Dr. Kevin Most: Allergies & Drug Price Transparency Change

Doc Most readies the meds.

Drug Pricing on advertising

Late last week we heard Secretary Azar telling us that any  TV advertising for drug with a cost over $35 for a month’s supply will now have to post that cost in their advertising. Is this good?   Depends on how you look at it, true transparency is great, however a posted cost is not true transparency. Each of us pays a different price for our medications, for some plans routine generic medications are $5, others $10 others Free. It all is based on your insurance plan. Some plans feel that the patient should be responsible for medication costs, this forces the patient to ask the doctor for the generic, where others are generous and the patient may ask the doctor for the newest medication even if the cost does not outweigh the benefit. The simple act of posting a price may confuse patients.

It is interesting that this requirement will initially only be required on TV ads, not printed ads or radio ads

Some are concerned that the cost will be sticker shock and prevent patients from seeking care for some medical conditions. Remember although the ads are specific for a drug, they discuss the condition the drug treats.  The ripple effect of this is that some undiagnosed patients will see an ad about a drug and realize they have the condition being discussed.

What is the goal? To have companies decrease the cost of the medication, allow consumers to make better choices, force doctors to be more educated about the costs.

The administration compared this to the fact that the price of cars has to be posted, that argument is a little ridiculous as a car is a luxury and a choice, a medication that may save your life is often not.

Allergies

We all make fun of Chicago seasons, often it is we have two season Road construction season and barriers with no construction season.  This year is a bit different, it appears that we are going to have 3 seasons for weather. Looks like we are going from Winter, to a season we will call, Rain then directly into summer, bypassing spring altogether. Some of you may say, Great ! No spring allergies!. Ummmmmm, Sorry that is not the case. In fact it appears that this may be a brutal allergy season in both the spring and summer, as many of the predictions show that the plants that would normally be spread out will be stack on each other and the recent rain and snow will add to the possibility of mold counts going high quickly as well.

Considering we just had snow 15 days ago, the tree pollen counts are getting pretty high already. This season may be  a bit compacted but it appears that it will carry a big punch. Think about it 15 days ago we had snow on the ground and now Tree pollen counts are already moderate and ready to go higher. With the rain we have had recently a few things happen, one is the trees and plants will have some accelerated growth soon as the weather changes and the chance for mold in the home increases. Remember now is the time to turn on the dehumidifiers many of which also will act as a filter in the home. May has the look of being a bad month for those of you who are allergic to any of the trees. Oak, maple, beech and cottonwood look to be the worst in May. Grass and weed allergies which classically start in the early to mid-summer may not be impacted by the unusual spring weather as much as trees have been.

Many of you may be feeling your allergies have actually gotten worse over the past few years. Scientists are telling us that because of the increased levels of CO2, the pollen is getting stronger from an allergic view. In fact we are seeing the number of allergy suffers increasing each year. You may hear more people say, I never had allergies and now I am suffering. This is because the pollen is actually more allergenic or potent. Individuals who in the past were not bothered are now finding themselves sneezing and coughing.

As we have talked about in the past, the best time to start allergy medicine is 2 weeks before the season actually begins. Many with spring allergies probably did not consider starting their medication as we had snow and cold weather. Now with the sudden change in temperature  we will see rapid growth in trees , grass and mold. So allergy season will be on us very quickly, in fact it is.

Estimates are that 75 million people in the US suffer from allergies bad enough to take medication.

We talk about how to treat allergies and we will discuss medications but first lets discuss some simple things you can do around the house. One will be difficult to do, and that is keep the house closed down as much as possible. Although we all want to open the doors and windows and get some “fresh air” in the house. Remember that “fresh air” is full of tree pollen at this time.  Keeping the doors and windows closed for a few more weeks may help your allergies more than any medications. Keeping the pollen from settling in the house will minimize the longer exposure. Another thing to do is to shower at night, especially if you have been outside all day. The pollen attaches to your skin and hair and bringing that to bed with you only assures that you will be exposed to pollen all night. A quick rinsing shower in the evening will help as well. Removing the clothes you were wearing when outside and putting them in the laundry again will minimize the amount of pollen in the house.

As far as medication, allergy medications do not cure allergies, they reduce the symptoms. That is the goal,  to block the release of histamine. Histamine is a chemical that is contained in cells in our body that is released when we are exposed to something foreign. It is a chemical that essentially helps us clear our things in our body that are foreign. The side effects of histamines are actually ways the body has to clear the foreign exposure. We don’t like to sneeze, but histamines make us sneeze, why? The body wants to clear the foreign substance from our respiratory tract, it makes our eyes water, why? Because it wants to clear the substance from our eyes, it makes us itch, why, it wants to trigger us to remove the substance from our skin, or avoid it in the future ( think poison ivy) . I think you get the concept. Histamine is actually trying to protect us, although we see it as an inconvenience.

