix it with more water & just drink the glass of it) after dinner to prevent GERD. As a side effect I don’t have the sinus drainage, constantly clearing my throat & coughing in the morning. ( I was on was on Prilosec & Tagament for years without complete relief, plus Tagamnet gave me diarrhea ) enzymes, fermented vegetables, bone broth, & ACV cured me! If I skip the ACV just one day I have sinus drainage down my throat again, but no GERD.
Luis
You all are obvious cat haters. Meanwhile while spreading your agenda of hating cats, you fail to mention dust mites. What about dogs…or even other humans. I suddenly lost respect for you all.
HelenM
Modesto
Luis, I am a cat lover and the truth is that cats have dander that can trigger allergic reactions. Yet these same people can have dogs without a problem. For cat lovers that cannot exist without serving one of these beasties, a cat without fur, hopefully then without dander, has been developed. However, for me, the fur is a large part of my love for my babies. Luckily, considering I have five rescue cats, and live in a heavily sprayed area, I do not have allergies. However, because of the spraying as mentioned by Rick, several times recently, and more so by my husband, I take several forms of choline, trying to keep my mild cognitive impairment from getting worse.
Susan
GA
I am wondering about quercetin as an alternative to anticholinergic drugs?
Deanna
NC
I don’t have severe respiratory allergies. However, I have a skin allergy to taking showers, I end up itching all over for about 15-30 minutes. 20 years ago, my doctor recommended quercetin. I take it every morning and it prevents the itching. It might also be the reason I don’t have respiratory allergies.