Allergy
How is it treated?
The main goals for treating allergic rhinitis are to minimize or prevent allergy symptoms and help allergy sufferers maintain normal daily activities and lifestyles.
The most effective treatment for allergies is to avoid what is causing the symptoms. If this is not possible, then medication selection should be based on the symptoms the individual is experiencing.
Generally speaking, if you have nasal congestion, an oral or nasal spray decongestant should be used. For symptoms such as runny nose, sneezing, or itchy/watery eyes, an antihistamine should be used. A combination of these medications can be used if you have both symptoms. For patients experiencing seasonal allergic rhinitis, treatment should be started 10-14 days before the allergy season when symptoms are expected to appear and should be continued for 2-3 weeks after the end of the allergy season to alleviate persistent symptoms.
Most physicians try to follow a stepwise approach to treating allergies based on the severity and frequency of allergy symptoms:
For Mild, Infrequent Allergic Rhinitis Symptoms:
For allergy symptoms such as a runny nose, watery/itchy eyes, or sneezing that occur infrequently, most individuals can be treated sucessfully with an oral non-sedating antihistamine such as loratadine (Claritin), desloratadine (Clarinex), fexofenadine (Allegra), cetirizine (Zyrtec), levocetirizine (Xyzal) or or an antihistamine nasal spray such as azelastine (Astelin) to be taken on an as needed basis when allergy symptoms arise. Another option may be to try to prevent allergy symptoms before the anticipated allergen exposure by using cromolyn (Nasalcrom) nasal spray prior to exposure to the allergen. Cromolyn nasal spray is also recommended for kids. Cromolyn (Nasalcrom) nasal spray, loratadine (Claritin), and cetirizine (Zyrtec) are products that are available over-the-counter without a prescription.
For infrequent nasal decongestion, over-the-counter oral decongestants such as psuedoephedrine (available behind the pharmacy counter without a prescription) or nasal spray decongestants such as phenylephrine (Neo-Synephrine products) or oxymetolazone (Afrin products) can be tried. Nasal spray decongestants will provide quicker relief but oral decongestants may provide longer relief of congestion. These products should be used on an as needed basis for no longer than 3 to 5 days.
For Persistent, Mild-to-Moderate Allergic Rhinitis Symptoms:
Treatment options include oral non-sedating antihistamines as listed above but taken on a daily basis. For individuals who have nasal congestion along with a runny nose, itchy/watery eyes, or sneezing, a combination non-sedating antihistamine/decongestant product can be tried such as Claritin-D, Allegra-D, or Zyrtec-D. Nasal corticosteroids such as beclomethasone (Beconase, Vancenase), budesonide (Rhinocort), flunisolide (Nasalide, Nasarel), fluticasone (Flonase), triamcinolone (Nasacort), or mometasone (Nasonex) may also be tried as separate therapy or added to antihistamines and decongestants. For children with persistent, mild-to-moderate allergy symptoms, cromolyn (Nasalcrom) nasal spray or an oral non-sedating antihistamine approved for use in children may be tried.
For Severe Allergic Rhinitis Symptoms:
For patients with severe allergy symptoms, nasal corticosteroids will most likely be needed along with a non-sedating antihistamine (with or without a decongestant). Cromolyn (Nasalcrom) nasal spray should be used in children. If needed, a short course (meaning 3 to 10 days) of oral corticosteroids can be used. For individuals with severe allergies, referral to an allergy/immunolgy specialist or an "ear, nose, and throat" allergy specialist is recommended.
Other allergy therapies include ipratropium nasal (Atrovent), a nasal spray sometimes used for individuals who have a runny nose from allergies. Older antihistamines such as diphenhydramine (Benadryl), brompheniramine (Brovex), chlorpheniramine (Chlor-Trimetron), and clemastine (Tavist) are also available and can be used to treat allergy symptoms like runny nose, itchy/watery eyes, and sneezing, but these older antihistamines can cause drowsiness and sedation more so than the newer non-sedating antihistamines.
Immunotherapy may also be considered but it is expensive, has certain risks, and requires a significant time commitment by the individual suffering from allergies. Immunotherapy is a series of injections where gradually increasing doses of antigens (substances that are responsible for triggering an allergic response) are injected into the patient in hopes to build tolerance to the allergen.
To learn more about the individual drugs used to treat allergies, click on the drug links below.
Drug classes used to treat Allergy Antihistamine and Decongestant Combinations Antihistamines Decongestants Leukotriene Modifiers Nasal Anticholinergics Nasal Corticosteroids Nasal Decongestants Nasal Mast Cell Stabilizers
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How is it treated?
