Allergy Medication & Treatment

 

How are allergies treated?

Several treatment options are available for allergies including:

  • avoidance of allergens
  • medication
  • nasal sprays and washes
  • allergen immunotherapy

What medications are used to treat allergies?

The wide range of allergy medicines may seem overwhelming – but if you understand how different medications treat allergies, you’re one step closer to control.

Read medication labels carefully and follow dosing and safety instructions.

Talk with your allergist or pharmacist about any possible side effects, especially if you’re a woman who is pregnant or breastfeeding.

Antihistamines

Antihistamines are the most common medicines used to treat allergies. They are available over-the- counter and by prescription. Taken as pills, liquids, nasal sprays or eye drops, they can be used by both children and adults.

Antihistamines do exactly what they describe – they block histamine, the chemical released in allergic reactions that causes allergy symptoms, including sneezing, runny nose, hives and red, itchy, watery eyes.

Antihistamines can be used on an “as needed” basis because they relieve symptoms quickly, but they become more effective when used daily. It’s best to use them before your allergy season begins to build long-term effectiveness.

Dozens of brand name and generic antihistamines are available; talk with your doctor about which is best for you.

First-generation antihistamines such as diphenhydramine (Benadryl®) tend to make you drowsy; don’t take them when you have to do any activities that require you to be alert. Also, recent research suggests there’s a link between long-term use of Benadryl and memory loss, so be sure to talk with your doctor before using Benadryl.

Newer antihistamines such as loratidine (Claritin®), fexofenadine (Allegra®), desloratadine (Clarinex®) and cetirizine (Zyrtec®) cause less drowsiness.

Nasal Corticosteroid Sprays

Nasal corticosteroid sprays and eye drops are designed to prevent and soothe inflammation in nasal tissues and airways. They are available over-the-counter and by prescription.

These non-sedating medications treat congestion, sneezing, runny nose and irritated, watery eyes; they start working quickly, but you may not feel the full effects for several weeks.

Doctors generally recommend that you start taking these medications a few weeks before your allergy season starts, or regularly if you have year-round symptoms.

Proper technique is critical to get the results you need for relief from symptoms. Here are step-by-step instructions for using a nasal spray:

How to Use a Nasal Spray

Read the package insert instructions for patients before using the first time, as each medication is different. Look for information on how to prime and clean; how to hold and position the canister or pump; and whether to inhale or not.

  1. Prime the spray as directed before the first use or if you haven’t used it in a while.
  2. Blow your nose gently to clear out mucus before using the spray. This will allow the medicine to get up into the nasal passages. If you are severely congested, you may need a nasal wash or a decongestant for a few days to open up your nose before you spray.
  3. Gently insert the tip of the nasal spray ¼ to ½ inch into your nose. (It’s designed not to go too far; don’t try to push it in and avoid touching the septum with the tip of the nasal spray.) Point it away from the center of your nose, toward your ear, ensuring the spray reaches the back of your nose and less medicine ends up on your septum (the tissue separating the two sides of your nose), which can be damaging. Try holding the spray with your left hand when applying to the right nostril, then switch for the other side.
  4. Lean forward slightly, press and close the nostril you are not treating. If instructed, inhale gently through the other nostril as you release the spray. Some nasal sprays do not require you to inhale; others may recommend you lean your head back instead of forward.
  5. Exhale through your mouth. Do not blow your nose for at least 15 minutes after using the spray; just wipe away any liquid that drips.
  6. Wipe the spray tip clean after every use and replace the cap. If it becomes clogged, check your manufacturer’s instructions for cleaning, but do not use a pin or other instrument to enlarge the hole.
  7. Keep track of the doses and priming sprays used and replace your nasal spray after you have used the recommended number. There may be liquid left in the container after all the doses have been used, but the medication mix is not likely to be accurate.

Leukotriene Modifiers

Leukotriene modifiers treat allergic rhinitis. They are designed to block leukotrienes, chemicals involved in allergic reactions such as inflammation, swelling and constriction of airways.

Montelukast (Singulair®) is a leukotriene modifier available by prescription as tablets, chewable tablets and sprinkles (for children).

Montelukast is prescribed for adults and children ages 6 years and older. Your doctor will advise you on the best time of day to take the medication. It is recommended that it be taken at the same time every day.

Mast Cell Stabilizers

Mast cell stabilizers prevent the release of histamine that causes inflammation. They address symptoms such as runny nose, stuffy nose, sneezing, postnasal drip and itchy eyes.

Cromolyn sodium (Nasalcrom®) is available as an over-the-counter nasal spray and prescription and over-the-counter eye drops.

They work best if used at least one week before your allergy season begins. They do not treat allergy symptoms that have already begun.

Doctors generally recommend that you start taking these medications a few weeks before your allergy season starts, or regularly if you have year-round symptoms.

Anticholinergics

Anticholinergics treat seasonal allergic rhinitis and nonallergic perennial rhinitis and relieve runny nose symptoms – usually when it’s a clear discharge – by reducing the formation of mucus.

Ipratropium bromide (Atrovent®) nasal spray is a prescription anticholinergic medication. Side effects may include nose dryness and irritation.

Understanding Allergies printed out and bound in magazine form

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What is Allergen Immunotherapy?

Allergen immunotherapy helps build a patient’s tolerance to allergens, reducing or eliminating symptoms. It works by the patient being given a gradually increasing amount of the allergen on a regular schedule, until a maintenance level is reached.

