Allergy management is possible through a number of different antihistamines and decongestants, but identifying the proper medications to treat your specific symptoms is key.
Do you have repeated sneezing, nasal itching, runny nose and nasal congestion either year-round or during certain times of the year? These common symptoms are caused by nasal allergies, known medically as allergic rhinitis, that are divided into two types: seasonal and perennial. Classic seasonal allergies are related to pollen, with tree allergy during spring, grass allergy during the summer and weed allergy during the fall. Perennial, or year-round allergies, are usually due to indoor substances, such as dust mites, mold spores, animal dander and insect particles.
The good news is that you don’t have to let nasal allergies get the best of you. While avoidance measures are important, for most people with nasal allergies, medication is also necessary to control symptoms. A number of excellent allergy medications are available both over the counter (OTC) and by prescription that can help you control your allergies.
Diphenhydramine | Fexofenadine | Loratadine | Cetirizine
The most commonly used OTC medications for nasal allergies are oral antihistamines, which block histamine, a natural body defense in the nose that causes some of your allergy symptoms. Sedating antihistamines such as diphenhydramine (Benadryl) are agents that are effective at controlling the runny, itchy nose. These medications can produce undesirable side effects such as sleepiness, leading to impaired performance at home, work and school. Antihistamines such as fexofenadine (Allegra), loratadine (Claratin) and cetirizine (Zyrtec) are generally just as effective as their sedating counterparts, but with faster onset and longer duration of action. In addition, they either eliminate or lessen sleepiness as a negative side effect.
Fluticasone propionate | Mometasone furoate |Triamcinolone acetonide
An effective medication for the treatment of all four major symptoms of nasal allergies sneezing, nasal itching, runny nose and nasal congestion is intranasal corticosteroids. These work by controlling the inflammation in the nose triggered by allergens. Most of these agents are available with a prescription, such as fluticasone propionate (Flonase) and mometasone furoate (Nasonex). Recently, the FDA approved triamcinolone acetonide nasal spray (Nasacort Allergy 24HR) for OTC use in the U.S., both for adults and patients as young as 2 years. This allows allergy sufferers greater access to this very effective and beneficial treatment. The most common side effect is nasal bleeding.
Cromolyn | Oxymetazoline |Phenylephrine |Pseudoephedrine
Other OTC agents for nasal allergies include intranasal sprays, and oral and topical decongestants. The intranasal spray cromolyn (NasalCrom) inhibits release of chemicals that lead to allergy symptoms in the nose, but it is generally not as effective as antihistamines or intranasal cortic osteroids and has to be sprayed several times a day. Topical decongestants such as oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine) are available for treatment of simple nasal congestion. Unfortunately recurrence of symptoms, known as rebound nasal congestion or rhinitis medicamentosa, can occur if they are used for more than 3-5 days.
Oral decongestants are also beneficial in controlling nasal congestion, but the most effective one, pseudoephedrine (Sudafed), may require a prescription in some states or will only be available behind the pharmacy counter. Pseudoephedrine can cause nervousness, insomnia, and in males, difficulty urinating. It is recommended that patients ask their health care professional before using pseudoephedrine if they have heart disease, high blood pressure, thyroid disease or diabetes.
Intranasal antihistamines |Anti-cholinergic sprays
Two other nasal sprays that are sold by prescription only may benefit some sufferers. Intranasal antihistamines (Astelin) are generally more effective than the oral ones, especially in relieving nasal congestion. The main side effect seen with some patients is that they cant tolerate the taste. Anti-cholinergic nasal sprays (Atrovent) are effective in controlling a runny nose, but do not affect sneezing or nasal congestion. Like intranasal corticosteroids, the most common side effect is nasal bleeding.
In addition, saline nasal sprays and the use of a Neti pot may benefit some patients with theirnasal allergies. Presently, good scientific data is lacking on vitamin and herbal treatments for controlling nasal symptoms.
Leukotriene receptor antagonists
Oral tablets known as leukotriene receptor antagonists (Singulair) are available by prescription only. Taken daily, they block the effects of a chemical called leukotriene that contributes to nasal allergy symptoms. Studies suggest they may be as effective as oral antihistamines but less effective than intranasal corticosteroids.
The newest prescription solution is a combination of two intranasal spray medicationsantihistamines and corticosteroids (Dymista). Studies show the combination works better on major nasal allergy symptoms than either agent alone, with the same side effects as both of theindividual agents.
Another tool for managing nasal allergies is immuno-therapy (allergy shots and sublingual tablets). Allergy shots inject increasing doses of the allergen or allergens to which you are allergic. This process builds up the immune system against your allergens. So, unlike medications that treat the symptoms, which come back when medication is stopped, allergy shots act as a vaccine to help lessen or eliminate your allergies over time. Typically, they take about 3-5 years.
While the sheer number of remedies can seem intimidating or confusing, the most important message is that you don’t have to suffer with your allergies. It may take time to determine the most effective combination of medications for your symptoms, but be assured that many remedies are available both with and without physician care to improve your quality of life.
Estimated symptom efficacy (effectiveness) of nasal allergy management agents
Dr. Michael S. Blaiss, MD, is a Clinical Professor of Pediatrics and Medicine for the University of Tennessee Health Science Center in Memphis, Tenn., and in private practice in Germantown, Tenn. A member of the editorial board for Allergy and Asthma Proceedings and American Journal of Rhinology and Allergy Dr. Blaiss has written for several peer-reviewed journals. He served on the Board of Directors for the American Board of Allergy and Clinical Immunology and is a Past President of the American College of Allergy, Asthma, and Immunology.