The best way to manage your allergy symptoms, of course, is to avoid them. Simple strategies to reduce your exposure to your allergy triggers are well worth your attention. Moderate to severe allergy symptoms might also be prevented by immunotherapy (allergy shots). Sometimes, of course, it is impossible to manage allergy symptoms without medicines. This section will help you to know your options if you have symptoms despite reasonable efforts to prevent allergies.
There are many medications on the shelves of your pharmacy, and your symptoms may vary from day to day or season to season. So how do you know which medication will work best for your symptoms? Several different strategies may work well for you. Here are a few basic points to help you navigate among the various allergy medications
Antihistamines treat almost all allergy symptoms. These medicines can be improve a runny nose, sneezing, skin itching, or itchy and watery eyes. Antihistamines are less effective for helping a congested (stuffy) nose.
Nonprescription antihistamines can be used alone or in combination with prescription medications to help reduce your costs. Most brands of antihistamine, particularly those that are sold for a low price, cause side effects such as drowsiness in at least one out of five people.
Some of the most recently developed antihistamines are labeled as non-sedating or second generation antihistamines. These modern antihistamines cause drowsiness in a more limited percentage of people who try them, relative to older antihistamines. If you do not have side effects from inexpensive first generation antihistamines, then purchase of the newer medicines will not provide you with any significant advantage. The term non-sedating for newer antihistamines may be misleading, since some people experience drowsiness after taking either kind of antihistamine.
Some of the less expensive, first generation antihistamines are less likely to cause trouble for you than are others. Among these medicines, Chlor-Trimeton (chlorpheniramine) is tends to be the least sedating. Tavist (clemastine) is an antihistamine that lasts longer between doses but is usually more sedating than is chlorpheniramine. It can be helpful at nighttime, as it tends to last about eight to 12 hours. Diphenhydramine (Benadryl) is very inexpensive, but it is highly sedating and wears off quickly.
Loratidine (Claritin, Alavert, Tavist ND), a non-sedating antihistamine, is available without a prescription. You can expect other non-sedating antihistamines to become nonprescription in the near future.
Antihistamines can be hazardous for some people, particularly the elderly, those who have dementia or a tendency to become confused, or those who are prone to falls. In children and some older individuals, they sometimes cause agitation or hyperactive behavior. Antihistamines can cause a dry mouth, cause constipation, or result in incomplete emptying of the bladder. (This last problem, called urinary retention, can be a particular problem for a person who has frequent bladder infections or a person who already experiences a delay when beginning to urinate.) Although not all brands have been studied formally, an increased rate of automobile accidents has been recorded in people who have taken antihistamines.
One antihistamine, available as a nose spray, is called Astelin (azelastine). This medicine might reduce runny nose symptoms while causing fewer side effects than oral antihistamines.
Some antihistamine brands are packaged together with a decongestant medication. An example of this would be Claritin-D, which combines the antihistamine loratadine (Claritin) with pseudoephedrine, a decongestant. Decongestant ingredients, as noted below, may cause side effects. You may wish to avoid a combination product if you are sensitive to these side effects.
Decongestants are useful for treating a runny or stuffy nose, but their usefulness can be limited by side effects. Decongestants work by tightening small blood vessels, such as the ones that supply the lining of your nose. With less blood flowing through your nose, there is less moisture available that can be used to make mucus. Decongestants reduce the amount of mucus that you produce, and reduce swelling in your nasal passageways.
Decongestants are available in several forms. Oral decongestants and decongestant nasal sprays are discussed here. Decongestant eye drops are discussed in a separate section.
Decongestant nasal sprays include oxymetazoline (Afrin, Dristan, Nostrilla) or phenylephrine (Neo-Synephrine, Sinex, Nostril). Nasal spray decongestants are very concentrated, so they sometimes work faster and than pill decongestants to open up your nasal passages, allowing you to breathe more easily. Unfortunately, they can be used for only three days because longer use (four to seven days, in most people) causes rebound congestion symptoms to occur in the nose between doses. This can mean that with too much use of nasal sprays, your symptoms might worsen rather than improve. Your doctor may recommend a nasal decongestant for a few days when you are first beginning treatment with a nasal steroid (a different type of nose spray, discussed below). In this case, the nasal decongestant can allow the nasal steroid dose to enter your nose more deeply (and provide a full steroid dose) during your first few days of its use.
