Part 3 in my three-part seasonal allergies series. Click here for part 1 (how allergies work). Click here for part 2 (how to choose an antihistamine).

5 types of allergy medicines that may work better for you than plain antihistaminesby James Hubbard, MD, MPH

Have you chosen an antihistamine to try out or to store in your survival stash? Well, we’re not done yet. You may want to add an additional medication or two to your seasonal-allergies arsenal.

That’s because antihistamines don’t do the trick for everyone. But there are other types of allergy medications that might. They can be used in addition to or instead of antihistamines (and each other). It’s a mix-and-match world. Just be aware that each med you take brings its own risk of side effects, interactions, and so on. Read up on precautions before diving in.

As with antihistamines, the following medicines work great in some people and not so great in others. Trial and error will help you decide.

Decongestants

Why you might consider them: You have a stopped-up nose or bloodshot eyes.

Tip: If the letter D is added to the end of an antihistamine (like Allegra-D or Claritin-D), it usually contains a decongestant. Read the ingredients for more specifics. If you use a nasal spray decongestant, watch out for rebound congestion. (Read on for more about that.)

Details: Histamines—those substances your body releases that cause allergy symptoms—tend to enlarge blood vessels. Decongestants constrict them. As a result, decongestants shrink the swollen nasal tissues and can help you breathe better.

Your options are:

  • Oral decongestants, such as pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE). Pseudoephedrine may be a little harder to find these days since it’s a common ingredient for making methamphetamine (meth).
  • Nasal spray decongestants, including oxymetazoline (Afrin Nasal Spray) and phenylephrine (Neo-Synephrine).
  • Decongestant eye drops, which decrease eye redness and swelling.

Decongestants work pretty quickly—the nasal sprays within minutes. They do tend to cause side effects, such as a jittery feeling, anxiety, or insomnia. They also may raise the blood pressure significantly or cause heart rhythm problems. And they can cause many of the same side effects as the antihistamines, including trouble with urinating.

Nasal decongestants can cause all of the same side effects as the oral ones but are less likely to do so. A big problem for them is if you use the spray for more than three days in a row you run the risk of rebound congestion, which means every time you try to stop them, allergies or not, your nose gets really congested. The more often you use the spray, the higher the risk for rebound. Once it occurs, most people get relief by reusing the nose spray, but soon, it starts not working as well, and you need more. At some point, it stops working. The treatment is stopping the nose spray and waiting sometimes many weeks for the congestion to get better. Oral steroids may also help.

Mast Cell Stabilizers

Why you might consider them: You need something for sneezing and an itchy, runny nose.

Tip: These are preventive, so you really want to start them early on—even before symptoms start.

Details: Mast cell stabilizers, such as cromolyn sodium (Nasalcrom, Crolom), were expected to be big sellers years back when these nasal sprays first were released for over-the-counter use. Perhaps the reason they haven’t been is you have to use the spray every four to six hours, and it can take up to about two weeks to be effective.

Nasal Steroid Sprays

Why you might consider them: You need something for sneezing and an itchy, runny nose.

Tip: The main drawback of nasal steroid sprays is they can take from several days to a couple of weeks to become effective. Needless to say, you need to use them regularly.

Details: Nasal steroid sprays are the newest allergy medicines to go over-the-counter. They work by decreasing the inflammation in the lining of your nose. They have few side effects other than possible nasal irritation, sometimes enough to cause nosebleeds. Still, read the side effects since there is a chance a small amount might get into your system.

The two currently available are triamcinolone (Nasacort) and fluticasone (Flonase).

What Allergy Medicine Combination Would I Take?

If I needed to take an over-the-counter combo for seasonal allergies, I’d probably use the following:

  1. An antihistamine
  2. A nasal steroid spray (which may take a week or more to work; that’s why I’d start with the fast-acting antihistamine)
  3. A decongestant—but only on occasion because I wouldn’t want rebound congestion
  4. Antihistamine eye drops (and/or decongestant ones) if this regimen didn’t clear up my eyes

If I had asthma, I’d scratch all this and try a nasal steroid inhaler first. If that didn’t help, I’d talk to my doctor about prescription leukotrienes.

Different people are different though. Your preferences may vary.

Leukotriene Modifiers

Why you might consider them: You have asthma, and steroid nasal sprays aren’t fighting your sneezing and itchy, runny nose well enough. (Some people without asthma also use leukotrienes.)

Tip: Leukotriene (pronounced loo-koh-tri’-een) modifiers are available by prescription only.

Details: Leukotrienes are another substance the immune system lets loose that can cause allergy symptoms. Medicines like zafirlukast (Accolate), montelukast (Singulair), and zileuton (Zyflo) can inhibit their action. Leukotriene modifiers can be particularly helpful in people who have asthma because they don’t dry out the airways as much as antihistamines do.

Oral or Injectable Corticosteroids

Why you might consider them: Some doctors prescribe these to tide you over until other allergy medicines kick in or for short-term, occasional use for bad symptoms.

Tip: Corticosteroids are available by prescription only.

Details: These are the big guns. They work great. The problem is they can cause a lot of serious side effects, especially if used long-term.

Examples are prednisone, dexamethasone (Decadron), and many others.

Subcutaneous Immunotherapy (SCIT)

Why you might consider it: Other drugs aren’t doing the trick or you just want to try this option so you can get off some of your medications.

Tip: This is a series of shots, but there’s a similar therapy that’s popular in Europe that involves simply letting a tablet melt under your tongue. If you’re interested, ask your allergist whether it’s available in your area yet.

Details: You’ll start with a test to see what you’re allergic to. Then you’ll get or give yourself periodic shots (usually weekly) that contain extremely low doses of the allergen. You’ll do this for three to five years. The hope is your body will get more used to these allergens so you won’t have such a bad reaction.

SCIT is more expensive than the other allergy-treatment options I’ve talked about, and people do rarely have severe allergic reactions to the shots. SCIT works better on some people than others. Even after you complete the injection course, you probably still can’t go rolling around in whatever you’re allergic to and expect not to have symptoms. There’s also SCIT for beestings and other allergies besides seasonal ones.

 

Whew. That’s a lot of allergy medicine options. It may seem like overkill, but some people have to go through quite a bit of trial and error before they find something that works for them. The good news is there are more choices than ever before.

What’s been your experience?

 

This has been the final installment of my seasonal allergies series. Click here for part 1 (how allergies work). Click here for part 2 (how to choose an antihistamine).

Photo: Flickr/Jason Hollinger, “Sweet Vernal Grass,” shared via CC BY 2.0.

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