When avoidance measures fail or are not possible, many people will require medications to treat their allergic rhinitis symptoms. The choice of medication depends on several factors outlined below:
- How severe are your symptoms?
- What are your symptoms?
- What type of medication will you take (over-the-counter, prescription)?
- Is the medication needed daily or intermittently?
- What side effects might you experience from the medications?
This is the most common class of medications used for allergic rhinitis. The first-generation antihistamines, which include Benadryl, are generally considered too sedating for routine use. These medications have been shown to affect work performance and alter a person’s ability to operate an automobile.
Newer, second-generation antihistamines have now become first-line therapy for people with allergic rhinitis. These over-the-counter medications include:
- Alavert, Claritin (loratadine)
- Allegra (fexofenadine)
- Clarinex (desloratadine)
- Xyzal (levocetirizine)
- Zyrtec (cetirizine)
These medications have the advantage of being relatively inexpensive and easy to take. They also start working within a couple of hours and, therefore, can be given on an “as needed” basis.
These medications are particularly good at treating sneezing, runny nose, and itching of the nose as a result of allergic rhinitis.
Side effects are rare and include a low rate of sedation or sleepiness, but much less than with the first-generation antihistamines.
Topical Nasal Steroids
This class of allergy medications is effective at treating allergic and non-allergic rhinitis, particularly if a person experiences nasal congestion.
There are numerous topical nasal steroids on the market and most are now available over the counter.
This group of medications includes:
- Beconase AQ (beclomethasone)
- Flonase (fluticasone)
- Nasacort AQ (triamcinolone)
- Nasarel (flunisolide)
- Nasonex (mometasone)
- Rhinocort Aqua (budesonide)
Nasal steroids are excellent at controlling allergic rhinitis symptoms. However, the sprays need to be used daily for the best results; they don’t work well on an as-needed basis.
Side effects are mild and limited to nasal irritation and nose bleeds. The use of these nasal sprays should be stopped if irritation or bleeding is persistent or severe.
Other Nasal Sprays
There are two other types of nasal sprays available, a nasal antihistamine and a nasal anti-cholinergic:
- Astelin (azelastine) is a prescription antihistamine that is effective at treating allergic and non-allergic rhinitis. It treats all nasal symptoms like nasal steroids do, but can be used intermittently, as it works within minutes. Still, regular use is best. Side effects are generally mild and include local nasal irritation. Astepro (azelastine) works similarly and has been approved for over-the-counter use.
- Nasal ipratropium (Atrovent nasal), the anti-cholinergic, works to dry up nasal secretions and may be useful in treating allergic rhinitis and non-allergic rhinitis. It works great at treating a “drippy nose,” but will not treat nasal itching or nasal congestion symptoms. Side effects are mild and typically include local nasal irritation and dryness.
Oral decongestants, with or without oral antihistamines, can be useful medications in the short-term treatment of nasal congestion in people with allergic rhinitis who do not have other underlying disease. This class of medications includes pseudoephedrine (Sudafed), phenylephrine, and numerous combination products.
Decongestant/antihistamine combination products (such as Allegra-D, Zyrtec-D, Clarinex-D, and Claritin-D) are indicated for treating allergic rhinitis in people 12 years of age and older. These can be taken for two to three days to treat acute symptoms; they should not be used daily long-term.
Side effects associated with long-term use can include insomnia, headaches, elevated blood pressure, rapid heart rate, and nervousness.
This class of medications is not recommended for people who are pregnant or trying to get pregnant. Oral decongestants also should not be used by those with underlying cardiovascular or cerebrovascular disease.
Those with other chronic diseases should discuss risks and benefits of this class of medications with their physician before use.
Singulair (montelukast) was originally developed for mild asthma but has also been approved for the treatment of allergic rhinitis.
However, two large review studies put forward that montelukast is not as effective as oral antihistamines or nasal steroids at treating allergic rhinitis and should only be considered a second- or third-line treatment option.
The medication must be taken daily for best effects, and it usually takes a few days before it starts working. Side effects include headaches, abdominal pains, and fatigue.
Montelukast also contains a black box warning due to risk of mental health side effects, including suicidal ideation in susceptible individuals. The U.S. Food and Drug Administration (FDA) stresses that montelukast should only be used in cases of allergic rhinitis as a last option when other treatments haven’t worked or aren’t well tolerated.