Antihistamine medications in the past  had been limited to simple Benadryl. Although Benadryl is a great antihistamine the side effects are often not tolerated. For many people taking 50 mg of Benadryl will put them to sleep or at least make them quite drowsy, for others it appears to do the opposite and make them hyper. Fortunately the discovery of non-sedating anti-histamines occurred in the early 90’s and patients were able to take symptom relieving medications without falling asleep at their desks. These medications include, Claritin, Allegra, Xyzal and Zyrtec, all of which can be purchased in a generic form.  One thing patients need to understand is that they may have success with one of the drugs and no success with the others. They are once a day medications and it is often recommended that you take them daily and monitor the allergen that causes your symptoms, knowing when trees are done pollenating will allow you to know when to stop the medications. Pollen counts can be found on many apps including most weather apps.

Other popular drugs include Flonase or other steroid nasal sprays. These medications act by decreasing the inflammation noted with allergies. It will help to limit the impact of the histamine, it does not block the release of histamine. By limiting the inflammation it helps limit the symptoms, so it will help with congestion, sneezing and itchy. This is a good drug that is often used in concert with the antihistamine to limit symptoms. This is also now over the counter.

Be careful when taking medications for allergies. As you walk down the row of medications you may be overwhelmed. This is a billion dollar business and everyone wants their slice. Look at the colorful packaging, do not make your decision based on claims made on the box. Take a minute to understand your symptoms and make sure the ingredients are what you need and not more. Taking a decongestant  won’t help you if you are not congested. Taking an antihistamine when all you have as congestion won’t help and may hurt. Many of the meds have Tylenol in them, make sure you check as you may be taking Tylenol separately which may lead to Tylenol overdose without even knowing it.

There are some new treatments that are being worked on now. We have talked in the past about having our immune system help us fight cancer, well researchers are looking to see if we can use our immune system to also help fight allergies. In order for histamine to be released from a cell another compound must bind to the cell with the histamine, that is the signal to release the histamine. Researchers are looking for the immune system to block the compound that tells the cell to release the histamine. If this can be done, the histamine is not released and the symptoms are not noted. This is still a few years away but may end up being a single medication that could potentially treat all allergies.

With many of the medications available over the counter, patients often self treat and do not look for a physician’s guidance. This is not recommended, however between information on the internet, high deductibles and the availability of medications over the counter it is not unexpected.

Many people know they have symptoms but have no clue what they are allergic to. Is it important to get tested. I would answer that by first asking how bad are your allergies, do they follow a specific pattern and do you want to avoid medication. If they are not too bad and the pattern is specific you can probably self treat and be fine.  If you are getting ready to plant some trees in your yard, or getting ready to move to a new area, the information on your specific allergies may be good to know. For example if you are allergic to Poplar trees, no use planting 3 in your backyard, why personally make your allergies worse. If you are planning on moving south, know what you are allergic to, for example North Carolina would not be a good idea if you are allergic to pine pollen.

So if needed,  how do we test for allergies.  We really have 2 ways to test for allergies, one is with skin testing the other is with a blood test. With the skin testing a physician takes multiple possible allergen’s and scrapes your skin in a distinct pattern. They then look for a local response and when they see it they know the specific culprit. It is felt to be the most accurate when completed by an expert. Most Ear, Nose and Throat physicians as well as Allergists perform this in their office. The other way to test is thru a blood test, although easier it is often more expensive and may take a while to get results and may need to be followed up with a skin test.

Results of these tests will allow you to tailor your medication timing, no need to take Claritin in December if you are allergic to grass. These results would also allow you to get “allergy shots” in the hopes that you can train your body to not react to the irritant. Essentially what is done is the doctor will start with a very low dose of the irritant and as the body tolerates it the dose is increased. Eventually you get to a point where the irritant no longer causes a response in the body and you are essentially “cured”  This may take a long time, years in most people, however the elimination of symptoms and the lack of not needing to take medication is often worth the effort. In some people taking the allergy shots is important as medications have not worked, for others the allergy medication may interact with a more important medication so they have to weigh the benefits. Discussing this with your doctor is important.

So get ready for a packed allergy season, start your medications now, and don’t worry it will be snowing again before we know it.

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