Si hace años, estar en tratamiento con antihistamínicos para la alergia era sinónimo de pasarse el día dormido, los de “segunda y tercera generación” se consideran no sedantes, si bien es cierto que la somnolencia depende de la predisposición individual de quien los consume, por lo que no hay que confiarse al volante.
Cuando se han realizado todas las pruebas pertinentes y existe un diagnóstico de rinitis a algún alérgeno como el polen de las plantas, el epitelio de los animales o los ácaros, los fármacos de elección por excelencia, son los llamados antihistamínicos. Los antihistamínicos son un grupo de medicamentos cuya característica común es la de inhibir los efectos de la histamina, una sustancia química que liberan las células en todos los tejidos corporales como respuesta inmunológica a un alérgeno, provocando reacciones alérgicas en la piel (picor, habones o ronchas, etc.), y en la mucosa respiratoria (lagrimeo, picor nasal y ocular, estornudos, destilación acuosa, etc.). Los antihistamínicos actúan uniéndose a los receptores H1 de la histamina, estabilizándolos en su forma inactiva durante horas e inhibiendo sus efectos.
Antihistamínicos, 3 generaciones
Los antihistamínicos se recetan dentro de un tratamiento sintomático, es decir, logran reducir los síntomas de la alergia, pero no curan la enfermedad. Actúan sobre los receptores H1, disminuyendo los efectos de la histamina. En términos prácticos, los antihistamínicos son clasificados en tres grupos: los antihistamínicos de primera generación o “sedantes” y los de segunda y tercera generación, mal llamados “no sedantes”. Los clásicos de primera generación atraviesan la barrera hematoencefálica y tienden a producir somnolencia en la mayoría de los pacientes, además de sedación, visión borrosa, sequedad de boca y estreñimiento, frente a lo que ocurre con los de segunda y tercera generación. De hecho, según informan desde la Sociedad Española de Alergología e Inmunología Clínica (SEAIC), el tratamiento con antihistamínicos de segunda generación, que no inducen sueño en la mayoría de los pacientes, puede en ocasiones causar una respuesta individual más sensible y producirlo. Hay que tener en cuenta que estos medicamentos se metabolizan en el hígado, por lo que hay que tener cuidado con otros medicamentos que también se metabolizan en el hígado y con los que va a interactuar (como las benzodiazepinas, los IMAOS y los antirretrovirales).
- Antihistamínicos de primera generación o “sedantes”. Pertenecen a este grupo la difenhidramina, la clorfeniramina, ladesclorfeniramida y ketotifeno. Según explica la farmacéutica Emma García Ruiz, vocal de Óptica y Acústica del COF de Badajoz, tienen una vida media corta de entre 6 y 8 horas, por lo que se suelen indicar hasta tres veces al día, y al atravesar la barrera hematoencefálica, nunca deben consumirse con alcohol.
- Antihistamínicos de segunda y tercera generación o “no sedantes”. Tienen mayor selectividad por los receptores H1 y poseen la capacidad de no atravesar la barrera hematoencefálica o de hacerlo muy escasamente. En este grupo se encuentran la cetirizina, la loratadina, la ebastina y la bilastina… Su vida media es más prolongada, de 12 a 24 horas, por lo que suele indicarse una sola pastilla al día). En cuanto a su eliminación, lo hacen por vía renal, por lo que hay que tener en cuenta al paciente con insuficiencia renal, sobre todo con la cetirizina, que se excreta en el 70% por vía renal.
Descongestivos nasales y corticoides
Según explica la farmacéutica Emma García Ruiz, vocal de Óptica y Acústica del COF de Badajoz, además de los antihistamínicos, otro grupo de medicamentos indicados en el tratamiento de la alergia son los descongestivos nasales, que actúan provocando una vasoconstricción local y, por tanto, una disminución del edema nasal. No tienen efecto sobre los estornudos, el picor o la rinorrea y suelen producir un efecto rebote secundario. Además, están contraindicados en caso de hipertensión arterial, cardiopatías isquémicas, hipertiroidismo, diabetes no controlada, glaucoma de ángulo cerrado, hipertrofia de próstata no controlada, en pacientes en tratamiento con Inhibidores de la monoaminooxidasa (IMAOS) para la depresión, así como durante el embarazo y la lactancia.
Por su parte, los corticoides reducen la hiperreactividad nasal, a la vez que disminuyen de forma potente la inflamación nasal. Son eficaces para el tratamiento de todos los síntomas (obstrucción nasal, estornudos, rinorrea…), salvo los oculares. En este grupo están la beclometasona, el acetonido de triamcinolona, la mometasona, fluticasona, flunisolida y budesonida.
Rinitis: pautas para el día a día
Según explica Emma García Ruíz,los síntomas nasales de rinitis son diversos y abarcan desde obstrucción, rinorrea, estornudos, cefalea, dolor facial y epistaxis, hipoacusia, otalgia, disfonía, molestia faríngea, prurito ocular, tos y expectoración. Ante esta serie de síntomas, los lavados nasales pueden contribuir a mejorar el estado general del paciente, ya que descongestionan, eliminan la mucosidad e hidratan la zona. Igualmente, según la SEAIC, es necesario observar una serie de medidas higiénico sanitarias que incluyen la evitación del alérgeno (no saliendo al campo en los días de fuerte polinización y no abriendo las ventanillas del coche cuando se viaja); evitar ventilar y abrir las ventanas al amanecer y al anochecer; tender la ropa en el interior de las casas; cambiarse de ropa al volver a casa, tras estar en la calle; emplear gafas de sol y mascarillas que filtren el polen y filtros para el polen en los aires acondicionados del domicilio y los coches, así como evitar las actividades al aire libre en las primeras y últimas horas del día.
El médico y el farmacéutico son los profesionales más adecuados para orientaros en la pauta de consumo de estos fármacos.
RINITIS ALÉRGICA, ASMA, CATARRO Y CORONAVIRUS
¡DISTÍNGUELOS
● Rinitis alérgica: picor nasal, picor de ojos, estornudos repetidos, destilación nasal acuosa y congestión nasal. No hay fiebre, salvo que se complique con sinusitis aguda.
● Asma: tos seca y dificultad para respirar, pero sin fiebre.
● Catarro: congestión y agüilla nasal y, a veces, estornudos. Aumentan en intensidad en el espacio de 1 a 3 días y el moco evoluciona a espeso, verdoso-amarillento. No suele haber fiebre alta. Puede aparecer febrícula y acompañarse de algo de malestar general.
● Coronavirus: la sintomatología puede ser leve, habitualmente con síntomas similares a los de una gripe: fiebre de moderada a intensa, malestar general y abatimiento, tos habitualmente seca, y puede asociar flemas y dificultad para respirar.
FÁRMACOS DE ELECCION
- Rinitis: los síntomas se recrudecen al aire libre y mejoran con cierta rapidez tras la toma de antihistamínicos tópicos u orales.
- Asma: los síntomas del asma suelen revertir fácilmente con el uso del broncodilatador de rescate (salbutamol o terbutalina).
- Catarro: los síntomas se van atenuando progresivamente. En más o menos 6-7 días estaría resuelto si no se complica con sinusitis. Se trata con medicamentos descongestionantes y mucolíticos.
- Coronavirus: los síntomas son progresivos y se asocian a la sensación de malestar general como cuando empezamos con una gripe. Para la fiebre y el malestar se puede tomar antipiréticos o analgésicos del tipo paracetamol.
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