Allergy symptoms can often be treated successfully with over-the-counter (OTC) drugs. If these don’t work well enough, your doctor can prescribe alternatives. Some of which are stronger versions of OTC products.
Many allergy medications work best when taken before you come in contact with allergens and have symptoms. That way the drugs can prevent or reduce the productions of chemicals responsible for the allergic reaction.
Antihistamines are often the first choice. They treat the effects of histamine, which are sneezing, runny nose, and itchy eyes. But it does not treat nasal congestion. Products come in pills, nasal sprays, and eyedrops.
“Second-generation” antihistamines are long-lasting—12 or 24 hours. They often do not cause drowsiness.
- Cetirizine (Zyrtec)
- Desloratadine (Clarinex)
- Fexofenadine (Allegra)
- Loratadine (Claritin, Alavert)
Most are available as less expensive OTC generics. Some also contain a decongestant. This is indicated by a “D” appended to the brand name.
Older “first-generation” antihistamines have side effects. They should be used with caution.
- Diphenhydramine (as in Benadryl)
- “Pheniramines” (such as chlorpheniramine, as in Chlor-Trimeton)
Antihistamine effect wears off after several hours. But they can cause drowsiness that sometimes lasts more than 12 hours. For this reason, people take them before going to bed. The sleepiness can still impair driving the next day, even if you don’t feel drowsy. What’s more, these drugs have anticholinergic effects. That means they interfere with the neurotransmitter acetylcholine. Side effects of which include:
- Cause or worsen memory problems, confusion, and cognitive impairment in older people
- Worsen urinary symptoms in men with prostate enlargement
Decongestants shrink dilated blood vessels in the nose, lessening swollen nasal passages. They come as OTC pills, capsules, liquids, and nasal sprays.
- Oral products contain pseudoephedrine or phenylephrine.
- Sprays contain phenylephrine or oxymetaxoline.
- Pseudoephedrine and oxymetazoline provide symptom relief longer than cold formulations containing phenylephrine.
You shouldn’t use decongestant nasal sprays for more than two or three days in a row. That’s because they lose effectiveness and can cause a rebound effect, resulting in even worse nasal congestion.
Talk with your healthcare provider or pharmacist before using either oral or nasal decongestants if you:
- Have high blood pressure, heart disease, glaucoma, thyroid disease, an enlarged prostate, or diabetes
- Are pregnant or breastfeeding
- Are taking other medications on a regular basis (many of which interact with decongestants)
You may be able to use decongestant nasal sprays even if you are advised against pills or capsules. That’s because they are less likely to have systemic effects. Finally, these drugs can cause nervousness, sleeplessness, and palpitations in some people.
Cromolyn sodium nasal spray
Cromolyn sodium nasal spray is safe and effective for preventing hay fever symptoms in adults and children as young as six.
- It blocks the release of histamine.
- It is best started before allergy season begins.
- It won’t help as much after symptoms appear.
Unlike decongestant nasal sprays, it doesn’t produce rebound congestion. It also has the fewest side effects of any allergy drug, but it isn’t as effective as nasal steroid sprays.
- Saline nasal sprays: help wash out nasal mucus and can be used long term. Neti pots work similarly.
- OTC eyedrops that contain antihistamines (pheniramine) may help relieve itchiness caused by allergies.
- Some also contain a decongestant that constricts blood vessels in the eyes. These should not be used for more than a few days, since they can produce rebound redness and swelling in the eye.
- Don’t use conventional eyedrops, which contain only vasoconstrictors (decongestants).
- People with glaucoma should never use eyedrops that contain vasoconstrictors.
- Doctors may prefer prescription eyedrops or non-sedating antihistamines for red, itchy eyes.
- Artificial tears, preferably without preservatives, can be taken whenever needed for temporary relief of itchy eyes.
- Nasal steroid (corticosteroids)sprays are the most effective drugs for treating nasal allergy symptoms. They used to be available only by prescription but now select products can be bought OTC.
- They start working within 12 hours. But maximal effect may not occur for seven days or more.
- Most people tolerate nasal steroids well. But some drugs cause dryness, irritation, burning, or bleeding of nasal passages, and throat soreness.
- There’s some concern that long-term use in children may reduce body growth. This is especially concerning in children also taking corticosteroids for other conditions, such as asthma.
- If you have a severe runny nose and can’t tolerate or do not respond to other drugs, oral corticosteroids may need to be prescribed for short-term use.
- There are a few potential drug interactions with nasal steroids, so read the label carefully.
- Topical steroids are sometimes prescribed for allergic skin conditions such as atopic eczema and hives.
- There can be side effects with long-term use.
- OTC hydrocortisone cream is usually least effective, but also has fewer side effects.
- Monoclonal anti-IgE drugs have been approved to treat allergic asthma but not allergic rhinitis. Some doctors, though, prescribe it for that.
- One such drug is omalizumab. It is injected under the skin every two to four weeks.
- It decreases IgE antibody levels in blood and IgE receptors on mast cells. Thus, it reduces allergic reactivity and the release of histamine in response to exposure to allergens.
- Leukotriene antagonists or blockers inhibit the inflammatory effect that produces nasal congestion.
- One such prescription drug is montelukast (Singulair). It is approved for long-term control of allergic rhinitis and allergic asthma.
- It reduces swelling of the airways and relaxes smooth muscles around the airways. But in many people it is not as effective as nasal steroids. Thus, they may be given as just one medication in a several drug treatment plan.
The World Health Organization defines medication adherence as "the degree to which the person's behavior corresponds with the agreed recommendations from a health care provider." Poor adherence to prescribed regimens can result in serious health impacts including hospitalization and death.
About half of all medications for chronic diseases are not taken correctly. People change or skip doses, stop too soon, don’t take them at all, or never fill their prescriptions.
What to do when you get a new medication:
- Take notes on what your doctor tells you about the medication.
- Double check with the pharmacist on how to take the medication.
- Ask questions to make sure you fully understand the medication. Be clear about when and how to take it.
- Creating a chart for your daily medication regimen can help you stay on track. So might a pill box with multiple sections. This is helpful if you take more than one medication. This is also helpful if you take medications more than once a day.
- If you’re being treated for a chronic condition, check regularly with your doctor about whether you are taking the medication(s) correctly.
- If you are concerned about or are experiencing side effects, talk to your doctor.
- Do not take yourself off of medications without the knowledge and guidance of your doctor.
- If you’re having trouble sticking to your medication, for any reason, talk with your doctor. They may be able to suggest other treatments or refer you to services that can help.