Dealing with allergy symptoms can be frustrating, whether they’re seasonal, pet-related, or triggered by other allergens. Understanding the different types of allergy medications available can empower you to effectively manage your symptoms and improve your quality of life. This guide provides a comprehensive overview of allergy medicines to help you navigate your options.
Understanding Allergy Relief: Nasal Rinses and Sprays
One of the simplest yet most effective ways to alleviate nasal allergy symptoms is through nasal rinsing. Using a saline solution helps to wash away mucus and allergens from your nasal passages, providing natural relief. Remember to follow the directions carefully when using nasal rinses to ensure proper and safe application.
For more targeted relief within the nasal passages, corticosteroid nasal sprays are often recommended by healthcare professionals. These sprays work by reducing inflammation in the nose and blocking allergic reactions at their source. They are considered the most effective type of medicine for allergic rhinitis as they can alleviate a wide range of symptoms, including nasal congestion, sneezing, and runny nose. Furthermore, they can also offer some relief from eye allergy symptoms. Generally, corticosteroid nasal sprays are associated with minimal side effects, although some individuals may experience headache, nosebleeds, or nasal irritation.
Common examples of corticosteroid nasal sprays include:
- FLONASE®
- Nasacort®
- Nasonex™
- Nasalide/Flunisolide
- Omnaris™
- QNASL®
- RHINOCORT®
Antihistamines: Targeting Sneezing, Itching, and Runny Nose
Antihistamines are a widely used class of allergy medications known for their ability to relieve sneezing and itching in the nose and eyes. They are also effective in reducing runny nose and, to a lesser extent, nasal congestion. When choosing an antihistamine, it’s generally advisable to opt for a long-acting, non-drowsy formulation to minimize disruptions to your daily activities. Modern antihistamines are generally safe, without the toxicity concerns associated with older medications like diphenhydramine.
A variety of allergy medications available over the counter.
Non-steroidal antihistamine nasal sprays are also available, but it’s important to be aware that some of these may cause drowsiness. Examples include Astelin®, Astepro®, and Patanase®.
For oral antihistamines, options range from non-drowsy to those that may cause drowsiness in some individuals:
Non-drowsy oral antihistamines:
- Allegra®
- CLARINEX®
- Claritin®
Oral antihistamines that may cause drowsiness:
- Xyzal®
- ZYRTEC®
When it comes to pregnancy, cetirizine (ZYRTEC®) and loratadine (Claritin®) are often considered the antihistamines of choice due to their established safety profiles during pregnancy and effectiveness in treating allergy symptoms.
It’s important to exercise caution with diphenhydramine and similar short-acting antihistamines like promethazine. Diphenhydramine, commonly known as BENADRYL®, is not an ideal choice for managing allergy symptoms due to its short duration of action and potential for significant side effects. These side effects can include drowsiness, sedation, dry mouth and eyes, and fatigue. Furthermore, these medications can impair alertness, concentration, multitasking abilities, and memory, potentially affecting daily functions such as learning in children and operating machinery or driving in adults. Due to these potential impairments, these older antihistamines can impact work performance and overall safety.
Eye Drops: Soothing Itchy, Watery Eyes
For eye-related allergy symptoms like burning, itching, redness, increased tearing, and swelling, allergy eye drops can provide targeted relief.
Antihistamine eye drops available include:
- Azelastine/Optivar
- Bepreve®
- Elestat®
- LASTACAFT®
- Opcon-A®
- Systane® ZADITOR®
- Patanol™
- Pataday®
Decongestants: Relieving Nasal Stuffiness
Decongestants are medications designed to shrink the lining of the nasal passages, effectively relieving nasal congestion or stuffiness. It’s generally recommended to use decongestants for short periods only, typically around 3 days. Carefully read and adhere to the product instructions and avoid extended use, as prolonged use of decongestant nasal sprays can lead to a rebound effect, paradoxically worsening congestion. Consult your doctor for guidance on appropriate decongestant use, limitations, and potential side effects.
Nasal spray decongestants include Afrin® and Vicks Sinex™. Oral decongestants are also available, such as SUDAFED®.
Some allergy medications combine an antihistamine and a decongestant for comprehensive symptom relief. Certain combination medicines, particularly those containing pseudoephedrine as the decongestant, may be available “behind the counter” at pharmacies, requiring consultation with pharmacy staff due to purchase limitations governed by state and federal laws.
Examples of decongestant + antihistamine combination medications include Allegra-D®, Claritin-D®, Clarinex-D, and ZYRTEC-D®.
If you have pre-existing conditions such as high blood pressure, heart disease, glaucoma, thyroid disease, or urinary problems, it’s crucial to check with your doctor before using decongestants. Decongestants may exacerbate these conditions or interact with other prescription medications you are taking.
Regulatory Changes Affecting Decongestants
It’s worth noting recent regulatory updates concerning decongestants. The oral form of phenylephrine (PE), a common ingredient in many over-the-counter decongestants, has been reviewed by an FDA expert panel. Studies suggest that oral PE is not effective in relieving nasal congestion at commonly used doses. The FDA is proposing to remove oral PE products from the U.S. market. This change would specifically affect oral forms and not nasal spray formulations of PE.
Decongestants containing pseudoephedrine (PSE) are regulated, requiring photo identification for purchase and are typically available behind the pharmacy counter.
Cromolyn Sodium: Preventing Allergy Symptoms
Cromolyn sodium nasal spray offers a different approach by preventing allergy symptoms before they start. It works by blocking the release of chemicals in the body, such as histamine and leukotrienes, that trigger allergic reactions. This medication has a favorable side effect profile but requires consistent use, typically three to six times daily. For optimal results, Cromolyn sodium should be used daily throughout your allergy season and can be started up to a week before the allergy season begins. NasalCrom® is a brand name for cromolyn sodium nasal spray.
Leukotriene Receptor Antagonists: Managing Asthma and Allergic Rhinitis
Leukotriene receptor antagonists, also known as modifiers, are oral medications that block the action of chemical messengers other than histamine that are involved in allergic reactions. These medications are beneficial in managing both asthma and allergic rhinitis symptoms. The frequency of administration varies depending on the specific medication. Discuss the appropriate use, benefits, and risks of these medications with your doctor.
Options in this category include ACCOLATE®, SINGULAIR®*, and Zyflo CR®.
*It’s important to be aware that montelukast (SINGULAIR®) carries a black box warning from the FDA due to the potential for serious mental health side effects. This highlights the importance of discussing any new medication with your healthcare provider to understand potential risks and ensure safe use. If your doctor recommends montelukast, have an open conversation about potential risks and concerns.
Medical Review: March 2025 by John James, MD
