Choosing the Right Allergy Medicine for You - 2010 Update

Health Professional

One of the first posts I wrote when I joined was about how you could know which allergy medicine would be best for you. And to date, it is still one of the most popular articles on this site. Seems allergy medication is a hot topic for allergy sufferers

I understand why. There is nothing more annoying than trying to get through your day and having to put up with constant sneezing, a runny nose, feeling like your head's going to explode, not to mention itchy eyes, nose and throat, or maybe watering, burning eyes. I've been there with you every step along the way and it is no fun. All we want is a little relief, right?

So, since it's been 3 years since I wrote that original post, I thought it was a good time to revisit the topic and update you on all the new choices you have available now. And that's the good thing about allergies -- they're so common, new medications are being developed all the time.

A Little Background...

Before I get into the new choices that have emerged in the last few years, I'd encourage you to read my original article, where I explain the different types of allergy medicine in detail. There's also a point worth repeating in that article. There is no one way to know which allergy medicine will work best for you. Everyone seems to respond slightly differently to medication.

Personally, I've found that Allegra worked best for me. But I know people who've sworn by one of the other medicines too. Basically, you just have to try them out, one by one. If you find a medicine that works for you, then stick with it as long as you can. If one doesn't work after a few weeks (give it a good two to three weeks, minimum), then try something different.

Changes in the Original Options for Treating Nasal & Eye Allergies

In my other post, I talked mostly about oral medications that were the traditional treatment for allergies. This included antihistamines, both the older kind that are available over the counter, usually for a fairly cheap price, but that can make you sleepy, and also the newer variety that have less side effects but cost more.

When I wrote that post, only one of the newer variety antihistamines, Claritin, was available over the counter (OTC). Since then, Zyrtec has also gone OTC. Allegra continues to be available only by prescription. Singulair is another prescription pill, called a leukotriene blocker that is also available only by prescription.

In addition, a new antihistamine was approved for use in the U.S. at the end of 2007, called Xyzal. I wrote about that here.

The OTC antihistamines are great for people who don't have a doctor or health insurance, but the newer ones can be pretty pricey. However, most discount stores like Walmart offer generic versions that are considerably cheaper than the brand versions. I use generic cetirizine, which is the same thing as Zyrtec and it works just as well.

Another change in the past few years is that many of the older allergy formulations have become less available, including ones that contained pseudoephredrine, such as Drixoral. There are various reasons for these changes, including the fact that pseudoephedrine is an ingredient misused by meth manufacturers. You can still buy these drugs, one packet at a time, in some areas, but they're stored behind the pharmacy counter and you have to show ID to get them.

It amazes me when I read here about so many people who are absolutely dedicated to these older allergy medicines. There are so many new, more effective and safer medicines these days, but it seems people are reluctant to change when they find something that works!

New Options for Allergy Treatment

We'll look at several different classes of medicines:

  • oral antihistamines
  • nasal sprays
  • antihistamine eye drops

In the oral antihistamine class, there have been no real changes, other than new branded versions of the same old medicines. Get familiar with the chemical names so you don't get fooled. Any drug containing loratidine is the same thing as Claritin. Any drug containing cetirizine is the same as Zyrtec and fexofenadine is the same thing as Allegra.

Nasal sprays are great if you can tolerate them, because they work right where your symptoms are, in your nose. Quite a few new options are available in the class of nasal sprays. There are three types you should know about.

Topical nasal steroids. These sprays are only available by prescription and are similar to the inhaled steroids that people with asthma use, except that you squirt them into your nasal cavities. They are very effective, and have few side effects in most people, although a few have had irritation in the nasal passages and bleeding. Some also can have an irritating odor or after taste.

Examples are:

  • fluticasone (Flonase ®)
  • mometasone (Nasonex ®)
  • budesonide (Rhinocort Aqua ®)
  • flunisolide (Nasarel ®)
  • triamcinolone (Nasacort AQ ®)
  • beclomethasone (Beconase AQ ®)

This type of nasal spray must be used every day on a regular basis in order to work well. They're not useful on an as needed basis only.

Nasal antihistamine sprays. There is only one spray in this class and it is called azelastine (Astelin ®). It is a first-generation antihistamine, so it can cause drowsiness and other annoying side effects. Although quite effective at controlling nasal allergy symptoms, it must be used daily to work well. Astelin is a prescription medication.

Nasal anticholinergic spray. Again, there is only one spray in this class, called nasal ipratropium (Atrovent nasal ®). It can be useful both for nasal allergies and for colds, since it dries up nasal "dripping." It won't really do anything for nasal congestion, though, or for an itchy nose. Side effects tend to be mild irritation at the worst.

There are also a few OTC nasal sprays you can get, though none are as effective as the prescription variety. Most of them are decongestants and can only be used for a few days once in a while. More frequent use can actually worsen your symptoms. Examples include: oxymetazoline (Afrin ®) and phenylephrine (Neo-Synephrine ®).

There is also a spray called NasalCrom ® that only works if you use it before you are exposed to allergy triggers. Good luck with that!

Another great change in available treatment options are the OTC antihistamine eye drops that are now available. While the oral antihistamines and some of the prescription nasal sprays sometimes help with eye allergies, eye drops get right to the heart of the problem. They work great for me, and mean I can get relief when I need it, without having to see my eye doctor.

The drops are all made from the same drug, called ketotifen fumarate. Currently available brands that contain ketotifen include:

  • Zaditor
  • Alaway
  • Claritin eye drops
  • Zyrtec eye drops

It's important to note that neither Claritin or Zyrtec eye drops contain the drug that is in each of the oral versions of those medications. They're all ketotifen, so presumably one works pretty much the same as the other. As I said, my experience has been really positive with these drops.

If you're not getting relief from what you've been taking for your allergies, then talk with your doctor. There's always something else you can try, as you can see.