Allergies are a pain in the … face. Having one symptom — runny nose, watery eyes, itchy throat — would be bad enough, but often those of us with allergies have to deal with them all at the same time. And despite our allergy haze, we are still expected to function like responsible adults. This is where allergy medications enter the picture, and why a pharmacy can seem both glorious and terrifying. While the shelves are stocked with seemingly endless options, how do we know what will work? The answer is we need to know how each medication works in order to understand which will work best for our symptoms.
What are the types of allergy drugs?
To keep things focused, we’ll be covering only allergy medication used for seasonal or year-round allergies, hay fever and other runny-nose-inspiring allergies, and not topical creams, allergic emergency medications or allergic asthma treatments. Let’s start with the basics.
Antihistamines – When a person with allergies is confronted with an allergen (pollen, dust, animal dander, etc.), their body overreacts with a barrage of antibodies that release chemicals. One of those chemicals is called histamine, which causes the symptoms of allergic rhinitis, such as itching, sneezing and runny nose. Antihistamine drugs work to block histamine receptors and keep your allergy symptoms at bay. These drugs are classified as first and second generation, the main difference being that second generation drugs do not bring the same level of side effects, such as drowsiness. So, second-generation antihistamines are generally preferred.
Decongestants – During an allergic reaction, blood vessels in the nose and eyes swell in response to the allergen, causing swollen, red tissue and increased production in fluid or mucous. Decongestants work by shrinking these blood vessels. Oral decongestants are typically combined with an antihistamine.
Dry Nasal Corticosteroid – A new prescription drug just hit the market, as of April 2012, and it is the first dry nasal corticosteroid, rather than a liquid spray. The benefit of having a dry corticosteroid is there is no post-nasal dripping, as there is with traditional nasal sprays. Furthermore, this drug comes with a dose counter, so you know when you need a refill.
Nasal Sprays - Nasal sprays come in several different forms, however nasal- spray corticosteroids are considered to be the most effective treatment for controlling allergic rhinitis. Corticosteroids (often just referred to as steroids) reduce the inflammatory response in the body brought on by allergic reactions. Nasal corticosteroids are often used in combination with second-generation oral antihistamines, but can also be used alone. It’s important to note that nasal corticosteroids are only available by prescription, and can have some serious side effects. Generally, steroids carry a risk of long-term complications with prolonged use, however, nasal-spray form affects only local areas unless used excessively. Side effects include dryness, burning and stinging in the nasal passages, sneezing, headaches and nosebleeds.
Antihistamine sprays, which are also available by prescription, are as good, if not better than antihistamine pills, but are not as effective as nasal corticosteroids.
OTC nasal sprays are short-term solutions and are not recommended for long-term use. None of these are as effective as the prescription sprays, and if used for more than three days can create a cycle of dependency and rebound. This means that after three days of use, the spray loses effectiveness and can cause swelling in the nasal tissue. This causes the person to use the nasal spray more often, which will continue to worsen congestion and swelling, which again, causes the person to use more, and so on.
The benefit of using nasal decongestants as opposed to oral decongestants is that they cause less drowsiness and work more quickly. If after three days of using the spray you are still experiencing symptoms, it’s time to either talk to your doctor about a prescriptions spray, or add an antihistamine pill to your allergy regimen.
Eye Drops – Itchy, watery eyes can be extremely uncomfortable, physically, of couse, but also socially because people will think you are crying. While oral antihistamines and some nasal sprays can help with eye allergy symptoms, they are not as effective as eye drops, as they are applied directly to the irritated area. There are several types of eye drops, both prescription and OTC, that can really help. There are great OTC antihistamine drops on the market that clear up itchy watery eyes. Previously, OTC drops largely meant decongestants that do not work as well, or artificial tears, which are just used to lubricate your eyes. Prescription options are also available, but the OTC antihistamines are worth a first pass.
What are the active ingredients in each?
It’s important to know that medications with the same active ingredients work pretty much the same. By knowing which active ingredient is in a medication, you can make more informed choices about what will work best for your symptoms. Since there are so many allergy medications available, we will go through some of the most popular.
