Allergy Medication Treament

Allergy medicine can be quite helpful for control of allergy symptoms. A variety of over the counter allergy meds flood the aisle of the local pharmacy during the spring. The first agents to mention are of course not really medications at all but the saline sprays, rinses, netty pots and eyedrops. These soothing liquids remove allergen from the lining of the nose and eyes and are safe to use.

Oral Antihistamines

The most popular over the counter medication agents are the oral antihistamines. These can be taken in liquid or pill form. Some over the counter eye drops also contain antihistamines. Antihistamines can help reduce itching, sneezing, runny nose, post nasal drip, and to a mild degree, nasal congestion. Different antihistamines contain active ingredients with different effects. The antihistamines are grouped in 2 general categories. The first generation antihistamines include diphenhydramine (aka Benadryl®), chlorpheniramine, brompheniramine, doxylamine, and others. The first generation antihistamines cause drowsiness and should NOT be used with driving or operating heavy machinery.

The second generation antihistamines include loratadine (such as Claritin®, or Alavert®), cetirizine (Zyrtec®, or Allertek®), or fexofenadine (such as Allegra®). In general these agents are less sedating although cetirizine can be associated with sedation in 10% of the individuals.

The antihistamine/decongestant combinations (the above antihistamines in combination with phenylephrine or pseudoephedrine) can produce more significant relief of nasal congestion that with antihistamines alone.

Cromolyn Sodium

This agent is available as a nose spray over the counter. It interferes with the ability of the body to release chemicals that make an allergic reaction. The spray is generally used 3-4 times a day and it is best used prior to any known exposure of allergen.

Nasal Steroids

Nasal steroids (triamcinolone (Nasacort®), fluticasone (Flonase®), mometasone (Nasonex®), ciclesonide (Omnaris®, and flunisolide (Nasarel®) are available by prescription and recently one has been approved to go over the counter. These agents reduce nasal inflammation are considered first line therapy for anyone who has symptoms more than 3x week either during an allergy season or on a consistent basis. These medications take anywhere from days to two weeks to work. It is important to use these medications correctly. When using a nasal spray, the head should be bent slightly down and the nasal spray angled away for the nasal septum (dividing line separating the nostrils). After using the nasal spray, one should sniff in gently and dab away any excess spray. To maximize circulation to the upper nose, one should brush his/her teeth after use.

Nasal Antihistamines

There are nasal sprays containing antihistamines that are available by prescription. These include olpatadine (Patanase®) and azelastine (Astepro®) . Both of these agents help with nasal congestion, nasal itching, sneezing and runny nose. They can also help with eye symptoms. These tend to work promptly and can be used on an as needed basis. They do not provide the longer term anti-inflammatory effects of a nasal steroid but can help with symptoms and also to augment the effects of nasal steroids.

Leukotriene Modifiers

Leukotriene modifiers (montelukast, Singulair®) also help reduce the effects of chemicals released during an allergic reaction. These medicines are available by prescription and help with nasal drip, itching, sneezing, and cough. These can also be used for asthma treatment and exercise induced bronchospasm.