[Editor’s note: This article was originally hosted on MyFamilyDoctorMag.com, our sister site.
It’s now featured here as part of our new general-health section.]

 

Antihistamines, decongestants, nasal sprays, injections… you just want to breathe again! But which of the plethora of allergy meds will do the trick?

That isn’t the only question you should be asking, according to Dennis Ownby, M.D., section chief of allergy and immunology at the Medical College of Georgia Health System. Once you choose one, you then need to know how to take it to get the most bang for your buck.

“Most people wait until they are sick and then jump from one medicine to another, complaining that none of them work,” Dr. Ownby says. “That’s like looking for your life jacket after you fall overboard in a storm.”  Here, he gives us the whats, whens and hows of allergy medicines.  In other words, everything your nose ever wanted to know.

How to Tell If You Have a Cold or Allergies

First things first: Is it a cold or allergies?  “If there’s fever present, it’s much more likely to be a cold,” says Dr. Ownby.  Also, a cold only lasts a few days (rarely more than 14).

On the other hand, you probably have an allergy if you notice that exposure to something in particular triggers your symptoms, or if you “wake up and then sneeze five, 10, 15 times in a row.”

Quick Tips for Allergy Relief
  1. Avoid the allergen, if possible.
  2. Irrigate in the morning and at night.
  3. Take an antihistamine every day during your allergy season.
  4. Take a decongestant as needed.
  5. If steps one through four don’t work, ask your doctor about prescription steroid nasal sprays or allergy shots.
When To Go To Your Doctor for Your Allergies

Whether you should visit a health-care provider “depends predominantly on the severity of the symptoms,” says Dr. Ownby.  If your seasonal allergies don’t interfere with your everyday life, you can treat them yourself.

How To Treat Allergies

“There are only three general ways to treat allergies,” Dr. Ownby says: avoiding the allergen, taking medication and getting allergy shots.  If avoidance isn’t an option, he suggests the following steps.

Allergy Treatment: Step 1: Antihistamines
Home Remedy for Allergies: Nasal Irrigation

Dr. Ownby’s tip: Irrigate often. “Normally, twice a day is sufficient. … Start it as soon as you have symptoms.”

How Nasal Irrigation Works
Nasal irrigation involves using saltwater to rinse out the inside of the nose, cleaning out allergens.

How to Irrigate Your Sinuses
Neti pots, which originated in India, are available for such use. “Another easy way to do it is to get the little rubber squeeze balls that are sold to suck things out of kids’ noses,” says Dr. Ownby.

For the irrigation solution, Dr. Ownby recommends mixing 1/2 teaspoon of table salt and 1/2 teaspoon of baking soda in 15 to 20 ounces of warm water. Others recommend 1/4 teaspoon in one or two cups of water. (If the ratio isn’t right, you’ll know it; it will burn.)

During the process of irrigation, the solution should go up your nostril and then out of your mouth or the other nostril.

Click here for an instructional video from the Himalayan Institute.

Dr. Ownby’s Tip: Start early, and keep it up.

“The problem I see with most people … is that they wait until their symptoms are very bad and then try to take an antihistamine,” says Dr. Ownby.  Allergy symptoms are like a snowball that starts small but then gets bigger, faster and more destructive. “If you wait until it’s really going, it gets very difficult to stop.”

So start the antihistamines at the beginning of your allergy season and don’t stop until it’s over.  If you’re allergic to something that’s present all year, he says, “by and large, there doesn’t seem to be any major danger of taking antihistamines year-round.”

How Antihistamines Work
Some people’s bodies perceive threats where there are none.  If yours thinks something like grass or cat dander is dangerous, it releases chemicals, including histamine, to get rid of the invader.  Histamine can cause itching, sneezing, runny nose, watery eyes, congestion, swelling—in other words, an allergic reaction.  Antihistamines prevent histamine from starting this reaction.

What Does “D” Mean on Allergy Medications?

Many over-the-counter allergy meds have the letter “D” at the end: Allegra-D, Claritin-D,Tavist-D.  These are antihistamines with an added decongestant.

Though taking one of them may be more convenient and cheaper than taking the antihistamine and decongestant separately, many doctors, including Dr. Ownby, recommend that you go the separate route. That way, you can take the antihistamine throughout your allergy season and just use the decongestant as needed, thus avoiding the risk of building a tolerance to the decongestant.

