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I read Dr. Mitchell's blog faithfully. It helps me find tips on how to prevent my asthma symptoms, and get information on the latest developments in treatment.

Over-the-Counter Allergy Medications: What you Need to Know

The majority of allergy medications are now available without a prescription. over-the-counter allergy medicationsThis is obviously a good thing if you are an allergy suffer, as you do not have to see your doctor to get a prescription for a simple treatment.

However, you should be careful. Over-the-counter medications can be tricky if you don’t know all of the benefits or risks of using them.

This is where I come in. I am going to educate you on the best over-the-counter medication for your spring allergies.

Oral Antihistamines


Benedryl (which has the generic name diphenhydramine) is the best known oral antihistamine. It has been around the longest and is the most widely used, but it shouldn’t be!

Benedryl may be beneficial for an acute allergic reaction to a food, but as a chronic medication it has too many drawbacks.

Benedryl is a short-acting antihistamine, so it’s protection is limited to a few hours. The other well-known adverse reaction is that it crosses into the brain, and makes users tired. Pharmaceutical companies have taken advantage of this drawback by adding diphenhydramine to pain medications, like Tylenol PM or Advil PM, in their nighttime formulas.

A Better Choice

A much better choice of oral antihistamines are the newer products: Claritin (loratidine ), Allegra (fenofexadine) and Zyrtec (cetirizine). These antihistamines act for a much longer period of time, varying from 24 hours to 3 days with just one pill.

These antihistamines tend to be much less sedating than the older antihistamines and with few drug interactions or side-effects.

Advantages of Oral Antihistamines

There are advantages to taking an oral antihistamine for allergic symptoms such as sneezing, runny nose and eye itching.

These medications can block each one of these reactions and are easy to administer. There is no difficult technique involved in taking these types of antihistamines, which include eye drops or nose sprays.

Therefore, you would probably think these antihistamines are the perfect anti-allergy medication. However, in reality they are good, but not great!

Topical Medications

female using allergy nasal sprayFor the tougher allergy symptoms, such as severe nasal congestion, red eyes and throat itching, topical medications trump the oral antihistamines.

By administering the topical solution to the nose and/or eye, the tissue gets an immediate and deeper absorption of medicine to block the allergic reaction.


My patients continually talk about their confusion when choosing over-the-counter nasal sprays. Many are aware of Afrin but are afraid to use it. They have heard it is addictive – and they are right!

Afrin is not a good medication to use to treat nasal allergies on a long-term basis. It does not block allergic inflammation, and you can get a rebound effect where after you stop using it you become even more congested, hence the addictive quality to it.


Additionally, many patients are aware that nasal sprays can contain cortisone and have concerns around whether it is dangerous. Cortisone nasal sprays, such as Flonase (fluticasone) or Nasacort are steroid sprays that are available over-the-counter. They can work wonderfully in relieving symptoms within an hour and last for a full day.

These nasal sprays tend to be very safe, since they mainly work locally in the nasal tissue without significant absorption by the rest of the body. This avoids concern of a drug-drug interaction, which can happen with an oral antihistamine. However, like with all nasal sprays I tell my patients that technique is very important, so important that you are using them in the right way.

The Importance of Technique 

When using nasal sprays, it is essential that you have the right technique. You should aim the spray to the side of the nose, not to the middle! If you aim to the middle of your nose you can irritate your nasal septum or, in the worst case scenario, perforate or make a hole in the septum. If you have been using a cortisone nasal spray for over a month, I would advise checking with your doctor to see if have been using the right technique.

using eye drops Ophthalmic Eye Drops

Ophthalmic eye drops are an excellent way to relieve severe eye itching and redness. There are many different types, and of course some are good and some are bad.

The Bad

The over-the-counter Visine is a bad choice. The decongestant in the Visine may “Get the Red Out” as they advertise in the commercials, but like Afrin it can be addicting and cause more long-term problems.

