Hay Fever

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Allergic rhinitis is typically a lifelong condition. The best way to control your allergies is to identify the allergens that trigger your symptoms and then take steps to limit your exposure to them. Air conditioning reduces pollen counts indoors by 90 percent or more. Face masks, similar to what surgeons wear, can significantly reduce the amount of allergen inhaled when outdoors or while doing yard work. You can learn more about avoiding allergens in our section on managing hay fever.

If you fail to get relief with this strategy, however, medications or allergen immunotherapy, or allergy shots, can be helpful. Those who look for relief at the local pharmacy are faced with many product choices. To make the right choice for you, you first need to learn what types of medications are available, how each works, and which symptoms they alleviate. Always talk with your doctor before using any over-the-counter medicines.

Medications

Decongestants such as phenylephrine (in Neo-Synephrine) and pseudoephedrine (in Sudafed, Sinutab, and Afrin) are taken to help unblock nasal passages and so relieve the feeling of fullness or pressure in your nose and head. These drugs can also improve breathing by easing airflow through your nose. Decongestants are available over the counter and by prescription, both as pills and as nasal sprays. Nasal sprays are generally faster acting than pills; however, intranasal decongestants are recommended only for the short term and should not be used for more than three days. The drugs may cause such side effects as lightheadedness, wakefulness, nervousness, or a jittery feeling. Other side effects include an irregular heartbeat and increased blood pressure. Decongestants are not recommended for people with glaucoma, and caffeine taken with the drugs may make insomnia and feelings of restlessness worse.

Antihistamines such as diphenhydramine (in Benadryl) and chlorphreniramine (in Chlor-Trimeton) help relieve symptoms by blocking the action of a chemical in the body called histamine, which causes the tissues in your nose to itch and swell. Antihistamines may be taken as tablets, caplets, or liquids. They can cause drowsiness and performance impairment. First-generation antihistamines should not be taken when driving a car, drinking alcohol, or taking other drugs that cause drowsiness. Other possible side effects include an upset stomach, dry mouth, impaired coordination and judgment, loss of appetite, and urinary retention. Your doctor may prescribe a second-generation antihistamine such as fexofenadine (Allegra), which is "nonsedating." Another nonsedating antihistamine, loratadine (Claritin), is now available without a prescription.

Antihistamine eye drops (such as Visine-A) are available without a prescription and can relieve itchy, watery eyes and eye redness. Side effects include temporary stinging in the eyes or blurred vision.

Cromolyn sodium (in Nasalcrom) helps relieve sneezing and an itchy and runny nose. Possible side effects include nose irritation or nosebleeds, skin rash, and increased sneezing.

Corticosteroids such as fluticasone (Flonase and Veramyst), mometasone (Nasonex), and budesonide (Rhinocort) are used to treat all rhinitis symptoms—and are more effective than antihistamines, particularly for stuffiness and runny nose.

A warning about phenylpropanolamine

Phenylpropanolamine, or PPA, was used for years as an ingredient in many cold and cough remedies to relieve a stuffy nose and congestion and in diet pills to control appetite. In 2000, PPA was linked to a significantly increased risk of stroke, especially in women ages 18 to 49. As a result, the federal Food and Drug Administration in November 2000 banned the use of PPA in all prescription and over-the-counter medications.

Although newly manufactured drugs do not contain PPA, older medications you may still have in your medicine cabinet could contain the ingredient. Now may be a good time to clean out your medicine cabinet and discard all old medications. If you have concerns about PPA or its risks, talk to your healthcare provider or pharmacist.

Read the Food and Drug Administration's 2000 public-health advisory on phenylpropanolamine.

Allergen immunotherapy, or allergy shots

Immunotherapy is a treatment strategy designed to increase your tolerance to the substances that cause your allergy symptoms. Immunotherapy is usually recommended for people who suffer from allergies more than three months of the year. The shots do not cure allergies but significantly reduce your sensitivity to, and level of symptoms produced by, certain substances.

Clinically relevant allergens are injected periodically into your body in increasingly larger doses, over a period of three to five years. The injections continue until your immune system no longer considers the allergen an invading agent. The beneficial effects of allergy shots develop gradually, and it may take six to 12 months of receiving shots on a regular basis before any benefit is seen. In properly selected patients with allergic rhinitis (or asthma), allergy shots have shown to reduce both symptoms and patients' reliance on medications.

What to expect

For most people, immunotherapy starts with a buildup phase. At this stage, shots typically are given once or twice a week, with gradually increasing doses of allergens. This stage usually continues for three to six months but may last up to a year.

The buildup phase continues until you have reached your maximum dose of allergens. Then this dose—the "maintenance" dose—is given with the frequency of injections tapering to every two to four weeks. This phase goes on for five years or sometimes even longer.

Symptoms may improve somewhat in the first year of treatment. But they're likely to improve more noticeably in the second year. If your allergies aren't getting better after a year on the maintenance dose, it might be time to reconsider the shots.

At each visit: Tell your doctor if you've had any change in your health, especially if you have had more allergy symptoms, asthma problems, or an upper respiratory infection lately. Your doctor might decrease the dose during the pollen season or if you've missed several shots in a row.

After each visit: The doctor will ask you to wait 30 minutes before leaving the clinic, so that you'll be close to medical help if you have a systemic reaction to the shots. These are rare but do occur on occasion. The symptoms of a systemic reaction may include shortness of breath, lightheadedness, or a throat that feels constricted. If you suddenly experience some of this cluster of symptoms after you leave, you should go back to the doctor's office or to an emergency room.

Weighing the pros and cons

  • Allergy shots might make sense for you if:
  • Your symptoms are so severe that they often cause you to miss work or school, visit the hospital emergency department, lose sleep, or otherwise affect your daily activities.
  • Your allergies last for more than a few months of the year.
  • Your allergies cannot be controlled with medications, available medications have unacceptable side effects, or you're averse to taking medications. It is not practical or possible to avoid those substances that you're allergic to.
  • Allergy shots might not make sense for you if:

    • You're not sure you'll be able to meet the time commitment of regular doctor's visits for three to five years.
    • You're averse to injections.
    • You’re taking a beta blocker.
    • You’re currently pregnant or planning to become pregnant soon.
    • Bear in mind that the shots don't work for everyone and that systemic reactions, while rare, can be serious or even life threatening.

      People who are taking beta blockers or who are pregnant should not start allergy shots. There are other medical conditions that might prevent you from starting allergy shots, including unstable angina, poorly controlled asthma, or poorly controlled urticaria (hives). Your doctor should be aware of all medical conditions before you begin immunotherapy.

      A doctor may recommend against using allergy shots in preschool-age children. But for older children, some studies have suggested that this intervention may help prevent them from getting asthma later in life and from becoming allergic to more allergens.

      Last reviewed on 08/20/2008

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