Allergy Pills vs. Nasal Spraysby Paula J. Busse, M.D. Health Professional
Hi, I hope that everyone is doing ok with his or her spring-time allergies. Frequently I am asked which is better to treat allergies: pills (oral anti-histamines) or nose sprays. For many people, putting medication in the nose may not be very appealing and they would rather take oral medications. However, several well-done studies have suggested that the first medication one should use to treat allergies to environmental proteins is the steroid nose sprays. Steroid nasal sprays have been proven to more effectively reduce nasal stuffiness, sneezing and post-nasal drip than allergy pills (anti-histamines). In fact, allergy pills on their own do not help with nasal congestion. Some allergy pills contain a decongestant in them, and are labeled with a "D" after their name, which will help with nasal congestion. These pills contain both the allergy medication and pseudophedrine. Although these are good medications (the combination allergy/pseudophedrine pills), they may be dangerous for some patients to take. If someone has a history of heart disease, high blood pressure, glaucoma, thyroid disease or an enlarged prostate, they should be taken with extreme caution with close physician follow-up if they decide to take the oral antihistamines with "D."
The name steroid in the nasal steroids often is frightening for patients. However, nasal steroids are very safe and we use them in small children. Since they are administered only to the nose, they do not cause many of the side effects that they do when taken as a pill or given by an IV. If taken by these routes (mouth or IV), the steroid can affect many different organs in the body. The types of steroids used in the allergy nose sprays are in the class called corticosteroids and are not what could be used to "build" muscles. The corticosteroids work by decreasing inflammation in the nose. Nasal inflammation results when someone who is allergic to a protein is exposed to it. The inflammation causes nasal stuffiness, nasal drip and sneezing. When nasal steroids are used, they must be used on a daily basis. They can not be used as needed, as they usually take about one week to start working. Therefore, if you have spring allergies, you should start taking your nose sprays a few weeks before your symptoms usually arrive. Side effects of the nasal steroids are minimal, although some patients may have nose bleeds, but this is infrequent.
If nose sprays alone do not help treat your allergy symptoms, we usually next add on the allergy pills (anti-histamines) to your treatment with the nasal steroid. We can also add on another type of pill which blocks another important inflammatory protein called leukotrienes. Unfortunately allergic eye symptoms may not be completely relieved by the nose sprays and anti-allergy pills. In these cases, we add on anti-allergy eye drops. These can be taken on an as-needed basis.
I hope that this clarifies some of the rationale that we as allergists use for treating allergies. Again, if you have questions, please write. Also, every patient is different and please consult with your allergist for a specific treatment plan.