Drug Uses

Allegra-D is indicated for the relief of symptoms associated with seasonal allergic rhinitis in adults and children 12 years of age and older. Symptoms treated effectively include sneezing, rhinorrhea, itchy nose/palate/ and/or throat, itchy/watery/red eyes, and nasal congestion.

How Taken

The recommended dose of Allegra-D is one tablet twice daily for adults and children 12 years of age and older. It is recommended that the administration of Allegra-D with food should be avoided. A dose of one tablet once daily is recommended as the starting dose in patients with decreased renal function.

Warnings/Precautions

Do not take Allegra-D if you have taken a monoamine oxidase inhibitor (MAOI) in the last 14 days; asthma or another lung disease; diabetes; thyroid problems; glaucoma or increased pressure in the eye; urinary retention or an enlarged prostate; kidney or liver disease; or heart disease, high blood pressure, or an irregular heartbeat. You may not be able to take Allegra-D, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above. Allegra-D is in the FDA pregnancy category C. This means that it is not known whether it will be harmful to an unborn baby. Do not take Allegra-D without first talking to your doctor if you are pregnant or could become pregnant during treatment. It is not known if Allegra-D passes into breast milk. Do not take Allegra-D without first talking to your doctor if you are breast-feeding a baby. Allegra-D is not approved for use by children younger than 12 years of age.

Missed Dose

If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.

Possible Side Effects

Nausea, stomach upset, trouble sleeping, headache, or cold symptoms may occur. If these persist or worsen, notify your doctor promptly. Unlikely but report promptly: dizziness, mental/mood changes, fast heartbeat, fever. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: fainting, irregular heartbeat. Although drowsiness is very uncommon at usual doses under normal circumstances, be aware that drowsiness may occur and may affect the ability to perform tasks requiring alertness (e.g., driving). If you notice other effects not listed above, contact your doctor or pharmacist.

Storage

Store at room temperature between 68 and 77 degrees F (20-25 degrees C) away from sunlight and moisture.

Overdose

In large doses, Allegra-D may give rise to giddiness, headache, nausea, vomiting, sweating, thirst, tachycardia, precordial pain, palpitations, difficulty in micturition, muscular weakness and tenseness, anxiety, restlessness, and insomnia. You can present a toxic psychosis with delusions and hallucinations or you may develop cardiac arrhythmias, circulatory collapse, convulsions, coma, and respiratory failure.

More Information

Use caution when driving, operating machinery, or performing other hazardous activities. Allegra-D may cause dizziness. If you experience dizziness, avoid these activities. Do not take Allegra-D close to a dose of an antacid that contains aluminum or magnesium. These antacids may decrease the effects of Allegra-D.

Disclaimer

This drug information is for your information purposes only, it is not intended that this information covers all uses, directions, drug interactions, precautions, or adverse effects of your medication. This is only general information, and should not be relied on for any purpose. It should not be construed as containing specific instructions for any particular patient. We disclaim all responsibility for the accuracy and reliability of this information, and/or any consequences arising from the use of this information, including damage or adverse consequences to persons or property, however such damages or consequences arise. No warranty, either expressed or implied, is made in regards to this information.

