A primer on allergy medicines
By Louis Neipris, MD — A trip to the drug store to find relief for allergy symptoms such as sneezing, itchy eyes and runny nose can be overwhelming. If the rows of over-the-counter remedies don’t intimidate you, then the prescription options might.
Whether your allergy symptoms trouble you once or twice a season, or last year-long, a review of allergy meds is in order. Learn all you can about over-the-counter and prescription options to help you make the best choice to manage your allergy symptoms.
Antihistamines block histamine, a chemical released during an allergic reaction. By blocking histamine, the symptoms of allergy can be reduced. Antihistamines work especially well against nasal itch, sneezing and watery, runny nose. They are sold as liquid, tablets, time-release capsules and nasal sprays. Several are available over the counter.
Sedating drugs. These include allergy-fighting classics such as diphenhydramine (Benadryl) and brompheniramine (Dimetapp). But, they can make you sleepy and have other side effects, such as:
Trouble urinating, especially for men with prostate enlargement Dry mouth Constipation Nightmares and irritability in some children Non-sedating drugs. These include cetirizine (Zyrtec), fexofenadine (Allegra) and loratadine (some brand names are Alavert and Claritin). Some are available over the counter, others by prescription. They are not as sedating as older antihistamines and are also less likely to cause other side effects. For this reason, they are often prescribed first. Antihistamine nasal spray. Azelastine (Astelin) is available by prescription.
These drugs constrict blood vessels, which reduces the amount of fluid that leaks out into the lining of the nose. This relieves nasal swelling and congestion. Look for the words “pseudoephedrine” or “Phenylephrine” on the label. Potential side effects include:
Insomnia Nervousness Increased heart rate Irregular heart beat Increased blood pressure
These are not recommended if you have certain medical problems including high blood pressure, heart disease or glaucoma (elevated pressure in the eye).Talk to your doctor before using them if you have any medical conditions or take other medications.
Decongestant nasal spray. If you use a nasal spray more than three or four days in a row, you can develop rebound rhinitis. This means that your nasal passages become dependent on the nasal spray. The congestion returns after you stop using the nasal spray after four days.
Controller medicines help stop the underlying inflammation that can lead to allergy. They are also taken for asthma. They are:
Mast cell stabilizers. These are non-steroid medications that prevent the release of inflammatory chemicals. They include the prescription drug cromolyn, which comes as an inhaler (Intal) and nasal spray (NasalCrom). Corticosteroids. These are not the anabolic steroids that are abused by some athletes. They are anti-inflammatory medicines. Nasal steroids are sprayed into each nostril every day during allergy season. These include beclomethasone (Vancenase) and budesonide (Rhinocort). Leukotriene inhibitors. These block the chemical leukotriene, which can also lead to allergy symptoms. Monoluekast (Singulair) is a prescription leukotriene pill that you take once a day for indoor or outdoor allergies.
Decongestants are often combined with antihistamines. Several combination products are available over the counter and include:
Zyrtec D Claritin D
Drug-free over-the counter products
Saline (salt-water solution) is sold as a nasal spray that can help relieve congestion. You spray the solution into each nostril to loosen mucous and prevent crusting.
Artificial tears are drops you apply to each eye. They can help relieve any dryness of the eyes that may go along with nasal allergies in some people.
What else do I need to know about allergy meds?
Talk to your doctor before you take any over-the-counter medicines. This is especially important if you are pregnant or have any medical problems or allergies or if you take any other medications.
Carefully read and follow all instructions on the label. If you have any questions about interactions with food or other drugs, talk to the pharmacist, even about over-the-counter medicines.
See your doctor if your symptoms are severe, don’t improve after taking medication or if:
You start to wheeze You develop a cough Clear runny nose becomes thick, yellow mucous You start having headaches Your ear starts to ache You develop a fever
American Academy of Allergy, Asthma and Immunology. AAAAI allergy and asthma medication guide. Accessed: 05/12/2009 American Academy of Allergy, Asthma and Immunology. Tips to remember: asthma and allergy medications. Accessed: 05/12/2009 Sadovsky R. Overview of methods for treating allergic rhinitis. American Family Physician. 2000;61(1):192. Accessed: 05/12/2009 Orban NT, Saleh H, Durham SR. Allergic and non-allergic rhinitis. In: Adkinson NF, Bochner BS, Busse WW, Holgate ST, Lemanske Jr RF, eds. Adkinson: Middleton’s Allergy: Principles and Practice, 7th edition, Philadelphia, PA: Mosby Elsevier; 2008.