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Rhinitis (Hay Fever)
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ACAAI > Patients & Public > Allergies > Types of Allergies > Rhinitis (Hay Fever)

Hay Fever Treatment

When allergy symptoms are not well controlled with avoidance measures, allergy medications can help to reduce nasal congestion, runny nose, sneezing and itching. They are available in many forms, including oral tablets, liquid medication, nasal sprays, and eye drops. Some medications may cause side effects, so it is best to consult your allergist if there's a problem.

Intranasal Corticosteroids: Intranasal corticosteroids are the single most effective drug class for allergic rhinitis treatment. They can significantly reduce nasal congestion as well as sneezing, itching and runny nose. These drugs are frequently prescribed, and are of particular value when rhinitis symptoms are more severe. They are most effective when taken daily, as directed by your health care provider, but may have some benefit when taken as needed.

These medications are safe when used under physician supervision. They are designed to avoid the side effects that may occur from steroids when they are taken by mouth or injection. However, care must be taken not to spray them against the center portion of the nose (the nasal septum). The most common side effects are local irritation and nasal bleeding. Some older preparations have been shown to have some effect on children's growth, but data about some newer nasal steroids have not shown an effect on growth.

Antihistamines: Antihistamines are inexpensive and commonly used to treat allergic rhinitis. These medications counter the effects of histamine, the irritating chemical released within your body when an allergic reaction takes place. Although other chemicals are involved, histamine is primarily responsible for causing the symptoms.

Antihistamines do not cure, but help relieve nasal allergy symptoms such as:

  • Sneezing, itchy, and runny nose
  • Eye itching, burning, tearing and redness
  • Itchy skin, hives, and eczema
  • Certain other allergic conditions.

There are dozens of different antihistamines and wide variations in how patients respond to them. Some are available over-the-counter and others require a prescription.

Generally, the newer (second generation) products work well and produce only minor side effects. Some people find that an antihistamine becomes less effective as the allergy season worsens or their allergies change over time. If an antihistamine loses its "strength," notify your physician, who may then recommend an antihistamine of a different class or strength. Persons with excessive nasal dryness or thick nasal mucus should avoid taking antihistamines without consulting a physician. Contact your physician for advice if an antihistamine causes drowsiness or other side effects.

Proper use: Short-acting antihistamines can be taken every four to six hours, while timed-release antihistamines are taken every 12 to 24 hours. The short-acting antihistamines are often most helpful taken 30 minutes before an anticipated allergic exposure (such as a picnic during ragweed season). Timed-release antihistamines are better suited to chronic (long-term) use for those who need daily medications.

Proper use of these drugs is just as important as their selection. The most effective way to use them is before symptoms develop. A dose taken early can eliminate the need for many later doses to reduce established symptoms. Many times a patient will say that he "took one, and it didn't work." If he or she had taken the antihistamine regularly for three to four days, and built up blood levels, it might have been effective.

Side effects: Older (first generation) antihistamines may cause drowsiness and/or performance impairment, which can lead to accidents and personal injury. Even when these medications are taken only at bedtime, they can still cause considerable impairment the following day. Impairment can occur even in people who do not feel drowsy. For this reason, it is important that you do not drive a car or work with dangerous machinery when you take a potentially sedating antihistamine. Some of the newer antihistamines do not cause drowsiness.

Another frequently encountered side effect is excessive dryness of the mouth, nose and eyes. Less common side effects include restlessness, nervousness, over excitability, insomnia, dizziness, headaches, euphoria, fainting, visual disturbances, decreased appetite, nausea, vomiting, abdominal distress, constipation, diarrhea, increased or decreased urination, urinary retention, high or low blood pressure, nightmares (especially in children), sore throat, unusual bleeding or bruising, chest tightness or palpitations. Men with prostate enlargement may encounter urinary problems while on antihistamines. Consult your allergist should these reactions occur.

Alcohol and tranquilizers increase the sedation side effects of antihistamines.

Important precautions:

  • Never take anyone else's medication.
  • Do not use more than one antihistamine at a time, unless prescribed.
  • Keep these medications out of the reach of children.
  • Know the effect of the medication on you before working with heavy machinery, driving or doing other performance-intensive tasks; some products can slow your "reaction time."
  • Follow your physician's instructions.