Antihistamines (and Decongestants) – Any allergy medication that includes pseudoephedrine as a decongestant will have a – D in the drug name, such as Zyrtec-D or Claritin-D. This signifies that you are getting a combination antihistamine and decongestant medication. Pseudoephedrine has also been known to cause side effects, such as nervousness, restlessness and sleep problems.
1st generation: Diphenhydramine (Benadryl) and Chlorpheniramine (Chlortrimetron) are both available over the counter, but are much less desirable than the second-generation antihistamines. These first-generation drugs come with side effects, such as extreme drowsiness, which makes it difficult to take them on a daily basis.
2nd generation: These drugs can be taken on a regular basis because they do not cause the same level of drowsiness. They also come in long-lasting versions that only have to be taken once a day. Fexofenadine (Allegra), Cetirizine (Zyrtec) and Loratidine (Claritin) are all OTC second-generation antihistamines. Cetirizine is the only antihistamine to date approved for infants as young as 6 months. Prescription antihistamines include Levocetirizine (Xyzal), which is approved for patients age 2 years and older, and Desloratadine (Clarinex), which is like Claritin, but stronger.
Antihistamine Spray - Azelastine (Astelin, Astepro) can cause drowsiness, because it is a first generation antihistamine.
Nasal Corticosteroids - There are number of nasal corticosteroids available, including triamcinolone (Nasacort), mometasone furoate (Nasonex), fluticasone (Flonase), beclomethasone (Beconase, Vancenase), flunisolide (Nasarel) and budesonide (Rhinocort). These sprays need to be taken every day to be effective, rather than taken only when symptoms appear. Talk to your doctor at the time of prescription about which might work best.
The new dry nasal corticosteroid QNASL delivers beclomethasone dipropionate as an HFA inhaler, like an asthma inhaler, for the nose. Like liquid nasal sprays, QNASL is used to treat nasal symptoms brought on by allergic rhinitis.
Nasal anticholinergic spray – There is only one nasal spray in this category and it is nasal ipratropium (Atrovent nasal). This spray can help with runny nose, but will not help with congestion or itching
OTC sprays/decongestants — A couple examples of OTC nasal sprays are oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine). Neither of these works as effectively as prescription sprays, and should be used for only a few days. Cromolyn (NasalCrom) is also OTC, but only works if used before being exposed to allergens.
Antihistamine – There are a number of OTC antihistamine drops that work very well, and they all have the same ingredient — ketotifen fumarate. The brand names include, Zaditor, Alaway, Claritin eye drops and Zyrtec eye drops.
Corticosteroids – If you are in need of something stronger than an OTC drop, talk to your doctor about a corticosteroid. These are typically used to treat severe irritation. Loteprednol (Lotemax) is a prescription drop and a steroid. Remember that steroids are not recommended for long-term use due to serious side effects.
Decongestant/antihistamine – There are several examples of OTC decongestant eye drops and combination decongestant and antihistamine drops. One example is naphazoline/pheniramine (Naphcon-A, Opcon-A, Visine-A), which only provides temporary relief for red, itchy eyes.
How do I know which is best?
Now that you know how each ingredient works in your body, you can make more informed decisions about what will work best for your symptoms. If you’ve only tried OTC medications, make an appointment with an allergist to discuss some of these prescriptions options. If you’ve been taking Benadryl for 10 years, try out a second-generation antihistamine. The good news is that there are so many options on the market, if something doesn’t work for you, keep trying things until something does. Remember to look at the ingredient list to figure out which is active in a particular medication. This can stop you from trying several brand name and generic drugs that all have the same ingredients. If an ingredient isn’t relieving your symptoms, move on to the next, or try a combination of a nasal spray and an oral medication.
It’s also important to note the side effects of each type of drug, and talk to your doctor about which is appropriate for you. For instance, taking decongestants can cause complications for people with heart disease, high blood pressure, thyroid disease, diabetes and several other conditions. If you are at risk, your doctor can guide you on how to proceed in your quest for the greatest allergy medication of all time (for you).