SpringAllergies2Q: “My allergies always hit hard in the spring. How do I know which product in the pharmacy aisle is best for me? And when is it important I go see a doctor?” 

Martha White, MD: As a first line of treatment, the best option in terms of over-the-counter allergy medications are – in my opinion – non-sedating antihistamines. They are designed to treat allergic rhinitis symptoms (stuffy or runny nose, sneezing, postnasal drip, itchy eyes, ears or throat) and hives.

Two nonsedating antihistamines are currently approved for use: loratadine (Claritin®) and fexofenadine (Allegra®). A third option, cetirizine (Zyrtec®), has a sedation rate of 13.7 percent, just past the cutoff point for being classified as nonsedating.

Each are available in generic forms. Not all people respond to medications the same, but in clinical trials, fexofenadine and cetirizine were similarly effective, with both demonstrating superior efficacy compared with loratadine.

Nonsedating antihistamines are available in pill and liquid forms, and can be used by both children and adults. They provide 24-hour relief, and are also available combined with decongestants if significant congestion is a problem. Decongestant versions are “behind” the counter but don’t require prescriptions.

Meantime, the U.S. Food & Drug Administration (FDA) recently approved a nasal corticosteroid spray, Nasacort®, for over-the-counter use in children and adults. It’s expected to be available for the spring allergy season.

Nasal corticosteroid sprays, when used on a daily basis, can help prevent and treat allergic reactions to inhaled allergens such as tree and grass pollen. Unlike nasal decongestant sprays, it often takes a few days before their beneficial effects are felt. These medications are best used when antihistamines alone are insufficient to control symptoms, and can be used in addition to oral antihistamines.

It’s important to use the spray correctly: aim the nozzle away from the middle of the nose, to get maximal benefit and reduce risk of nosebleeds.

Nasal decongestant sprays are completely different from nasal corticosteroid sprays. They act to quickly decongest the nose, but they can irritate the inner lining of the nose and some studies show they can be addictive. Nasal decongestant sprays are usually used for symptoms of a cold, and are not generally used to treat seasonal allergies. I do not recommend using them for more than 1-3 days because of the potential for addictive side effects.

As with all medications purchased over the counter, it is important to read and follow the dosing and safety instructions printed on the medication label and talk with your health care professional about any concerns.

In general, if your symptoms tend to last longer than two weeks, or are not adequately controlled with over-the-counter medications, it’s a good idea to see a doctor – before your symptoms get the better of you!

Martha White, MD, FACAAI, is a board-certified allergist at the Institute of Asthma and Allergy in Wheaton, Md., a member of The Network’s Board of Directors, an Allergy & Asthma Network medical editor since 1985 and a fellow of the ACAAI.

Have a medical question? Email editor@allergyasthmanetwork.org or write to Ask the Allergist, Allergy & Asthma Network, 8229 Boone Blvd., Suite 260, Vienna, VA 22182.