Before you jump into this allergy medicine, read this

Heart disease and some allergy medications don’t mix. Here’s your guide to safely stopping seasonal symptoms.

Allergy season can make anyone unhappy with sneezing, coughing, a stuffy nose, and itching and watery eyes. For people with heart problems, getting through allergy season requires extra vigilance.

Just because allergies affect you more than someone without a heart problem doesn’t. In fact, it’s not clear whether allergies make heart disease worse, according to the American Heart Association. Two studies have shown conflicting effects: one in the American Journal of Epidemiology found that the risk of a heart attack increased by 5.5% on days when pollen counts were high, while another Annals of Allergy, Asthma and Immunology found that people diagnosed with allergic rhinitis had a lower risk of coronary heart disease, cerebrovascular disease, and death from all causes.

The reason to be vigilant is that the risk to heart health in allergy season comes from the drugs used to prevent allergies from making you miserable. They can have serious side effects for people with underlying heart conditions, which is why you shouldn’t just take a box of over-the-counter allergy medications and call it a day. Here’s what you need to know to find safe relief.

Stay away from decongestants

When allergies cause a stuffy nose, the first thing many people want to take is a decongestant. However, these drugs should be the number one concern for people with heart disease and high blood pressure, says Paula Miller, MD, director of cardiac rehabilitation and the women’s cardiac program at UNC Medical Center in Chapel Hill, North Carolina. .

Decongestants help relieve congestion in the nasal passages by constricting the blood vessels in the nose and sinuses. “When you constrict the peripheral blood vessels that affect your blood pressure, it increases it,” says Dr. Miller, while increasing your risk of aneurysm, heart attack, and stroke.

That doesn’t mean you should ban decongestants from your allergy relief toolbox if you have heart disease. You just need to be very selective when choosing one. “Decongestants containing pseudoephedrine or phenylephrine may be a problem for some of these patients and cause high blood pressure and rapid heart rate,” says Christian Nageotte, MD, allergist and immunologist at the Henry Ford Health Center in Novi, MID.

Among these two active ingredients, pseudoephedrine, found in Sudafed and similar decongestants, is of greatest concern, as it is a stimulant and something to watch out for if you have heart rhythm problems, such as atrial fibrillation, or if you have high blood pressure. Decongestants can sometimes cause your heart rate to increase slightly, says Dr. Miller. “If you [already] have palpitations, this may make the palpitations a little worse. Nothing bad will happen to you, she said, but the feeling can be overwhelming.

If you have heart problems but high blood pressure isn’t one of them, pseudoephedrine may not affect you as much, says Dr. Miller. “It’s not like you take pseudoephedrine, your blood pressure is going to double or you are going to have a stroke. There’s no real correlation to that, ”she says. “Even people with high blood pressure can use it. They just need to use it sparingly.

As always, consult your doctor before using a decongestant and follow these tips:

  • Pick one with a 24 hour delay. “That way, you don’t get a big burst of pseudoephedrine in your system,” says Dr. Miller.

  • Use it sparingly, for the shortest amount of time, according to label directions. Do not take a decongestant for more than 7 days without consulting your doctor.

  • Monitor your blood pressure using a home cuff while you are taking the decongestant.

In general, however, if you have heart disease or high blood pressure, it’s best to avoid decongestants and try safer alternatives first, says Dr. Miller.

Safer options for decongestants

Antihistamines are one of the oldest drugs used to treat allergic rhinitis, your body’s inflammatory response to allergens. Antihistamines work by blocking histamine, the chemical your body releases when an allergic reaction occurs.

These drugs are considered safe for the heart. “Most heart patients can take antihistamines that do not contain decongestants without a problem,” explains Dr. Nageotte.

Antihistamines come in the form of syrups, eye drops, nasal sprays, and oral tablets. Older antihistamines, such as diphenhydramine, the active ingredient in Benadryl, can make you drowsy or cause physical impairment, which can lead to accidents or injury. It is best to take them before going to bed. Whenever possible, choose antihistamines without drowsiness, says Dr. Miller. These include Zyrtec (cetirizine) and Claritin (loratadine).

Nasal sprays are also on the table

Getting straight to the source of your allergic discomfort can help. This means treating your nasal passages directly with nasal sprays. But some nasal sprays are better than others for people with heart problems, says Dr. Miller. For example, saline nasal sprays are a natural and effective way to cleanse your sinuses of pollen and other allergens. If you’re concerned about the sodium in saline nasal sprays, don’t worry. There isn’t enough sodium to raise blood pressure, says Dr. Miller. “Your system isn’t absorbing a lot of it. “

However, you should use caution when using nasal sprays containing oxymetazoline hydrochloride, the active ingredient in Afrin, Vicks Sinex 12-Hour Nasal Spray, and more, as it can be habit-forming and worsen congestion if used for too long. “It can narrow the capillaries in your nose. So you should only use them for a maximum of three days. Longer than that and you can get a rebound effect and sinus congestion, ”says Dr. Miller. In addition, any restriction in blood flow affects your blood pressure by raising it.

There are non-addictive nasal spray options. Steroid nasal sprays, known as intranasal corticosteroids, such as Flonase and Nasacort, are two of them. “These are available now, over the counter, without a prescription, and they are very, very safe when used as directed. And they are not addictive, ”says Dr. Nageotte. “In addition, these are generally not bioavailable in the bloodstream and would generally not cause any effects in heart patients.”

There are a few exceptions on who should be careful with when using a nasal spray: people taking blood thinners for an arrhythmia or other problem, and anyone prone to nosebleeds. “Any type of nasal spray could cause quite serious nosebleeds in these patients,” explains Dr. Nageotte. “For someone who is already on a blood thinner, a simple nosebleed can become a serious problem.”

Try to prevent allergies in the first place

Avoiding allergens is the key to decreasing symptoms, says Dr. Nageotte, and therefore the need for allergy medication. Try these effective prevention measures to avoid exposure to allergens:

  • Wear a face mask when you are outside. A study published in the Journal of Allergy and Clinical Immunology found that nurses who wore face masks due to COVID-19 had reduced symptoms of allergic rhinitis. “Some form of face covering would reduce exposure to the allergen that is causing your symptoms,” says Dr. Nageotte. “It makes good sense. If there is a filter or barrier between your nose and mouth and the environment, you are going to have fewer symptoms with your allergies.

  • Take a shower before going to bed. It helps to remove pollen and allergens from your body and hair.

  • Stay well hydrated. “You have to keep your body well hydrated to keep the mucus clear and thin,” says Dr. Miller. “Sometimes that doesn’t happen and that’s when you need a decongestant.”

  • Wear glasses or sunglasses outside to prevent pollen from entering your eyes.

  • Keep windows closed on days of high pollen concentrations. Instead, use an air conditioner.

  • Wash hands after petting animals.

  • Use dust mite covers for the mattresses.

  • Use a dehumidifier to control mold in your home.

One more thing to know

Unless your medication label says otherwise, you can take allergy medications along with your heart medications, says Dr. Miller. “They don’t really interact with heart medications on an individual basis.” Be sure to discuss your allergies and how you are treating them with your doctor so that your heart continues to hum unperturbed.

Rita Colorito