Antihistamine Side Effects
The main side effect is drowsiness, since histamine also helps your brain stay awake. The newer antihistamines, Allegra, Clarinex and Zyrtec, don’t get into your brain as much, so they’re less likely to make you sleepy. Over-the-counter loratadine (Claritin, Alavert) is also nonsedating, but, in Dr. Ownby’s opinion, “is not as effective.”

Older antihistamines, such as diphenhydramine (Benadryl), clemastine (Tavist) and chlorpheniramine (Chlor-Trimeton), are effective and may be less expensive than their newer counterparts.

How to Avoid Drowsiness With Antihistamines
Start slowly.  For example, says Dr. Ownby, “for Benadryl, the normal dose for an adult is 25 to 50 milligrams three to four times per day.”  Shocking your system with this much antihistamine all at once is bound to make you sleepy.  Instead, allow your body to adjust gradually beginning with 25 milligrams at bedtime.  (“The drowsiness is usually worse as the blood levels increase in the first four to six hours.”)  Then, increase the amount by 25 milligrams every three days until you’re at (not over) the maximum dosage.

Also, get enough sleep while you’re on antihistamines.  “It doesn’t take much to cause some additional drowsiness.”

Allergy Treatment Step 2: Decongestants

How Decongestants Work
By shrinking blood vessels and reducing swelling, thus unstopping your nose.

Down Side of Decongestants
You can’t take them all the time.“If you take them regularly, you develop some tolerance,” Dr. Ownby says.  So only use them as needed.  Decongestants can also have side effects, like increasing your blood pressure, and can “cause some people to be jittery or shaky.”

In addition to the pills, decongestant nasal sprays are available,but the body builds up a tolerance to them more quickly, so you shouldn’t use them more than three days in a row.

NasalCrom

One alternative to antihistamines and decongestants is NasalCrom. This non-steroidal nose spray, which does not cause drowsiness or jitteriness, is available over-the-counter for people 6 and older to treat runny, itchy, stuffy allergic noses, along with sneezing.

“It works by blocking the ability of the nose to have an allergic reaction,” says Dr. Ownby. “It doesn’t become addictive, but to get maximum benefit it has to be used at least four times a day.” While he finds that many adults think this regimen is inconvenient, the doc does recommend it for children “because it is so safe.”

Allergy Treatment Step 3: Prescription Steroid Nasal Sprays

How Steroid Nasal Sprays Work
By causing nasal blood vessels to shrink and inhibiting your immune system’s ability to attack the nose.

How to Use Steroid Nasal Sprays
Like antihistamines, you should use steroid nasal sprays continually throughout the season.  And the point is not to inhale the med but to get it directly onto the lining of your nose.  “Aim straight for the back of the head. Dr. Ownby advises—not too straight up or too much to one side.

Also, he says, prime (pump) the bottle if it hasn’t been used for “at least several days or a week.  To prime it every time you use it is just wasting medication, though.”

Two Side Effects of Steroid Nasal Sprays
Rarely, they can cause nasal septum perforation (a tiny hole in the nose).
If your nose starts bleeding and this lasts for more than a few hours, stop using the spray, cautions Dr. Ownby.  Steroid nasal sprays may also slightly increase your risk for cataracts.

By the way, these sprays are not addictive and Dr. Ownby notes that only “a very tiny fraction” of the steroids in the spray get into your system.

Important Note

Read the labels on all your medications.  The advice in this article (as with any article on this site) does not replace the directions, warnings and other information on medication labels, nor does it replace your doctor’s advice.  Some medicines are not safe for people with certain conditions.

Allergy Treatment Step 4: Allergy Shots

Dr. Ownby’s tip: Allergy shots are the only treatment designed to make you less allergic over time.

How Allergy Shots Work
Allergy shots increase your tolerance to allergens.
They’re “specific for each individual allergen,” says Dr. Ownby, “so you have to be tested to see what you’re allergic to,” usually through a skin test.  Most people then get a shot once or twice a week, eventually reducing that frequency to once a month.  “Typically, allergy shots are then continued over a period of three to five years. After that, most people can stop.”


Last updated and/or approved: July 2012. Original article appeared in spring 2006 issue of the former My Family Doctor magazine. Bios current as of spring 2006. This article is not meant as individual advice. Please see our disclaimer.

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Article last updated and/or approved: August 2009.Bios current as of spring 20