Allergy medications: Know your options

Several types of medicines are used to treat allergy symptoms. Here's what you should know.

Allergy medicines are available as pills, liquids, inhalers, nasal sprays, eye drops, skin creams and shots, also called injections. Many allergy medicines are available without a prescription. Here are the different types of medicine options available to treat allergies. Talk with a healthcare professional to find the one that's best for you.

Antihistamines

Antihistamines block certain cells in the body from receiving histamine. Histamine is a chemical released by the immune system that causes the symptoms of an allergic reaction.

Nasal sprays

Antihistamine nasal sprays help relieve sneezing, an itchy or runny nose, sinus congestion, and postnasal drip.

Side effects of antihistamine nasal sprays might include a bitter taste and feeling very sleepy.

Examples of antihistamine nasal sprays include:

• Azelastine (Astepro).
• Olopatadine.

Eye drops

Antihistamine eye drops relieve itchy, red, swollen eyes. These eye drops may have a combination of antihistamines and other medicines. Some antihistamine eye drops require a prescription.

Side effects might include headache and dry eyes. If antihistamine eye drops sting or burn, try keeping them in the refrigerator. Or use refrigerated artificial tear drops before adding antihistamine eye drops.

Examples of antihistamine eye drops include:

• Ketotifen (Alaway, Zaditor).
• Olopatadine (Pataday).

Pills and liquids

Oral antihistamines ease many symptoms of allergies. These include a runny nose, itchy or watery eyes, hives, and swelling. Some of these medicines are available without a prescription.

Side effects include drowsiness, so use with caution if you need to drive or be alert.

Antihistamines that tend to cause drowsiness include:

• Diphenhydramine.
• Chlorpheniramine.
• Hydroxyzine.
• Brompheniramine.

Antihistamines much less likely to cause drowsiness include:

• Cetirizine (Zyrtec Allergy).
• Loratadine (Alavert, Claritin).
• Fexofenadine (Allegra Allergy).
• Levocetirizine (Xyzal Allergy 24HR).
• Desloratadine (Clarinex).

Please note that cetirizine and loratadine are still known to cause drowsiness in about 10% of people who take them.

Corticosteroids

Corticosteroids suppress inflammation caused by allergies. This relieves symptoms.

Nasal sprays

Corticosteroid sprays, also called glucocorticoid sprays, prevent and relieve nasal allergy symptoms. These medicines are very effective on their own for treating ongoing or seasonal hay fever.

Side effects can include an unpleasant taste, nasal irritation and nosebleeds.

Examples of glucocorticoid nasal sprays:

• Mometasone (Nasonex).
• Fluticasone furoate (Flonase Sensimist).
• Fluticasone propionate (Flonase Allergy Relief).
• Flunisolide.
• Triamcinolone (Nasacort Allergy 24HR).
• Budesonide (Rhinocort).

Aerosol formulas provide the benefits without the unpleasant taste or the feeling of liquid running down the throat.

Examples include:

• Beclomethasone (Qnasl).
• Ciclesonide (Zetonna).

Eye drops

Corticosteroid eye drops provide special relief for itchy, red or watery eyes when other treatments don't work. An eye doctor, also called an ophthalmologist, usually monitors the use of these eye drops because of risks.

Risks include cataracts, glaucoma and infection.

Examples of corticosteroid eye drops include:

• Loteprednol (Alrex, Lotemax).
• Prednisolone (Omnipred, Pred Forte, others).

Pills and liquids

Oral corticosteroids are used to treat severe symptoms caused by all types of allergic reactions. These medicines can worsen high blood pressure and cause other long-term risks.

Long-term risks include cataracts, osteoporosis, muscle weakness, stomach ulcers, high blood sugar and delayed growth in children.

Prescription oral corticosteroids include:

• Prednisolone (Prelone).
• Prednisone.
• Methylprednisolone (Medrol).

Inhalers

Inhaled corticosteroids are often used in the daily treatment of asthma. Asthma is caused or worsened by reactions to airborne allergy triggers, also called allergens. Some inhalers combine corticosteroids with other medicines that open the airways called bronchodilators.

Side effects are often minor. Inhalers can irritate the mouth and throat and cause oral yeast infections, also called thrush.

Prescription inhalers include:

• Beclomethasone (Qvar Redihaler).
• Budesonide (Pulmicort Flexhaler).
• Ciclesonide (Alvesco).
• Fluticasone (Flovent, ArmonAir Digihaler).
• Mometasone (Asmanex Twisthaler).

Skin creams

Corticosteroid creams relieve allergic skin reactions such as itching, scaling, or a change in skin color. Although some mild treatments are available without a prescription, talk to your care team before using these creams for more than a few weeks.

Side effects can include irritation and a change in skin color. Long-term use can cause thinning of the skin and changes to hormone levels, especially with stronger prescription corticosteroids.

Examples include:

• Hydrocortisone (Locoid, Micort-HC, others).
• Desonide (DesOwen).
• Mometasone.
• Fluocinolone (Synalar).
• Triamcinolone.
• Betamethasone (Dermabet, Diprolene, others).

Mast cell stabilizers

Mast cell stabilizers block the release of chemicals in the immune system that lead to allergic reactions. These medicines are often safe but need to be used for several days to produce the full effect. Mast cell stabilizers are used when antihistamines are not working or well tolerated.

Nasal spray

Nonprescription nasal sprays include:

• Cromolyn.

Eye drops

Prescription eye drops include:

• Cromolyn.
• Lodoxamide (Alomide).
• Nedocromil.

