Allergy treatment usually starts with avoiding the substances
(allergens) that cause your signs and symptoms. If you can minimize
your exposure to allergens — which may include everything from
pollen, mold, pet dander and dust mites to certain foods, drugs and
chemicals — you'll have less sneezing, coughing and itching.
But because you can't always avoid everything that triggers your
allergies, your doctor may prescribe allergy medication. The right
medication or combination of medications depends on the allergy
symptoms you have. Allergy medications are available in pill,
liquid, nasal spray, eyedrop and topical (applied to the skin)
forms, some over-the-counter and others by prescription only. To
make the best choice, get advice from your doctor, and find out
which medications are best for different symptoms.
The main types of allergy medications are:
- Corticosteroids. These medications help prevent and treat the inflammation associated with allergic conditions.
- Antihistamines. These drugs block histamine, an inflammatory chemical released by your immune system during an allergic reaction.
- Decongestants. These drugs relieve nasal and sinus congestion.
- Leukotriene modifiers. These medications block the effects of leukotrienes, inflammatory chemicals released by your immune system during an allergic reaction.
- Mast cell stabilizers. These preparations prevent the release of histamine.
Corticosteroids help prevent and treat the inflammation
associated with most allergic conditions, although the site and
severity of inflammation varies. Except for some over-the-counter
skin creams, corticosteroid medications usually are available only
by prescription. They include:
- Nasal sprays.
Corticosteroid medications sprayed in the nostrils are the
preferred treatment for hay fever because they help prevent and
relieve nasal stuffiness, sneezing and an itchy, runny nose.
Examples include budesonide (Rhinocort), mometasone (Nasonex),
fluticasone (Flonase) and triamcinolone (Nasacort). Although these
medications aren't usually immediately effective, you may start to
notice improvement after you've used them regularly for days or
even a week or two. Nasal corticosteroids are generally safe for
extended use. Mild side effects may include an unpleasant smell or
taste, or irritation, crusting and bleeding in your nose. Nasal
irritation may be especially noticeable during the winter. Rarely,
more serious side effects can include sinus damage and infection.
Unlike steroids taken by mouth or inhaled deeply through an
inhaler or nebulizer, most nasal steroids don't appear to reduce
bone density or affect growth in children. Still, to be on the
safe side, doctors usually prescribe the lowest effective dose of
nasal corticosteroids.
- Eyedrops. Corticosteroid
drops formulated for the eyes relieve the redness, tearing and
itching caused by hay fever and allergic conjunctivitis. Examples
include dexamethasone (Decadron, Dexair, others), fluorometholone
(Eflone, Fluor-Op, others) and prednisolone (AK-Pred, Econopred,
others). They shouldn't be used if you have glaucoma or an eye
infection. They can cause side effects such as blurred vision.
Because they've been shown to cause birth defects in animals, you
may be advised to avoid them if you are pregnant or plan to become
pregnant. Also, if you wear contact lenses, corticosteroid
eyedrops increase your risk of eye infections, so you may be
advised to switch to eye glasses during treatment.
- Skin creams. Best for
relieving the scaling and itching caused by eczema (atopic
dermatitis), corticosteroid skin creams come in different
strengths. Low-potency skin creams include hydrocortisone
(Allercort, Dermacort, others). Medium to very high potency skin
creams include triamcinolone (Aristocort, Flutex, others).
Although such skin creams are usually safe, they can sometimes
cause skin irritation and discoloration.
- Pills, liquids. Oral
corticosteroids such as prednisone (Cordrol, Dexasone, others) are
sometimes used to treat severe allergy symptoms. Because the
long-term use of such medications can cause severe side effects
such as cataracts, osteoporosis and muscle weakness, they're
usually prescribed only for short periods of time.
Antihistamines block the action of histamine, an inflammatory
chemical released by your immune system during an allergic reaction.
Blocking histamine reduces such symptoms as redness, swelling, runny
nose, itchy, watery eyes, and hives (urticaria). Prescription and
over-the-counter antihistamines include:
- Pills, liquids.
Over-the-counter oral antihistamines include diphenhydramine
(Benadryl), chlorpheniramine (Chlor-Trimeton) and clemastine
(Tavist). Because these older, first-generation antihistamines may
make you sleepy, avoid using them before driving or operating
heavy machinery. Newer, second-generation antihistamines — such as
loratadine (Claritin), which is available over-the-counter — are
less likely to cause sedation. Fexofenadine (Allegra) is a
nonsedating prescription antihistamine. Another prescription
antihistamine, cetirizine (Zyrtec), has an intermediate risk of
causing drowsiness or driving impairment.
- Nasal sprays. The
prescription antihistamine azelastine (Astelin) is effective for
hay fever, but may cause drowsiness.
