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Treatment of Allergic Rhinitis

Medications for Hay Fever


Updated August 10, 2014

Treatment of Allergic Rhinitis
Updated August 10, 2014

Hay Fever Treatment: Use of Medicines for Allergies

When avoidance measures fail or are not possible, many people will require medications to treat their allergic rhinitis symptoms. The choice of medication depends on numerous questions to be answered by the person or person’s physician:
    1. How severe are the symptoms?
    2. What are the symptoms?
    3. What medication can the person get (over the counter, prescription)?
    4. What medication will the person take?
    5. Is the medication needed daily or intermittently?
    6. What side effects might the person experience from the medications?

Oral anti-histamines. This is the most common class of medications used for allergic rhinitis. The first generation anti-histamines, which includes Benadryl®, are generally considered too sedating for routine use. These medications have been shown to affect work performance and alter a person's ability to operate an automobile.

Newer, second-generation anti-histamines have now become first-line therapy for people with allergic rhinitis. These prescription medication include cetirizine (Zyrtec®), fexofenadine (Allegra®), and desloratadine (Clarinex®). Loratadine (Claritin®, Alavert® and generic forms) is now available over the counter.

These medications have the advantage of being relatively inexpensive, easy for people to take, start working within a few hours, and therefore can be given on as “as needed” basis. The medications are particularly good at treating sneezing, runny nose, and itching of the nose as a result of allergic rhinitis. Side effects are rare, and include a low-rate of sedation or sleepiness, but much less than the first-generation anti-histamines.

Topical nasal steroids. This class of allergy medications is probably the most effective at treating nasal allergies, as well as non-allergic rhinitis. There are numerous topical nasal steroids on the market, and are all available by prescription. Some people note that one smells or tastes better than another, but they all work about the same.

This group of medications includes fluticasone (Flonase®), mometasone (Nasonex®), budesonide (Rhinocort Aqua®), flunisolide (Nasarel®), triamcinolone (Nasacort AQ®) and beclomethasone (Beconase AQ®).

Nasal steroids are excellent at controlling allergic rhinitis symptoms. However, the sprays need to be used daily for best effect and therefore don’t work well as needed. Side effects are mild and limited to nasal irritation and nose bleeds. The use of these nasal sprays should be stopped if irritation or bleeding is persistent or severe.

Other prescription nasal sprays. There are two other prescription nasal sprays available, a nasal anti-histamine and a nasal anti-cholinergic. The anti-histamine, azelastine (Astelin®), is effective at treating allergic and non-allergic rhinitis. It treats all nasal symptoms similar to nasal steroids, and should be used routinely for best effect. Side effects are generally mild and include local nasal irritation and some reports of sleepiness, as it is a first-generation anti-histamine.

Nasal ipratropium (Atrovent nasal®) works to dry up nasal secretions, and is indicated at treating allergic rhinitis, non-allergic rhinitis and symptoms of the common cold. It works great at treating a “drippy nose”, but will not treat nasal itching or nasal congestion symptoms. Side effects are mild and typically include local nasal irritation and dryness.

Over-the-counter nasal sprays. This group includes cromolyn nasal spray (NasalCrom®) and topical decongestants such as oxymetazoline (Afrin®) and phenylephrine (Neo-Synephrine®). Cromolyn works by preventing allergic rhinitis symptoms only if used before exposure to allergic triggers. This medication therefore does not work on an as-needed basis.

Topical decongestants are helpful in treating nasal congestion. These medications should be used for limited periods of 3 days every 2-4 weeks; otherwise there can be a rebound/worsening of nasal congestion called rhinitis medicamentosa.

The side effects of the above are both generally mild and include local nasal irritation and bleeding, but topical decongestants should be used with caution in patients with heart or blood pressure problems.

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