Allergies: Yogurt or Singulair?

Given that it is the allergy season, two recent headlines suggested that I blog about allergies.
Allergies are nothing to sneeze at. Allergic Rhinitis (nasal allergies) affects about 40 million Americans, cause about 4 million missed days from work or school, and cost about 8 billion dollars a year.

The first headline was from ABC news, that discussed a Finnish study that gave probiotics (healthy bacteria that can be found in certain yogurts), to pregnant women who had allergies or whose husband had allergies, since their child would be genetically predisposed to developing allergies. The infants whose mothers got the priobiotics had 30% less chance of getting eczema, which is an allergic skin condition. The study is intriguing and goes along with they "hygiene hypothesis" which suggests that since we now live in a much cleaner environment, our immune system is not stimulated enough when we are infants and children, and this leads to allergies later in life. Probiotics are generally safe and have been found helpful in other conditions. Not sure I am ready to recommend this to all pregnant women with an allergy history.

A second story, that did not seem to get a lot of attention but to me was very interesting is the announcement that The Food and Drug Administration has turned down an application by Merck and Schering-Plough to combine the drugs they make, Singulair and Claritin respectively, into one pill. It is somewhat surprising to me that they would try this again since previous attempts to combine the pills have failed and since Claritin and Zyrtec are now over the counter (and Allegra is now generic), it would seem to me difficult for insurance companies to approve a combo pill, which would likely be expensive.

More on Allergic Rhinitis
There are several treatments for nasal allergies:
Non-sedating antihistamines: Claritin, Zyrtec, Allegra
Leukotriene modifiers: Singulair
Inhlaed nasal steroids: Flonase (fluticasone), Rhinocort, Nasacort, Veramyst
Inhaled nasal antihistamines: Asteline

There are muliple studies that show that fluticasone (Flonase) is better than Singulair, better than Claritin, and several studies that show that the combination of Singulair and Claritin is not better than either agent alone. However, in one study, though the combination of Singulair and Singulair was better than either agent alone, the individual agents were no better than placebo. In another study, Flonase was not only better than the combination of Singulair/Claritin or either alone, but for night time allergy symptoms both the combination Singulair/Claritin or Claritin alone was no better than placebo.

An excellent review by Dr. Robert Nathan showed that "leukotriene receptor antagonists (Singulair) are sometimes more effective than placebo, are no more effective than nonsedating antihistamines (Claritin) , and are less effective than intranasal corticosteroids in the treatment of allergic rhinitis." -my parenthesis and bolds

In other words, the non-sedating antihistamines do work some, Singulair is really no better than the non-sedating antihistamines , and the inhaled nasal steroids are clearly the best agents.

A recent guideline from World Health Organization suggests that for patients with mild, intermittent allergic rhinitis; treatment with non-sedating antihistamines and leukotriene modifiers were both acceptable forms of treatment, but patients with more chronic or bothersome symptoms, inhaled nasal steroids should be used.

Bottom Line: If you are an allergy sufferer, and you have symptoms that don't really bother you that much, and you don't get symptoms regularly, an as needed pill is a good option. Since prescription Singulair is really no better than over the counter Zyrtec or Claritin (and their generic equivalents), either of these non-sedating antihistamines should be fine. Patients with more chronic or bothersome symptoms should use an inhaled nasal steroid like fluticasone (generic for Flonase).