Whether your nasal allergies are seasonal or year round, you may feel like you’re always being bombarded with ads for a dizzying array of products that promise to treat your itchy, red eyes and runny, stuffy nose. But what allergy medicine works best?
An updated clinical guideline for allergic rhinitis, or hay fever, from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) can help you and your doctor sort out the various therapies.
“While a wide variety of treatment options are available to combat the con- dition’s hallmark symptoms, the way these treatments are used varies widely,” says Lee M. Akst, M.D., an assistant professor of otolaryngology–head and neck surgery and director of the Voice Center at Johns Hopkins University School of Medicine in Baltimore. “The guideline helps clarify the most effective treatments as well as identifies therapies that have little or no evidence to back up claims of symptom relief.”
The allergy medicine that you and your doctor choose depends on your symptoms, their severity, and how often they occur as well as your overall health. Below is a brief overview of some recommendations from the AAO-HNS guideline:
1. Steroidal nasal sprays. The first line of treatment to relieve bothersome symptoms should be a steroid spray, such as Flonase or Nasacort, both available over the counter (OTC), and Nasonex, which is prescription-only.
2. Oral antihistamines. If sneezing and itching are your main complaints, try an OTC allergy medicine like Claritin or Zyrtec, which are “second-generation” antihistamines. They can begin relieving symptoms shortly after you take them. Avoid older, first-generation antihistamines like Benadryl, Dimetapp, Chlor-Trimeton, and Tavist, which can cause significant sedation and make you sleepy. In older adults, they can cause dry mouth and eyes, difficulty urinating, and confusion. Note that some second-generation anti- histamines are labeled “nondrowsy,” but they may still have a sedating effect on certain people.
3. Antihistamine nasal sprays. Prescription antihistamine sprays are options if you have seasonal, perennial (year-round) or occasional allergies. They work better for nasal congestion than oral antihistamines, but they can leave a bitter taste in your mouth that some people find off-putting. Sprays include Astelin, Astepro, and Patanol.
4. Combination therapy. If a nasal spray or an antihistamine doesn’t relieve symptoms on its own, combining two or more allergy medicines may do the trick. Dymista is a prescription combination of the nasal steroid fluticasone (Flonase) and the nasal antihistamine azelastine (the generic version of Astelin and Astepro) that can improve symptoms better than either drug alone. Your doctor may also prescribe two drugs, such as a steroidal nasal spray and an oral antihistamine.
5. Immunotherapy. Allergy shots, or immunotherapy, may succeed when allergy medicine has failed. The shots work by helping you build up resistance to the allergen so you’re no longer bothered by symptoms. The downside of immunotherapy is the long-term commitment: You’ll need to visit your doctor for weekly injections of a solution that contains the allergen(s) you’re allergic to for several months and then continue monthly maintenance injections for three to five years. Sublingual immunotherapy is a newer form of the therapy, which involves placing a pill that dissolves under your tongue each day. It may be more convenient but works with only grass and ragweed allergies.
6. Acupuncture. If you want to avoid drugs, consider trying acupuncture. Some studies have shown that it may be more effective for perennial allergies, but its overall benefit is probably limited.
7. Herbal remedies. The guideline doesn’t recommend Chinese herbal therapies, such as butterbur and biminne, because of the small size and quality of studies, along with concern about the inconsistent quality of herbal remedies themselves and their safety.
Avoiding allergy triggers may also reduce symptoms, Akst says. Depending on the triggers, measures such as using pillow and mattress covers, washing sheets and blankets weekly in warm water and then drying them on the dryer’s hot setting, dusting regularly, and using a vacuum with a HEPA filter can help reduce allergens, but it’s not clear how well they actually reduce symptoms.
Removing pets from your home can help, too. But that’s not an option for most people. Instead, you can try keeping animal dander to a minimum by washing your dog at least twice a week and your cat once a week, which may or may not help keep your symptoms at bay.