Male Speaker: The American Academy of Pediatrics came out, thank god saying you shouldn’t use cough syrups until the age of 6. The FDA had said under 4, but basically every -- probably in the work but if a kid had nasal symptoms, a safe alternate is putting a steroid or if you want to use a antihistamine spray, is that true?
Michael Marcus: This is true. Symptoms of cough and congestion are not relieved to any great extent by any of the over-the-counter medications, and so we have moved away from these over-the-counter medications because the risk of having problems with the medications are now greater than any perceived benefit from the medication. So cough syrups and cough cold medications for the most part are shadow away from children under 6.
If patients do have nasal congestion, that’s blocking their breathing, that’s making uncomfortable, then topical nose sprays are the best way to go. Simple nasal sailing so where nose drops is a starting point. Sometimes just spinning the secretions out, is enough to make it more comfortable and help the child sneeze or blow their nose and clear it.
Beyond that, if physician could prescribe a nasal steroid or nasal antihistamine. Nasal steroids are mostly beneficial in allergy so the primary cause of the congestion. When viral infections are the cause of the infection, then nasal steroids aren’t going to give you that degree of benefit. A nasal antihistamine, Azelastine or Astelin has been on the market now for a number of years which has approved both for allergic rhinitis, running nose of course by allergies as low as days are moderate rhinitis which is running nose towards body irritants, infections are the triggers.
Male Speaker: What age group can it be used in?
Michael Marcus: it can be use in children six-years of age and not in fact off-label are used it down to the age of 2.
Male Speaker: Off-label means that you can use it, but you have to tell parents that it is something that the FDA has not approved but this is for great experience in your hands and many other doctor’s hands.
Michael Marcus: Exactly. Off-label means that the drug company hasn’t submitted studies to the FDA, in that specific age group. It doesn’t mean that it’s not safe, it just means that drug company hasn’t spent some money to do those studies. But many times in pediatrics, we use a drug off-label because we have experienced it – we have developed experience using it, in an age group were it has been proven and then we bring it down to a younger age group because the physiology of that age group really is entirely different.
Male Speaker: If you use Astelin, use it once a day, twice or how to use it?
Michael Marcus: Generally we start by using it twice a day, a puff in each nostril, you could go up to two puffs in each nostril in the older children are adults. If it’s contripation is controlled well and twice day use, many times we drop it down to just once a day use, so it help maintain that control.
Male Speaker: And have you used it for long periods of time?
Michael Marcus: I have used it for very long periods of time. In fact it’s approved for chronic use, so it’s not the kind of medication, where you have to limit time of its use because of complications, it has a very good safety profile.
Male Speaker: Is there any side-effect that you come across, or you are concerned about?
Michael Marcus: The only side-effect that really comes up in my experience is that it does have a funny taste. Some patients just don’t like the flavor of the medication. Now that would be one side effect that could be annoying, sometimes it’s a little irritating to the nose, that’s any nose spray might be.
Male Speaker: Get across sometimes a little nose bleed?
Michael Marcus: On rare occasion. I found that it causes much less nose bleed problems then the inhaled Corticosteroids do. The nasal steroids seem to have more nose bleed issues. Astelin, since it is not a steroid, has not have that degree of epistaxis of nose bleeds associated.
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