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Ask the doctor: My hay fever symptoms have gone through the roof after stopping my antihistamine. Is it withdrawal?

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Many people can suffer withdrawl symptoms if they suddenly stop the long term use of an antihistamine

Many people can suffer withdrawl symptoms if they suddenly stop the long term use of an antihistamine

Many people can suffer withdrawl symptoms if they suddenly stop the long term use of an antihistamine

Q: I have been taking an antihistamine since before the summer and stopped a few days ago. I am really suffering from itchy sore skin and other allergy-like symptoms. My friend said it was withdrawal from the antihistamine. Is this true? Should I start taking them again and wean off slowly?

Dr Grant replies: Allergic rhinosinusitis is one of the main indications for taking a long-term antihistamine, as it helps reduce symptoms such as sneezing, skin/eye/nasal itch, congestion, and discharge. However, there are other equally, if not more efficacious treatments for allergic rhinitis such as intra-nasal steroid sprays which are particularly effective in relieving nasal congestion, with very few side effects when taken at the recommended doses.

The only indication to stop taking an antihistamine abruptly is due to a suspected medication adverse effect. You appear to be suffering a known withdrawal effect. Therefore, you are correct to think about restarting the antihistamine and slowly taper the dose down over several weeks to help reduce the intense itch that can be a withdrawal effect. Generally, a 25-50pc daily dose reduction is advised every one to four weeks. In the absence of withdrawal effects, then it is safe to continue to wean off the antihistamine and then stop. In the event of a recurrence of withdrawal symptoms, it is best to revert to the lowest tolerated dose and try weaning again after six to 12 weeks but at 5-12.5pc daily dose reduction every month. Alternatively, taking a short course of oral steroid medication can also be helpful in reducing the withdrawal effects from long term use of antihistamines.

Don’t forgot the simple measures that can help reduce skin itch such as avoiding any potential contact irritants, moisturising the skin using a non-fragranced cream ideally with 10pc urea, and keep room temperatures low. You should consider that alternative treatment options may be available. Are your allergy symptoms due to hay fever, animal dander or house dustmite? There are over 30 different types of pollen and 20 types of spores that can trigger hay fever. Fungal spores such as from mushrooms/toadstools and aspergillus can trigger hay fever, particularly in humid areas.

An allergy specialist can do skin testing and IgE blood tests to help identify your allergic triggers. By identifying your specific allergen, it may help you avoid them and highlight other treatment options. There are two highly effective new allergy treatments.

The first is called allergen immunotherapy by sublingual immunotherapy (SLIT) which is taken as a dissolvable tablet (under the tongue) or an aqueous/liquid extract daily for three years. The majority of studies of SLIT have been performed with grass pollen allergens but recently for house dust mite and birch tree pollen SLIT has become available. SLIT not only treats your hay fever as effectively as steroids and antihistamines, but it also retrains your immune system to be ‘less allergic’ giving it the potential to get rid of your hay fever symptoms forever.

The second treatment is called rhinolight intranasal phototherapy which is painless. A small nasal endoscope is inserted into the nostril emitting safe ranges of light spectrum to reduce inflammation.

Dr Jennifer Grant is a GP with Beacon HealthCheck

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