Allergen and biological immunotherapy

Immunotherapy is meant to train the body's immune system not to react to certain allergens. This treatment might protect broadly against allergens that are hard to avoid such as pollens, dust mites and molds. Biologic medicines make changes to the body's immune system to treat allergic conditions such as asthma, sinusitis, hives and food allergy.

Immunotherapy is carefully timed and monitored while exposure to allergens is slowly increased. Immunotherapy might be useful in several cases, especially when other treatments aren't effective or tolerated.

Shots

Immunotherapy may be given as a series of shots, also called injections, usually one or two times a week. The dose may be increased during this time based on a person's tolerance. The highest tolerated dose can then be given year-round every 2 to 4 weeks.

Side effects might include irritation at the injection site and allergy symptoms such as, sneezing, congestion, hives, and itchy or watery eyes. Rarely, allergy shots can cause anaphylaxis.

Biological medicines given by injection include:

• Dupilumab (Dupixent). This medicine treats asthma, sinus pressure and allergic skin conditions.
• Omalizumab (Xolair). This medicine treats asthma or hives when other medicines don't help.
• Mepolizumab (Nucala). This medicine treats asthma and sinus discomfort.

Pills and liquids

When treating a peanut allergy in children, a pill might help. Although peanuts may still need to be avoided, this medicine might help prevent a severe reaction if peanuts are eaten by accident. It cannot be used as emergency treatment for anaphylaxis.

Side effects include swelling of the throat and anaphylaxis in rare cases. If you have asthma, this treatment may make your symptoms worse.

Oral treatment for peanut allergies:

• Peanut allergy powder (Palforzia).

When treating for dust mites or hay fever, a medicine tablet may be placed under the tongue. This is called sublingual immunotherapy (SLIT). The medicine dissolves and is absorbed under the tongue. This method is known to relieve asthma and allergy symptoms.

SLIT treatment for dust mites:

• House dust mite allergen extract (Odactra).

SLIT treatments for hay fever:

• Short ragweed pollen extract (Ragwitek).
• Sweet vernal, orchard, perennial rye, timothy, and Kentucky blue grass mixed pollens allergen extract (Oralair).
• Timothy grass pollen allergen extract (Grastek).

Decongestants

Decongestants are used for quick, temporary relief of nasal and sinus congestion. They're not intended for routine or long-term treatment of allergy symptoms. They also are not recommended for people with high blood pressure, heart disease, glaucoma or overactive thyroid, also called hypothyroidism.

Side effects include trouble sleeping, headache, increased blood pressure and irritability.

Nasal decongestant sprays and drops

Nasal decongestant sprays and drops relieve nasal and sinus congestion. But they only should be used for a short time. Use of these sprays and drops for more than three days in a row can cause more congestion when treatment stops. This is called rebound congestion.

Examples include:

• Oxymetazoline (Afrin).
• Tetrahydrozoline.

Pills and liquids

Oral decongestants also relieve nasal and sinus congestion. Many decongestants are available without a prescription.

Examples include:

• Pseudoephedrine (Sudafed).

Some oral allergy medicines contain a decongestant and an antihistamine. Examples include:

• Cetirizine and pseudoephedrine (Zyrtec-D 12 Hour).
• Desloratadine and pseudoephedrine (Clarinex-D 12 Hour).
• Fexofenadine and pseudoephedrine (Allegra-D).
• Loratadine and pseudoephedrine (Claritin-D).

Leukotriene inhibitors

A leukotriene inhibitor blocks chemicals that cause allergy symptoms. These chemicals are called leukotrienes. This oral medicine relieves asthma and hay fever and is available by prescription only.

Side effects of leukotriene inhibitors include anxiety, depression, strange dreams, trouble sleeping, and suicidal thinking or behavior.

An example of a leukotriene inhibitor:

• Montelukast (Singulair).

Emergency allergy medicine

Epinephrine shots are used to treat a sudden, life-threatening allergic reaction, also called anaphylaxis. Symptoms of anaphylaxis include swelling in the throat and difficulty breathing.

Shots to treat anaphylaxis are given with an autoinjector. This device has a self-injecting syringe and needle. You might need to carry two autoinjectors if there's a chance you have a severe allergy. Severe allergic reactions might be triggered by food, such as peanuts, or insect venom, such as bees and wasps.

A healthcare professional will train you on how to use an epinephrine autoinjector. Get the type that your health professional prescribes, as each brand may work differently. Also, be sure to replace your emergency epinephrine before the expiration date.

Sometimes, a second injection is needed. If anaphylaxis happens, call 911 or get emergency medical care.

Examples of these emergency allergy medicines include:

• Adrenaclick.
• Auvi-Q.
• EpiPen.
• EpiPen Jr.
• Symjepi.

Get your healthcare team's advice

Work with your care team to choose the safest and most effective allergy medicine for you. Even nonprescription medicines have side effects. Some allergy medicines can cause problems when combined with other treatments and conditions.

It's even more important to speak to your care team about allergy medicines if:

• You are pregnant or breastfeeding.
• You have a chronic health condition. These include diabetes, glaucoma, osteoporosis or high blood pressure.
• You take other medicines. Other medicines include herbal supplements.
• You are treating allergies in a child. Children may need different medicines or doses than adults.
• You are treating allergies in an older adult. Some allergy medicines can cause confusion, urinary tract symptoms or other side effects in older adults.
• Your allergy medicine isn't working. Bring the medicine with you in its original bottle or package when you see your healthcare professional.

Keep track of your symptoms. Note when you use your medicines and how much you take. This information can help your care team figure out what works best. You might need to try a few different options to find the most effective medicine with the fewest side effects.