WASHINGTON (AP) – Allergy sufferers who rejoiced when Claritin went over the counter are now dealing with an additional headache: At nearly $1 a pill, nonprescription Claritin is more expensive for insured patients who were used to a $10 copay for a whole bottle.

Many insurance companies are also making it harder to get competing prescriptions, charging $35 to $50 for competitors Allegra or Zyrtec. Some demand proof that patients tried, and failed, OTC Claritin for a few weeks before even allowing their doctors to write a prescription for an alternative.

“It’s a real hassle,” says Dr. Gordon Raphael, a Bethesda, Md., allergist who reports being inundated with calls from patients desperate for him to certify they need a new medication.

Patients rethinking their allergy choices because of cost could find that other medicines actually control their symptoms better. Although Claritin once was the best-selling prescription allergy medicine, specialists like Raphael cite research showing there are more effective choices for the severely afflicted.

In fact, study after study finds prescription steroid nasal sprays – sold under such names as Flonase, Nasacort and Nasonex – the overall most effective hay fever treatment. Yet by far, most sufferers pop pills.

“That’s the power of modern advertising,” sighs Dr. Brian Smart of Illinois’ DuPage Medical Group, who recently reviewed medication options for the American Academy of Allergy, Asthma and Immunology – and calls the sprays his first choice.

But “there’s no one drug which is perfect for every single patient,” Smart stresses.

The options:

-Most popular are non-sedating antihistamine pills. They block histamine, the body chemical that causes hay fever’s itchy nose and eyes, runny nose and sneezing. They don’t help congestion unless combined with a decongestant.

If Claritin worked well for you, stick with it, allergists say. The only non-sedating option available without a prescription, it is most helpful for mild to moderate allergies.

While the well-insured may fuss at the new OTC price, they won’t have the time and expense of a doctor’s visit – and the uninsured will pay far less than they had been. Also, generic versions have just begun selling at 65 to 80 cents a pill; look for Claritin’s chemical name, loratadine.

Still available by prescription – albeit harder to get through insurance – are nonsedating Allegra, Zyrtec and Clarinex, Claritin’s successor. Some studies suggest they’re more potent than Claritin.

But all “are much more alike than advertisements might lead you to believe,” says Dr. David Pearlman of the Colorado Allergy and Asthma Centers, who heads AAAAI’s therapy committee. So finding the one best for you may require trial and error.

– Nasal steroids directly target various inflammation-causing substances inside the nose to treat all nasal allergy symptoms, runny nose as well as congestion. That means no separate decongestant.

Some people, children especially, find a nasal spray’s sensations uncomfortable or irritating.

But expect to see more ads for steroid sprays soon, as manufacturers try to increase use among insured patients struggling with antihistamine costs. Insurers typically charge a $10 to $30 copay.

– The newest option is Singulair, an anti-asthma tablet now found to also ease allergies’ itching, sneezing and congestion. It targets a different symptom-causing substance, leukotrienes, and thus can be used together with steroid sprays or antihistamines. Like the previous two categories, it has few side effects.

– A non-steroid prescription nasal spray named Atrovent also can dry up a runny nose.

– There also is a prescription antihistamine spray named Astelin; it can cause sedation.

– Decongestants ease nasal blockage, but can cause insomnia and sometimes heart palpitations.

– Be careful with nonprescription antihistamines other than loratadine, allergists warn. Older varieties are sedating and can impair performance even if you don’t feel sleepy.

Running out of options? Some patients find an antihistamine they haven’t used for several years works again – it’s like the body recognizes it again, says Dr. Paul Ehrlich of New York University.

Stay tuned: Pearlman expects a more broadly active injected medicine called Xolair to hit the market next year.

And don’t forget allergy shots, an old standby that, while inconvenient, can dramatically improve many people’s hay fever.

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EDITOR’S NOTE – Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

AP-ES-04-21-03 1851EDT

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