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Deaths of young children from anaphylaxis are very rare. Yet huge numbers of children now go around with adrenaline (epinephrine) injection kits. All medical treatments have side effects and dangers. Although adrenaline (epinephrine) injections given correctly are remarkably safe, they may be more dangerous than the disease if the risk to life from the disease is small enough.
A group of paediatricians in the UK suspects that the dangers of adrenaline do indeed outweigh the benefits. They are planning to find out how many children with food allergies under the age of 16 years actually die or nearly die from anaphylaxis per year. Their aim is to find better rules for deciding whether a child's life is in danger, so that far fewer children with allergies will need adrenaline kits.
If such research succeeds, vast numbers of parents would be able to heave a sigh of relief. Their families and their children's teachers and carers would be spared unnecessary fear and the burden of keeping and using adrenaline.
It is amazing but true that we don't have even remotely reliable figures for the number of deaths and near-deaths from food allergy. This is because of the way death certificates are filled in and turned into statistics, and to some extent because of the low importance given to allergy in the training of doctors. Without this knowledge we can't tell parents how the risk without treatment balances up against the risk of treatment. Widespread prescription of adrenaline is recent and we don't know the risks as well as we would like. What we are doing now is the best we can manage with inadequate information. Better information offers a definite hope of better treatment, which, according to the research group, could mean much less treatment.
Why do we prescribe adrenaline (epinephrine) for so many children ?
A few years ago it was a real rarity for a child in the UK to have adrenaline (epinephrine) to use for anaphylaxis. Now hundreds of children in Leicestershire alone have adrenaline (epinephrine), and the same is true in other parts of the UK and world-wide. Almost every school in Leicestershire now has at least one child with adrenaline (epinephrine) for food allergy, and most schools have more than one.
In Leicestershire there seem to have been three children who have died from nut allergy in the last five years, and we found out about each these through newspaper reports or by chance. So there may well have been other deaths we do not know about.
Parents with nut-allergic children tell me that they would happily see tens or hundreds of thousands of children given adrenaline (epinephrine) to save one child's life. So even just taking our local experience, it looks as if we are doing what parents want.
Since we know that national statistics on deaths from food allergy are very unreliable, they may be a big underestimate, so the risk may be greater than we know.
People who have died from nut allergy have often not had particularly life-threatening reactions before. This means that we have to regard almost all nut allergy as life-threatening. We knowingly prescribe adrenaline (epinephrine) for children in whom we are perfectly aware that the risk is very low. We say so to their parents. We prescribe adrenaline because this is what parents in general want and on balance it is what we feel we would want for our own children if we faced the same problem.
Not infrequently we find ourselves under pressure from a parent to prescribe adrenaline when we feel that the risk really is far too low to justify that; these discussions are difficult because of the great uncertainties.
Personally, I regard the prescribing of an adrenaline kit as an evil, but the lesser of two evils in an inadequately understood situation. If there were a safe way of prescribing less, I would welcome that with great relief.
What are the disadvantages of adrenaline (epinephrine)?
Risks
The usual side effects of adrenaline (epinephrine) are well-known, and given in a separate section (click here). They are normally not serious if you use the right dose in the right way. But for some people with other medical conditions or treatments there are special risks, which an expert doctor will have to take into account when considering a prescription for adrenaline. These special risks are especially rare in children.
But there are more disadvantages. Firstly it is a fact that not every adrenaline kit prescribed will be used correctly. People are simply not infallible. Although we must do everything we can to minimise this risk, it is no good ignoring it. Even in our own clinic, where we lay tremendous stress on training the adults in charge of a child repeatedly and where we are lucky to have facilities for this which most clinics don't have, it is a fact that distressingly many people make serious mistakes when we test their knowledge a couple of months later.
People have injected adrenaline into their thumbs (dangerous), have used the training dummy injectors on the wrong parts of the body, or have failed to give an injection because they didn't do what we had taught them. Elsewhere, there have been deaths because people gave too high a dose, either by giving too many injections or by giving too big an injection (impossible with the present UK kits). Doctors have mistakenly injected adrenaline into a vein at a strength which is only safe when injected into muscle or skin.
The risks from these mistakes are part of the risks of using adrenaline, and we must weigh them in the balance when we prescribe it.
Other disadvantages
Having to keep adrenaline kits at home, at school and when out and about is a serious nuisance. Having to remember to take it wherever you go is another burden on your life.
The fact that you have been told you need the adrenaline is a constant reminder of the risk of death. If that risk is in fact vanishingly small (for example much smaller than the risks from accidents, infections, or drug abuse), then the very fact that you have the adrenaline may harm you and your family by imposing another stress on your life on top of the others which you may face.
The cost of repeated and duplicated prescriptions and the time of your specialist and family doctor and nurses at clinics and at school is not trivial. These funds could otherwise be spent on other health care.
For all these reasons we should not take the view that we may as well prescribe adrenaline just because 'at least it can't do any harm'. It can and it does.
But if the risk of not having adrenaline is bigger than the risk from having it then we should offer adrenaline. We should then not be swayed by prejudice against the treatment, perhaps based on the fact that 'we never did it before' (when there was not so much nut allergy) or on under-reporting of the dangers of nut allergy because the medical statistics are unreliable.
What are the flaws in the argument that adrenaline is prescribed far more often than necessary?
There seem to be flaws in the argument and research plan as we have seen it in print. This may be because the authors were asked to be brief.
The job of doctors and experts is to establish the facts as well as possible, to explain these clearly, to make recommendations where we feel that known facts justify these, but to make final decisions after letting parents tell us what their priorities are. The reason for this is that such decisions are never a question of fact alone, but necessarily involve value judgements. Experts may be no better than lay people when it comes to these. Parents and patients have a right to have their views taken into account.
The authors seem overconfident that we can count the number of deaths from anaphylaxis accurately. Our information is that Death Certificate information is not accurate for this, and that not all deaths will become known to paediatricians. Over-busy paediatricians may not be as reliable at reporting incidents as the researchers hope. Standards of expertise and practice vary so much that treatment is an inadequate indicator of severity.
Most important of all is this question. How many children is it worth issuing with adrenaline kits to save the life of one child? I have debated this with groups of parents of nut-allergic children. Always they have come up with figures which astonish me, typically in the region of 100,000 children issued with kits to save one life.
Of course these parents would change their minds if it became clear that the risk of death from adrenaline was greater than the risk of death from the allergy. But this argument is likely to be difficult, because both figures should be very low.
People will reject the argument that deaths are unimportant because they are few if safe and acceptable measures can prevent them. Society provides other examples of public insistence on safety measures which seem hard to justify on quantitative grounds.
When it comes to judging the psychological disadvantages of having adrenaline around, doctors really cannot make the decision without serious discussion with parents, and even with the children.

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