The only antihistamine eye drops available are older version type antihistamines and I do not recommend them!

The Good

There are many good prescription antihistamine eye drops such as Patanol, Pataday, Elestat and Optivar. Be sure to check with your doctor to see which one would be best for you. Also, check with your insurance coverage. Many of these eye drops can be very expensive, so make sure you are covered.

Why Do You Need An Allergist?

At this point you may be wondering: ” Who needs an allergist when all of these over-the-counter medications are available?” I thought about this question long and hard, and surprisingly there are still many allergy sufferers who need my help.

One important service I provide to my patients is allergy desensitization or immunotherapy. I have treated thousands of patients effectively with sublingual drops to environmental allergens, like tree and grass pollen, cats and dogs and dust and mold.

Sublingual allergy immunotherapy, is a natural way to get lasting protection against airborne allergens. The only key factor is that a patient has to build up high levels several months before the beginning of their allergy season.

The snow is finally melting here in New York, so we are all braced to go out an enjoy the warmth and green of spring. If allergies slow you down, consider these medications available at your local pharmacy. If they paralyze your golf game or jogging, consider sublingual allergy drops – beating allergies has never been easier!

You can read more about how I use sublingual drops to treat my patients in my book: Dr. Dean Mitchell’s Allergy and Asthma Solution.

Allergy Testing Training for Physicians: Basics Part 1

I (Dr. Dean) am currently involved in expanding allergy training to physicians all over the United States. It is exciting to teach a mix of family physicians, pediatricians, internists and other specialists on how to utilize allergy testing in their own practices. doctor allergy testing skin

When assessing allergic patients, in addition to a good history, there are two options available: allergy skin tests or allergy blood tests. When performed and interpreted properly, these are two very sensitive and specific tests. As a board certified allergist, I use both of these types of testing in my practice to make an accurate allergic diagnosis.

Allergy Skin Testing

Allergy skin testing has never been more simple or safe. When I originally trained in my allergy fellowship 25 years ago, we were trained to do intradermal skin tests.

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Cold Urticaria And Cold Allergy: Not A Joke!

I’ve often joked around with my patients during this brutally cold northeast winter that “I’m allergic to the cold!” The dark, cold winter days are tough can be hard to get through both mentally and physically. However, I don’t want to belittle the existence of cold allergy, because it does really exist!
Cold Written on frost

Cold Urticaria

The medical term, cold urticaria, refers to the condition where a patient that is exposed to cold air or water develops hives (urticarial) and even swelling (angioedema).

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Sublingual Allergy Drops Training for Physicians: Expert Advice from an Allergist with Experience

It’s been over one hundred years and now (finally!) the field of allergy has a new form of immunotherapy to desensitize patients to environmental allergens. Welcome to the treatment of sublingual allergy drops.

Sublingual Immunotherapy Training 1

Sublingual Allergy Drops

Dr. Dean has been practicing sublingual immunotherapy for 16 years. He wrote about his experience, how he learned about this relatively new treatment and how it transformed his medical practice in his book, Dr. Dean Mitchell’s Allergy and Asthma Solution (De Capo, 2006).

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The Sinus Headache Mistake: Migraine or Sinus Headache?

“Sinus Headaches”: One of the true mysteries of clinical medicine

Patients regularly come into our offices complaining of pain in the area around their eyes. This pain usually also circles around their forehead and, without fail, these patients always ask for antibiotics to make the pain go away. However, all too often antibiotics are prescribed for sinus headaches that are not caused by a sinus infection. It is for this reason that we make sure we always carry out a careful history check when treating patients who complain of a sinus headache. This may all sound a little confusing, but let us explain.

Sinus headache

True Sinus Infections

The main symptom of a true bacterial sinus infection tends to be pressure over a particular sinus area: this can commonly take place over the cheeks or sometimes behind the bridge of the nose, close to the eyes. A true sinus infection is usually preceded by symptoms such as a low-grade fever and the subsequent development of mucus discharge. This discharge can be filled with various colors ranging from white, yellow or green pus.