- Eyedrops. Prescription
eyedrops include emedastine (Emadine), levocabastine (Livostin)
and olopatadine (Patanol). Side effects may include redness,
tearing, headache and mild stinging or burning. Antihistamine
eyedrops increase the risk of eye inflammation for contact lens
wearers, so you're safer wearing glasses during treatment.
Decongestants relieve nasal and sinus congestion caused by hay
fever, as well as eye congestion caused by allergic conjunctivitis.
Usually available over-the-counter, they include:
- Pills, liquids. Many
decongestants contain pseudoephedrine (Sudafed, Actifed, others),
sometimes in combination with another drug. Medications such as
Claritin-D, for example, combine pseudoephedrine with an
antihistamine. Because oral decongestants elevate blood pressure,
you should avoid them if you have high blood pressure
(hypertension). Oral decongestants can also exacerbate the
symptoms of prostate enlargement, making urination more difficult.
- Nasal sprays. Examples
include phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin).
Don't use a decongestant nasal spray for more than two or three
days at a time because, after longer use, you may develop severe
congestion as soon as you stop.
- Eyedrops. Examples include
tetrahydrozoline hydrochloride (Visine). Although these eyedrops
are generally safe, your eyes may become persistently red if you
overuse them.
These drugs block the effects of leukotrienes, inflammatory
chemicals released by your immune system during an allergic
reaction. Such medications have proved most effective in treating
allergic asthma, but they also relieve hay fever. Leukotriene
modifiers are only available by prescription. They're produced in
pill and chewable tablet form. Examples include montelukast
(Singulair), zileuton (Zyflo) and zafirlukast (Accolate). Headache
is the most common side effect of montelukast, and nausea or upset
stomach is the most common side effect of zileuton. Headache and
nausea are sometimes side effects of zafirlukast.
Mast cell stabilizers prevent the release of histamine, the same
inflammatory chemical that antihistamines stop from binding to cells
in the mucous membranes. Mast cell stabilizers may also reduce
inflammation associated with hay fever and allergic conjunctivitis.
They include:
- Nasal spray. Available
over-the-counter, the nasal spray cromolyn sodium (NasalCrom,
Children's NasalCrom) has no serious side effects but may make the
nasal passageways sting and burn, causing increased sneezing.
Cromolyn sodium works best when you take it before your symptoms
develop. Some people need to use the spray three or four times a
day.
- Eyedrops. Several different
mast cell stabilizer eyedrops are available by prescription, but
none are sold over-the-counter. Cromolyn sodium (Crolom) is
available in eyedrop form, as are slightly different mast cell
inhibitors, including lodoxamide (Alomide), pemirolast (Alamast)
and nedocromil (Alocril). Cromolyn sodium and lodoxamide may make
the eyes burn and sting, while pemirolast may cause chills,
coughing, sneezing and sore throat. Nedocromil may cause blurred
vision or dry, itchy eyes.
If you are taking any other medications or you have a chronic
health condition, talk to your doctor or pharmacist before starting
any treatment for allergies, to be sure you're not at risk of a drug
interaction or other adverse effect.
When allergies trigger asthma |
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If you have the type of asthma triggered by allergies, your
doctor may recommend medications such as inhaled corticosteroids,
inhaled mast cell stabilizers, bronchodilators and allergy
desensitization shots (immunotherapy). Omalizumab (Xolair), an
anti-IgE monoclonal antibody, may help you if you have severe
allergic asthma. Administered by injection every two to four weeks,
omalizumab blocks the IgE antibodies that your immune system
produces to attack substances that generally cause no harm, such as
pollen, dust mites and pet dander.
Immunotherapy: An option if medications are ineffective |
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If you have hay fever symptoms that don't improve with
medications or if you aren't able to take allergy medications
without side effects, your doctor may recommend allergy shots
(immunotherapy). Over a period of three to five years, you receive
regular injections containing allergen extracts. The goal is to
desensitize you to specific allergens and decrease or eliminate your
need for medications.
Immunotherapy may be especially effective if you're allergic to
cat dander, dust mites or pollen produced by trees, grass and weeds.
In children, immunotherapy may help prevent the development of
asthma. Rarely, immunotherapy injections can cause a severe allergic
reaction (anaphylaxis).
Injectable epinephrine: First aid for severe allergic reactions |
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If you're highly allergic to certain foods, such as peanuts, or
to bee or wasp venom, you may be at risk of anaphylactic shock — a
sudden, life-threatening allergic reaction. To be on the safe side,
your doctor may suggest that you carry an injectable dose of
epinephrine (adrenaline). Epinephrine can help slow the reaction
while you seek emergency medical treatment. You may be able to
administer the drug by yourself, after being taught how to use a
self-injecting syringe and needle. A friend, family member or
medical professional called in response to a severe anaphylactic
reaction also may administer the medication.
Allergy medications vary as much as allergies themselves. By
understanding how such medications work, you can help your doctor
develop a treatment plan that's best for you.
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