How to Treat Hay Fever / Seasonal Allergies – Your Cheat Sheet

 

Hay fever or seasonal allergies are a problem for many patients I see. The good news is many of the prescription medications are now over the counter and available to you. This is good news for patients! No longer do you need to worry if you forgot it at home. No more phone calls to the pharmacy or doctor to get a refill. However, what do you do now with all of the choices available to you? Not to worry, here is a suggested plan. As anything else on this blog, this information is meant to be informative and not a substitute for a medical evaluation. If you are not sure, check with your doctor. Hope you find these suggestions and tips useful!

Nasal steroid sprays.

The active ingredient, a steroid, can help decrease the inflammatory process causing the allergy response. These nasal sprays are typically well tolerated. Benefit – do not cause sedation. Typically well tolerated. Medication applied to specific area of problem, the nose! Side effect – Most common side effect I see is nosebleeds. However, if you read the directions on how to spray correctly, you should have less of a problem. One rare side effect (and I’ve only seen once case) is permanent loss of smell. Also, frankly, some patients don’t like to stick a spray up their nose!

There are different nasal steroid sprays over the counter. One is called fluticasone (brand name Flonase).

 

Antihistamines.

These medications block the histamine release by the mast cells of the body. It is this release of histamines that triggers the symptoms we associate with allergies. In the case of seasonal allergies, this means itchy eyes, runny nose, sneezing, nasal congestion. Benefits – is a pill. Side effect – can cause sedation depending on which antihistamine. Can cause dry mouth. Men with enlarged prostates (benign prostatic hypertrophy) may notice problem with urine flow.

The most potent antihistamines turn out to be the most sedating. In terms of effectiveness, diphenhydramine (brand name Benadryl) is the most potent and most sedating. Less potent and less sedating, often known as the non-sedating antihistamines are certizine (brand name Zyrtec), fexofenadine (Allegra). The least potent and least sedating is loratadine (Claritin). So if loratadine works for you, great! If not, you have other antihistamine options.

Decongestants.

These medications help with opening up the nasal passage and eustachian tube from congestion or plugging. Benefit – allow you to breathe through the nose better. Side effect – can elevate your heart rate and/or blood pressure. If you have a history of heart disease or high blood pressure (hypertension) check with your doctor.

Decongestants can come in a nasal spray with the active ingredient oxymetazoline (brand name Afrin) or oral form with the medication pseudoephedrine (Sudafed). Note that unlike the nasal steroid sprays listed above, the nasal decongestant oxymetazoline can only be used for 3 days and then must not be used for 4 days before using again. After 3 days, the nasal passages can become dependent on this nasal spray and you will find it becoming less effective. This is why it is always important to read the label!

For the pseudoephedrine pill, these must be purchased behind the counter. This means you need to ask the cashier or pharmacist to get it for you. Before purchasing, you must show your driver’s license. Is it worth the hassle? Yes! Other oral decongestants like phenylephrine (Sudafed PE)which are over the counter (and no identification is needed) in my experience and those of the majority of patients I care for find the latter not nearly as effective.

Suggested plan to treat allergies.

1) Avoid allergens / decrease exposure. Stay indoors and keep the windows closed / run air conditioning / filter the air to decrease pollen load. Use a saline rinse to clear you sinus passages from the pollen. Wearing protective eye gear (when mowing the lawn) and / or covering your nose and mouth also may help decrease the amount of pollen your eyes, nose, and mouth are exposed to. Less exposure means less allergy response.

2) Start with a nasal steroid spray OR an antihistamine. Take as needed or daily depending on how often you have symptoms.

3) Add another medication (either nasal steroid spray or antihistamine) to (2) if one medication alone is not helpful.

4) Add an oral decongestant, like pseudoephedrine, if nasal steroid spray and oral antihistamine combination is not effective.

5) If not improved, talk to your doctor about what other prescription medications might be added. If better, then after a period of time, step down therapy or stop completely. Initially if you needed all three medications (the nasal steroid spray, antihistamine, and oral decongestant), once you are better, stop the most recent medication first (this would be the oral decongestant). If still better, then stop the next most recent medication (this would be the antihistamine). The goal is to use the least amount of medications when possible.