By Dr. Paul Ehrlich
A new study shows that prescriptions for children under 18 declined seven percent from 2002 to 2010. Interpreting these numbers is often like trying to read tea leaves, but there are some interesting items for me as a pediatric allergist.
Adjusted for population change:
• Prescriptions for teenagers and children for allergy medicines declined by 61 percent.
• Prescriptions for skin corticosteroids rose by 10 percent.
• Asthma prescriptions rose by 14 percent.
Does this mean allergies are being treated less, while asthma and eczema are being treated more?
With pollen seasons growing longer and more intense, it’s hard for me to believe that parents aren’t paying for more antihistamines. Rather, I suspect that it’s really a matter of over-the-counter availability of proven “second-generation” antihistamines. Nearly two years ago when we were just starting this website, I wrote about a milestone in more than 30 years of practice. Namely, I had gone more than a month without writing a prescription for an antihistamine because the new drugs weren’t that much better than the old ones—Claritin (loratadine) and Zyrtec (cetirizine). Since then, the third of the big-3 —Allegra (fexofenadine)— has also gone OTC. If physicians and parents haven’t taken this message to heart, insurance companies surely have.
There’s not much to say about the skin medication—kids who are scratching themselves to the point of bleeding rightly warrant a trip to the doctor.
As for so-called asthma prescriptions, the numbers don’t tell us what kind of prescriptions. If it includes more inhaled corticosteroids (ICS), good, because it means there’s more emphasis on keeping inflammation at bay. If it means more albuterol to stave off exacerbations without controlling underlying inflammation, that’s not so good. Moreover, the period under study doesn’t include the final phase-out at the end of last year of Primatene Mist, the last OTC control medication on the market. We won’t see any statistics reflecting that development for years.
With all these conditions, whether concentrated in any or all of the sinuses, the skin, or the lungs, medication is only part of the solution. To really lessen the need for medication, environmental and behavioral elements come into play. I hope that doctors who write the prescriptions (and the parents who are paying for them) will make those additional factors part of the program.
Photograph by rootsweb.ancestry.com