10 Things You Need to Know About Allergy Medications
By Dennis Williams, PharmD
Millions of people in the United States have allergies that cause significant discomfort in their sinuses, eyes and nasal passages. For some, it’s seasonal depending on what allergens are present. For others, symptoms are present year-round. Here are some tips to help you get the most out of medicines that treat allergy symptoms.
- Antihistamines are the most common medicines used to treat allergies.They block histamine, the chemical produced and released in allergic reactions that causes many of the symptoms of allergies and hay fever.
- Nonsedating antihistamines are now available that are much less likely to cause drowsiness and sleepiness when used as directed. Drowsiness as a side effect varies from patient to patient, but nonsedating antihistamines such as loratadine (Claritin®), fexofenadine (Allegra®), desloratadine (Clarinex®) and even cetirizine (Zyrtec®) are less likely to make you sleepy than medications such as chlorpheniramine (Chlor-Trimeton®), clemastine (Tavist®), or diphenhydramine (Benadryl®).
- All antihistamines start working quickly to relieve your allergy symptoms, so you notice improvements after a couple of doses. Nonsedating antihistamines may be slightly slower to take effect, but their effects also last longer. Most people won’t tell a difference in the onset of effect.
- Nasal corticosteroids are very effective for patients with nasal allergies. Used on a daily basis, these anti-inflammatory nasal sprays relieve many symptoms of allergies, including runny nose and congestion. They can be used alone or along with antihistamines. Now some nasal corticosteroids are available over-the-counter (OTC), without a prescription.
- For relief of mild symptoms of nasal itching and congestion, some patients benefit from a saline nose spray. This is a mild saltwater solution (kind of like the ocean water) that can have a soothing effect when sprayed into the nose. You can think of it as a moisturizer for the nose. It also helps break up mucus in your nasal passages.
- People with seasonal allergies should start using antihistamines or nasal corticosteroids before the expected allergy period to get the best results. While some of these medications can relieve symptoms quickly, their long-term effectiveness builds up slowly. Starting medicine before an active pollen season can reduce most of the problems.
- Topical nasal decongestant sprays (such as Afrin® or NeoSynephrine®) are very effective for short-term symptom relief. Decongestant sprays should never be used for more than three to five days in a row; after that, they can actually increase congestion. This fancy name for this is rhinitis medicamentosa. This is not a problem with liquid or tablet decongestants.
- Now that people can get nasal corticosteroids without a prescription, it is important to know how to use them in the safest way possible. The best technique is to use your opposite hand to administer the nasal spray to the nostril; use your left hand to administer to the right nostril and your right hand to administer to the left nostril. This directs the spray away from the nasal septum (middle of the nose) and should reduce side effects and any other problems.
- Ipratropium nasal spray (Atrovent®) is helpful for patients with vasomotor rhinitis. This type of rhinitis is not considered to be caused by allergies. Patients with this problem generally have frequent runny noses with a clear discharge.
- There are still products for allergies that are available only by prescriptions. These include some oral, nasal and ophthalmic antihistamines, some nasal corticosteroids, and leukotriene blockers such as montelukast. Also, now there are allergy desensitization products that can be placed under the tongue, and may replace allergy shots for some patients with serious allergy problems. Talk with your allergist about these products.
Dennis Williams, PharmD, is Associate Professor, Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina School of Pharmacy, Chapel Hill. He is a member of Allergy & Asthma Network’s Board of Directors.