Hay Fever and Allergy Medications

This article has been reviewed by Thanai Pongdee, MD, FAAAAI

Seasonal allergic rhinitis known as hay fever symptoms range from being mildly annoying to seriously impacting day-to-day life.  These symptoms can include sneezing, stuffiness, a runny nose or itchiness in your nose, roof of your mouth, throat, eyes or ears.

Hay fever symptoms are most often triggered by tree pollen in the early spring. Grasses are often the culprit during the late spring and early summer. Weeds are most often the cause of late summer and fall hay fever symptoms.

While avoiding the allergens that trigger symptoms is the best way to control hay fever, your allergist / immunologist may prescribe an allergy medication to manage your hay fever symptoms. These medications include nasal corticosteroid sprays, antihistamine pills, nasal antihistamine sprays or decongestant pills.

If you have allergies, your allergist may prescribe an antihistamine. This medication treats hay fever and conditions such as hives. Antihistamines help prevent the effects of histamine, which is a chemical released by your body during an allergic reaction. By preventing the action of histamine, your allergy symptoms can be reduced. Antihistamines are available as a liquid, tablet or nasal spray.

Antihistamines are divided into:
•  “First generation, sedating,” which may cause drowsiness
• “Second generation, low-sedating or non-sedating,” which are much less likely to cause drowsiness

Potential side effects (usually associated with the “first generation” antihistamines):
• Dry mouth
•  Trouble urinating (especially in men with prostate problems)
• Constipation
• Drowsiness
• In some children: nightmares, unusual jumpiness, restlessness, irritability

These medications may reduce your stuffy nose and other symptoms associated with allergies. Decongestants work by narrowing your blood vessels, which decreases the amount of fluid that leaks out into the lining of your nose. They are available as a liquid, tablet or nasal spray.

Potential side effects:
• Nervousness
• Sleeplessness
• Increased blood pressure or heart rate
• “Rebound rhinitis” can occur with the decongestant nasal spray if used for more than three or four days in a row. This rebound causes your stuffy nose to become more severe, which may lead you to become dependent upon the use of the medication.

Nasal Steroids  
The mainstay of treatment for allergic rhinitis, or hay fever, is nasal steroids. It is important to note that these are not like body-building, or anabolic, steroids. This type of steroids helps to control inflammation, in this case in the nose. For those with other than very mild and intermittent symptoms, nasal steroids are very helpful.

Nasal steroids take at least several days to become fully effective, so they should be used on a daily basis for the best relief of symptoms. In those with only seasonal  allergies, nasal steroids should be started a week or two before the anticipated start of pollen season. For those with perennial, or year-round allergies, nasal steroids should be used year-round. Nasal steroids are also used for nonallergic rhinitis and nasal polyps, and they can help decrease the frequency of sinus infection.

There are two types of nasal steroids, aqueous or wet, and powder or dry. The liquid nasal steroids include Nasonex, Nasacort AQ, Rhinocort AQ, Veramyst, Omnaris and Flonase. Flonase, or fluticasone, is the only nasal steroid for which there is a generic form available. The dry nasal steroids are Q-Nasl and Zetonna. Dymista is a combination of fluticasone and a nasal antihistamine.

Nasal steroids should be sprayed in the nose, pointed away from the septum, or midline of the nose. Potential side effects include dryness, burning, stinging and nosebleeds. If you experience these potential side effects, your doctor may prescribe an alternative nasal steroid for you.

The majority of allergy medications for hay fever work best if started before tree pollen is in the air and allergy symptoms develop. If you start taking allergy medications before you first come into contact with spring allergens, the medication can prevent the release of histamine and other chemicals. As a result, allergy symptoms may be much less severe.

Healthy Tips
• Avoid using a decongestant nasal spray for longer than three or four days in a row. It may cause your stuffy nose to become worse and cause you to become dependent upon the medication.
• See your allergist to find out which medication is right for you.

Other Resources
A complete list of medications used to treat allergies can be found in the AAAAI Drug Guide.

Monitoring pollen levels can help you avoid being outdoors during peak pollen times. The National Allergy BureauTM (NAB) provides the most accurate and reliable pollen and mold levels. The AAAAI also offers a mobile pollen app. Visit pollen.aaaai.org from your iPhone, iPad, BlackBerry or Android and add this app to your home screen.

For long-term relief of allergy symptoms, talk to your allergist / immunologist about Immunotherapy (allergy shots). This is a proven treatment approach that provides lasting benefits for many people suffering from allergic rhinitis. Allergy tablets are also available.

AAAAI - American Academy of Allergy Asthma & Immunology