An Army of Placebos


Often, a patient comes in with allergy complaints that require a certain medication for relief, only to have an underlying medical condition which prevents him/her from being able to take that medication. Instead, we are left treating the allergic condition with another, less effective remedy. The classic example is the patient who has high blood pressure and a very stuffy nose. The best drug for the stuffy nose, Sudafed, often worsens the hypertension; thus, we have to choose the best alternatives. Interestingly, several allergy medicines have been shown to treat stuffy nose (nasal congestion) "better than placebo". That's good, right? Not necessarily. Remember the football coach who said that a game ending in a tie is like kissing your cousin? That's what "better than placebo" sounds like to me. Treating the stuffy nose with "better than placebo" means no Claritin-D, Allegra-D, Zyrtec-D, or any other oral decongestants. Still, we have prescription drugs like Astelin, Singulair, Clarinex, Flonase and Nasonex all bringing us evidence that they relieve nasal congestion "better than placebo". Usually, I would say, "big deal better than placebo ain't worth much more than getting hit in the face with a wet mop".

All the same, if our hypertensive patient with the stuffy nose takes Clarinex, which is great for runny nose and itching, and "better than placebo" for nasal congestion; and also takes Nasonex nose spray, which is wonderful for allergic drainage and sneezing, and "better than placebo" for nasal congestion, and maybe Singulair, the leukotriene blocker that is "better than placebo" for nasal congestion-well, you get the idea. It may take a few building blocks, but we often are able to relieve difficult-to-treat symptoms without bothering underlying medical conditions by recruiting this Army of Placebos.

For one last tip on helping stuffy noses, read this page about Breathe Right® strips.

Note: Information contained in this article should not be considered a substitute for consultation with a board-certified allergist to address individual medical needs.

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