Seasonal Allergies: Which Medication is Right for You?

The pollen count is sky-high. You’re sneezing, your eyes are itching, and you feel miserable. Seasonal allergies are real diseases that can interfere with work, school or recreation. Allergies can also trigger or worsen asthma and lead to other health problems such as sinus infections (sinusitis) and ear infections in children.

An allergy is your body’s reaction to an otherwise innocent substance that it has identified as an invader. If you have allergies and encounter a trigger—called an “allergen”—your immune system fights it by releasing chemicals such as histamines (hence the term “antihistamines”). Histamines cause symptoms such as repetitive sneezing and itchy, watery eyes.

Allergy Medicines: Antihistamines and More

Seasonal allergies are usually caused by plant pollen, which can come from trees, weeds and grasses in the spring, and by ragweed and other weeds in late summer and early fall.

Since you can’t always stay indoors when pollen counts are high, your health care provider may recommend prescription or over-the-counter (OTC) medications to relieve symptoms. The U.S. Food and Drug Administration (FDA) regulates a number of medications that offer allergy relief.

Antihistamines reduce or block symptom-causing histamines and are available in many forms, including tablets and liquids. Many oral antihistamines are available over the counter and in generic form.

When choosing an OTC antihistamine, patients should read the Drug Facts label closely and follow dosing instructions, says Jenny Kelty, M.D., a pediatric pulmonologist at the FDA. Some antihistamines can cause drowsiness and interfere with the ability to drive or operate heavy machinery, like a car. There are other antihistamines that do not have this side effect; they are non-sedating. Some non-sedating antihistamines are available by prescription.

Nasal corticosteroids are typically sprayed into the nose once or twice a day to treat inflammation. Side effects may include stinging in the nose.

Decongestants are drugs available both by prescription and OTC and come in oral and nasal spray forms. They are sometimes recommended in combination with antihistamines, which used alone do not have an effect on nasal congestion.

Drugs that contain pseudoephedrine are available without a prescription but are kept behind the pharmacy counter to prevent their use in making methamphetamine—a powerful, highly addictive stimulant often produced illegally in home laboratories. You will need to ask your pharmacist and show identification to purchase drugs that contain pseudoephedrine.

Using decongestant nose sprays and drops more than a few days may give you a “rebound” effect—your nasal congestion could get worse. These drugs are more useful for short-term use to relieve nasal congestion.

Immunotherapy is another option. One form of allergen immunotherapy is allergy shots in which your body responds to injected amounts of a particular allergen, given in gradually increasing doses, by developing immunity or tolerance to that allergen.

Patients can receive injections from a health care provider; a common course of treatment would begin with weekly injections for two to three months until the maximum dose is reached. After that, treatment could continue monthly for three to five years.

Another form of allergen immunotherapy therapy involves administering the allergens in a tablet form under the tongue (sublingual) and is intended for daily use, before and during the pollen season. These medications are available by prescription for the treatment of hay fever caused by certain pollens and have the potential for dialing down the immune response to allergens. However, they are not meant for immediate symptom relief, says Jay Slater, M.D., an allergist with the FDA. Sublingual therapy should start three to four months before allergy season. Although they are intended for at-home use, the first doses are to be taken in the presence of a health care provider.

A Word about OTC Products and Kids

Always read the label before buying an OTC product for you or your children, says Kelty. “Some products can be used in children as young as 2 years, but others are not appropriate for children of any age.” Talk to your health care professional if your child needs to use nasal steroid spray for more than two months a year.