Oral medicines include pseudoephedrine (Sudafed) or phenylephrine (Sudafed PE), and these same ingredients are packaged within many combination cold products. An oral decongestant may give you more controlled, longer-lasting relief compared to a nasal spray decongestant, and an oral decongestant is unlikely to cause rebound congestion symptoms. Unfortunately, oral decongestants can cause side effects such as heart racing, high blood pressure, anxiety, or insomnia. It is not safe for people with heart disease, a history of stroke, or poorly controlled blood pressure to use oral decongestants.
When decongestants are combined with antihistamines, they can provide additional anti-allergy relief for some people. Some people who experience drowsiness from antihistamines substitute decongestants during the daytime, because decongestants do not have that side effect.
Steroid Nose Sprays
Corticosteroid nose sprays (available by prescription only) reduce congestion, runny nose and sneezing. Some have an effect within a day or two, but some must be used for a week or longer before they provide relief. Studies show they are more effective at treating allergic nose symptoms than are over-the-counter or prescription antihistamines. They are the first choice of most doctors for treating nasal allergy symptoms.
A steroid nose spray may cause uncomfortable dryness in the nose with continued use. For this reason, some versions are combined with a salt-water spray, and are renamed aqueous (AQ) steroid nose sprays.
Steroid nose sprays do not cause much steroid to enter your bloodstream, so they have minimal side effects outside of the nose. They have not been shown to reduce bone growth in children who use standard doses.
The medicine montelukast (Singulair) is in this group. It can block allergic inflammation much like a steroid nose spray. It is in a pill form and requires a prescription.
Cromolyn Nose Spray
Cromolyn nose spray (Nasalcrom) prevents the release of histamine within the lining of your nose. Usually, allergy symptoms begin after cells named mast cells release histamine into their surroundings. Cromolyn is classified as a mast cell stabilizer. This medicine must be used at least 30 minutes prior to an exposure to your allergy trigger, in order to be effective. It is therefore only helpful for prevention of predictable allergies, and is not your most effective choice for rapid treatment of symptoms that are already active. Cromolyn is available without a prescription.
Eye Allergy Treatments
Several eye drops are available to relieve allergy symptoms. Eye drops are prepared without ingredients that could irritate the eye surface. Do not put any liquid (such as a nasal spray) in your eye that is not intended for use in the eye.
The most useful eye drops for allergy treatment (including astelazine (Optivar), levocabastine (Livostin), and others) contain an antihistamine without other active ingredients. These can relieve itchy, watery, red eyes that are reacting to allergy Some eye drops contain cromolyn or other mast cell stabilizers, without other active ingredients. These drops are helpful for prevention of eye allergy symptoms. These drops (like cromolyn nose spray) must be used prior to exposure or used at regular intervals through the day in order to keep allergy symptoms away. These treatments include olopatadine (Patanol), nedocromil (Alocril), cromolyn (Crolom, Opticrom), and others.
Some over-the-counter eye drops contain a decongestant, without other active ingredients. Decongestants for the eye include brands of naphazoline (Allerest, Clear Eyes, Naphcon, and others). They get rid of eye redness by limiting blood flow to the eye surface. As you can imagine, it is not entirely healthy for the eye surface if blood flow is restricted for too long a time. If they are used for longer than a few days at a time, decongestant eye drops can make your eyes feel needy enough for blood delivery that your eyes will try to make up for lost time (and become very red in their appearance, as they engorge blood vessels on their surface with blood) after the drops are stopped. This rebound of red eye after decongestant eye drop use limits the usefulness of these treatments.
Eye drops that combine two treatments are also available for allergy treatment. Naphcon-A combines an antihistamine and decongestant. This treatment can have the same side effect of rebound eye redness after it is stopped as can any decongestant eye drop.
Last updated February 27, 2008
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