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Latex Allergy: A Potentially Dangerous Allergen

Latex allergy is an allergy the medical world has been aware of for many years.

Latex is a natural rubber and latex products are primarily made from the rubber tree Hevea brasiliensis. Latex Rubber AllergyLatex is commonly thought of as being a contact allergen, which causes rashes (see our previous post on Allergic Rashes), however it can also have more serious health implications.

The Serious Side Of Latex Allergy

In the 1990’s a more serious symptom of latex allergy emerged. Dr. Dennis Ownby, at Henry Ford Hospital, had several cases of patients who went into anaphylaxis (allergic shock) after exposure to latex medical products. Several of the cases occurred after patients were having GI (gastrointestinal) tests for intestinal problems.

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Allergic Rashes From Products We Touch In Our Daily Lives

Allergy RashesAllergic Rashes and Everyday Products

Allergic rashes are often caused by products we use on a daily basis. When a medical professional identifies a chemical allergy we call it contact dermatitis because contact with the chemical often causes an allergic reaction in the form of a skin rash.

The list of contact allergens a person can get from having contact with substances range in the thousands since so many of today’s products are filled with preservatives and oils. However, only about two dozen of these are the main contact allergens that effect patients. As an allergy specialist, I can easily test these specific allergens using a special tape (no needles necessary!) to determine if a contact allergen is the cause of a person’s rash.

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Allergic Eczema: Treatment That Goes More Than Skin Deep

Winter SkinAllergic Eczema Skin Treatment

Winter can be an eczema sufferer’s worst nightmare. The harsh weather that hits most of the country can cause our skin to become dry and chafed, and patients that suffer from eczema are especially at risk for skin flares. In the past, typical treatments have relied on lathering on sticky creams to try to relieve the symptoms. However, this may not be enough. What we have learned through treating eczema patients is that for the best results you need to go deeper than just treating the skin. Our approach involves balancing out the immune system to stop the inflammation from reeking havoc on the surface of the skin.

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Chronic Cough Relief: Treating the Cause Can Lead to the Cure

chronic-cough-curesA noisy, chronic cough is not only uncomfortable, it’s unbearable for those around you such as family and co-workers.

We mostly tend to think of a cough related to an infection, which would respond to an antibiotic.  In many cases, this is erroneous thinking. It is easy to fall into this trap whether you are a patient or a physician. But I’ve learned in my over 20 years of practice to be especially careful in evaluating a chronic cough because there are so many underlying causes that can be at the root of the problem.

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Winter Sinus Pain: Do’s and Don’t’s for Sinus Relief!

woman-blowing-her-nose-in-cold-weatherIt’s hard not to see a million television ads for sinus, cold and flu relief on a daily basis. The winter seems to be a time when the nose takes the blows!

The reason is that the nasal tissue and sinuses play an important role in helping our respiratory system accommodate to the  brutally cold weather in most parts of the country. The dry air quality, and the fact that we spend most of our days indoors doesn’t help either. The most important thing you can do to protect yourself from sinus pain and other problems is maintaining good sinus hygiene and avoiding medications which can make the problem worse.

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Common Allergies NYC Allergy Doctor

New York Office
57 West 57th St, Suite 601,
NYC NY 10019
Call: 212.397.0157

Rockville Center Office
165 North Village
Avenue, Suite #129
Rockville Centre, NY 11570
Call: 516.678.9600

Allergy Relief
Over-the-Counter Allergy Medications: What you Need to Know

The majority of allergy medications are now available without a prescription. This is obviously a good thing if you are an allergy suffer, as you […]

Allergy Testing Training for Physicians: Basics Part 1

I (Dr. Dean) am currently involved in expanding allergy training to physicians all over the United States. It is exciting to teach a mix of […]

Read all articles
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