Some antihistamines appear to be safe, but there have not been enough studies to determine absolute safety of antihistamines in pregnancy. Again, consult your allergist or obstetrician if antihistamines must be taken.

While antihistamines have been taken safely by millions of people in the last 50 years, don't take antihistamines before telling your allergist if you are allergic to or intolerant of any medicine; are pregnant or intend to become pregnant while using this medication; are breast feeding; have glaucoma or enlarged prostate; or have any medical illness.

Decongestants: Decongestants help relieve the stuffiness and pressure caused by swollen nasal tissue. They do not contain antihistamines, so they do not cause antihistamiic side effects. They do not relieve the other symptoms of allergic rhinitis, such as runny nose, post-nasal drip and sneezing. Decongestants are available as prescription and non-prescription medications and are often seen in combination with antihistamines or other medications. It is not uncommon for patients using decongestants to experience insomnia if taking the medication in the afternoon or evening. If this occurs, a dose reduction may be needed.

At times, men with prostate enlargement may encounter urinary problems while on decongestants. Patients using medications for the management of emotional or behavioral problems should discuss this with their physicians before using decongestants. Pregnant patients should also check with their physician before starting decongestants.

Non-prescription decongestant nasal sprays work within minutes and last for hours, but should not be used for more than a few days at a time without a physician's order. Prolonged use can cause rhinitis medicamentosa, or rebound swelling of the nasal tissue. Stopping the use of the decongestant nasal spray will cure rhinitis medicamentosa, providing that there is no underlying disorder.

Oral decongestants are found in many over-the-counter and prescription medications, and may be the treatment of choice for nasal congestion. They don't cause rhinitis medicamentosa but need to be avoided by some patients with high blood pressure. If you have high blood pressure, you should check with your physician before using them.

Non-prescription saline nasal sprays will help counteract symptoms of dry nasal passages or thick nasal mucus. Unlike decongestant nose sprays, a saline nose spray can be used as often as needed. Sometimes, your physician may recommend washing (douching) of the nasal passage. There are many over the counter preparations for saline rinses, including neti- pots and saline rinse bottles.

Nasal cromolyn is a medication that blocks the body's release of allergy-causing substances. It does not work in all patients. The full dosage is four times daily, and improvement may take several weeks to occur. Nasal cromolyn can help prevent allergic nasal reactions if taken prior to an allergen exposure.

Nasal ipratropium bromide spray (Atrovent) can help reduce nasal drainage from allergic rhinitis or some forms of non-allergic rhinitis.

Montelukast is a tablet medication approved for treatment of allergic rhinitis, as well as asthma. It works against substances called leukotrienes that can cause symptoms of allergic rhinitis.

Antibiotics are for the treatment of bacterial infections. They do not affect the course of uncomplicated common colds and are of no benefit for non-infectious rhinitis, including allergic rhinitis.

Immunotherapy - Allergen immunotherapy, known as "allergy shots," may be recommended for persons who don't respond well to treatment with medications, experience side effects from medications, who have allergen exposure that is unavoidable, or desire a more permanent solution to their allergic problem. Immunotherapy can be very effective in controlling allergic symptoms. Immunotherapy does not help the symptoms produced by non-allergic rhinitis.

Allergy injections are usually given at variable intervals over a period of three to five years. An immunotherapy treatment program consists of injections of a diluted allergy extract, administered frequently in increasing doses until a maintenance dose is reached. Then, the injection schedule is changed so that the same dose is given with longer intervals between injections. Immunotherapy helps the body build resistance to the effects of the allergen, reduces the intensity of symptoms caused by allergen exposure, and sometimes can actually make skin test reactions disappear. As resistance develops, symptoms should improve, but the improvement from immunotherapy will take several months to occur.

Nasal surgery is of no benefit in allergic rhinitis, but it may help if patients have nasal polyps or chronic sinusitis not responsive to prolonged antibiotics and nasal steroid sprays.

Eye allergy preparations are used when the eyes are affected by the same allergens that trigger rhinitis, causing redness, watery eyes and itching. Over-the-counter (OTC) eye drops and oral medications are commonly used for short-term relief of some eye allergy symptoms. However, they may not relieve all symptoms, and prolonged use of some OTC eye drops may actually cause your condition to become worse.

