By Dr. Paul Ehrlich
As our news section recently noted, AAFA’s spring allergy report contained this comment:
“For the first time in this 9-year report, the average number of allergy medications-per-patient is less than 1.0 (actual national average this year is 0.94 medications used per patient). The Spring Allergy Capitals report mostly measures prescription (RX) medication purchases and refills, so this decline is most likely an indication that patients are relying more and more on over-the-counter allergy medications since the scope, variety and strength of over-the-counter medications today is much larger than in the past.”
While the adequacy of OTC medication for many allergic conditions has been a running theme of this correspondent, I can’t say it’s all my doing. However, I would like to comment based on my observations in my practice.
First, people are still suffering from these allergies, but I expect that many of them are trying to muddle through because of the expense of office visits, which undoubtedly accounts for the rise in OTC use. The ones who do come in are suffering so much that they welcome injections of steroids to tide them over until the worst of spring allergies are behind them.
Second, the economy probably still accounts for at least part of the lower utilization of the treatment strategy that could really make a difference in the long run, both from a health standpoint and a financial one—immunotherapy. The cost of OTC antihistamines can add up, depending on whether you buy generic or brand-name and whether you buy in big enough quantities—locally, generic cetirizine (Zyrtec) is $15 for 30 and $20 for 90. A study by Timothy J. Sullivan III, MD, of Emory University, showed that allergy shots over six years can save a patient can save $1,300 to $2,900. And that is just the financial savings. Improved work or school performance is an additional dividend.
Third, I worry that short-term “saving” on seasonal allergy treatment is echoed in asthma treatment. As we have written numerous times, uncontrolled asthma is a public health disaster. If patients are muddling through on seasonal allergies, what are they doing with asthma? I will look forward to data on emergency room visits with great interest.