Tolerance for the allergen typically continues after immunotherapy ends – however the long-term success rate varies from person to person.

Immunotherapy is proven to be successful for pollen, mold, animal dander, house dust mites, cockroach allergens and insect venom hypersensitivity.

In addition to reducing allergy symptoms, immunotherapy may help prevent new allergies and stop the progression of allergic diseases from rhinitis to eczema and asthma. It can also help control allergic asthma by interrupting the allergic response that sets off symptoms.

Talk with your allergist to determine if immunotherapy is right for you or your child.

photo of nurse giving a person a shot in the arm

Allergy Shots

Allergy shots – also called subcutaneous immunotherapy (SCIT) – are the most common form of immunotherapy. Several different allergens can be combined into one injection, helping to build tolerance to multiple allergens at once.

There is no age restriction for undergoing allergen immunotherapy. Shots are administered in a board-certified allergist’s office once or twice weekly. That schedule will continue for about 6-12 months, as your allergist increases the level of allergen extract in your injections until the maintenance dose is reached.

Depending on your response to therapy, your allergist may then decrease the frequency of your shots from once a week to once a month. If you are doing well after 3-5 years and no longer need most or all allergy medications, your allergist may discontinue immunotherapy.

While serious allergic reactions to allergy shots are rare, the procedure should be conducted in an allergist’s office equipped with epinephrine auto-injectors in case a serious reaction such as anaphylaxis occurs. Always remain at the allergist’s office for a full 30 minutes following the injection. A reaction can happen hours later, however, so be sure to carry epinephrine auto-injectors with you. If anaphylaxis symptoms occur – difficulty breathing, tightness in the throat, hives or swelling, nausea, vomiting, fainting, diarrhea or abdominal pain – immediately administer the epinephrine auto-injector and seek emergency treatment.

How long are allergy shots effective?

Allergy shots lead to a long-lasting reduction of symptoms for many people; others may lose their immunity at some point and choose to resume allergy shots.

If you completed allergen immunotherapy and are experiencing symptoms, see your allergist for testing and treatment. It may not necessarily be old allergies returning; it’s possible you developed a new allergy, perhaps after moving or starting a job in a different environment.

Under-the-Tongue Tablets

Sublingual immunotherapy (SLIT) involves taking a daily allergy tablet that dissolves under the tongue. The goal is the same as an allergy shot: to boost tolerance to allergens.

SLIT tablets approved by FDA treat grass and ragweed pollens and house dust mites. Each SLIT tablet covers one type of allergen. The first dose is administered in the doctor’s office, similar to allergy shots, and then patients can take the tablets at home – but epinephrine auto-injectors must be available in case of anaphylaxis.

NOTE: Patients using SLIT tablets for grass and ragweed pollen should start taking them 3-4 months (depending on the tablet given) prior to the start of their pollen season, as well as during pollen season, for best effectiveness. Tablets for certain grass pollens are available for children as young as 5 years old; ragweed tablets are for patients 18-65.

Patients using SLIT tablets for house dust mites should take them year round. It can take 8-14 weeks of daily dosing to experience a noticeable benefit. The tablets are indicated for patients 18-65 years of age.

Do saline sprays and nasal washes relieve allergy symptoms?

Saline sprays and nasal washes are common natural treatment options to reduce allergy symptoms and provide some relief.

Saline sprays

Saline sprays are saltwater solutions – they do not contain any medication. Available over-the-counter for both adults and children, they flush out irritated nasal passages caused by colds or allergies, or overuse of decongestant nasal sprays.

Think of them as a moisturizer for the nose that can also cleanse the nasal membranes. They may be especially helpful in winter when the air is cold and dry.

Ask the Allergist covers Allergy Immunotherapy Options in this Q & A

Nasal rinses and washes

Nasal washes are helpful for people of all ages who experience congestion and postnasal drip. A solution of saltwater (sodium chloride) and baking soda (sodium bicarbonate) in a rinsing device can help shrink swollen membranes, improve airflow and open sinus passages. Buy premixed solution packets at pharmacies or allergy supply stores – or make your own.

Choose Your Rinsing Device :

  • Flexible plastic squeeze bottles (often included in pharmacy kits)
  • Bulb or ear syringe (available at most pharmacies)
  • Large medical irrigation syringe (30cc)
  • Battery-powered sinus irrigator
  • Neti pot, which is like a teapot with a long spout

Fill the rinsing device with the saline solution. Stand over the sink or in the shower and squirt the mixture into your left nostril, aiming the stream toward the back of your head, not the top. Don’t inhale. Tilt your head forward, touching your chin to your chest to allow excess solution to drain out of your nose. If it drains into your mouth instead, simply spit it out or hold a washcloth in front of you.

Repeat the process with the right nostril. Continue alternating nostrils several times until you run out of solution. If you notice a mild burning sensation in your nose, add water to your solution to reduce the concentration of salt.

Ideally, the solution squirted into the left nostril will swirl around the back of your nose and come out the right side. Don’t be surprised if nothing flows on the first try. The crusts and/or mucus plugs will soften after a few minutes, so wait a little and give it another go.

If you use a nasal corticosteroid spray, always do the nasal wash before using the spray. The medication works better and reaches deeper into the nose and sinuses when it is sprayed onto clean and decongested nasal membranes.

For children: Put the solution into a small spray container, like a saline spray bottle. Squirt it several times into each nose. The child should not lie down; it’s easier and more comfortable to do when sitting or standing.

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