Prescription eye drops and oral medications also are used to treat eye allergies. Prescription eye drops provide both short- and long-term targeted relief of eye allergy symptoms, and they can be used to manage eye allergy symptoms

Check with your physician or pharmacist if you are unsure about a specific drug or formula.

Medications for the Treatment of Rhinitis (Brand Names)

Non-prescription Antihistamines

Newer antihistamines now available without a prescription are Òsecond generation antihistamines and generally do not cause drowsiness, slowed reaction time and dry mouth in most people.

  • Claritin, or generic loratadine
  • Alavert and other generic products (consult with your physician)
  • Zyrtec , or generic cetirizine

Older non-prescription antihistamines (some combined with decongestants/analgesics) are "first generation" antihistamines and generally cause drowsiness, slowed reaction time and dry mouth in most people. Following are some examples:

  • Actifed
  • Alka Seltzer Plus
  • Allerest
  • Benadryl
  • Chlor-Trimeton
  • Comtrex
  • Contac
  • Dimetapp
  • Drixoral
  • PediaCareSudafed
  • Tavist
  • Triaminic
  • Tylenol Sinus or Allergy
  • Vicks

Many brand name and generic formulas are available without prescription. If you are in doubt as to whether or not a product contains an antihistamine, consult your physician or pharmacist.

Prescription Antihistamines

The following medications are "second generation" antihistamines that do not generally cause the side effects of "first generation" antihistamines, such as drowsiness, slowed reaction time and dry mouth.

  • Allegra, or generic fexofenadine
  • Clarinex
  • Xyzal

The following contain "first generation" antihistamines (some combined with other medications) that can cause drowsiness, slowed reaction time and dry mouth.

  • Atarax, or generic hydroxyzine
  • Dallergy
  • Periactin
  • Temaril
  • Trinalin
  • Vistaril

Non-prescription Oral Decongestants

  • Chlor-Trimeton Decongestant
  • Dimetapp Decongestant
  • Drixoral Nasal Decongestant
  • Efidac/24
  • PediaCare Infants' Decongestant Drops
  • Sudafed12 Hour
  • Triaminic Decongestant Formula

Prescription Oral Decongestants

  • AlleRx
  • Respaire
  • Guaifed

Non-prescription Decongestant Nasal Sprays

Prolonged use may cause rebound congestion.

  • Afrin (and related products)
  • Dristan 12 Hour Nasal Spray
  • Nasacon
  • Neo Synephrine 12 Hour
  • Nostrilla 12 Hour Decongestant
  • Otrivin (and related products)
  • Vicks Sinex 12 Hour

Non-prescription Anti-allergy Nasal Spray

  • Nasalcrom (cromolyn)

Non-prescription Saline Nasal sprays

  • Afrin Saline Mist
  • Ayr
  • Breathe Right
  • NaSal Moisturizer AF
  • Ocean
  • Salinex

Prescription Antihistamine Nasal Spray

  • Astelin
  • Astepro
  • Patanase

Prescription Atropine-like Nasal Spray

  • Atrovent

Prescription Nasal Corticosteroid sprays

These do not contain antihistamines or decongestants.

  • Beconase
  • Flonase, or generic fluticasone
  • Nasacort
  • Nasalide, Nasarel, or generic flunisolide
  • Nasonex
  • Omnaris
  • Rhinocort
  • Rhinocort Aqua
  • Vancenase
  • Veramyst

Prescription Oral Leukotrine Pathway Inhibitors

  • Accolate
  • Singulair

Prescription Eye Drops

Antihistamines/Mast Stabilizer Dual-Action Therapies

  • Elestat
  • Optivar
  • Pataday
  • Patanol

Antihistamine

  • Livostin

Mast Cell stabilizers

  • Alamast
  • Alocril

Non- Prescription Eye Drops

Antihistamine/Mast cell Stabilizer Dual Action Therapies

  • Alaway
  • Refresh
  • Visine
  • Zaditor

There are many hay fever remedies, and each person's treatment must be individualized based on the frequency, severity and duration of symptoms and on the degree of allergic sensitivity. If you have more questions, your allergist will be happy to answer them.

For more medical information, please contact an allergist in your area.

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