How to get relief from allergy symptoms

Before choosing a medication, it helps to understand what’s causing your allergies. Dreamstime/TNS

By Howard LeWine, M.D.
Posted on June 19, 2022

Q: I am struggling with more allergy symptoms than usual this spring. There are so many over-the-counter products available. How does one choose?

A: Before choosing a medication, it helps to understand what’s causing your allergies.

Often, it’s a matter of inhaling a harmless substance, such as pollen or another allergen, which the immune system mistakenly perceives as a dangerous invader.

The immune system generates substances designed to fight the assumed invader. One of these substances is histamine, which triggers inflammation of mucous membranes and the production of mucus (lots of it).

This condition, called allergic rhinitis, is marked by a stuffy or runny nose, watery or itchy eyes, sneezing, coughing and sometimes a sore throat.

OTC treatments to start

If you haven’t tried an antihistamine yet, start there. Choose one of the second-generation over-the-counter (OTC) antihistamines, such as fexofenadine (Allegra), loratadine (Claritin), or cetirizine (Zyrtec).

Compared with first-generation antihistamines, like diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton), the newer ones are less likely to make you drowsy.

Antihistamine eye drops, such as ketotifen (Zaditor), can be used for watery eyes.

If an antihistamine isn’t resolving your symptoms, you can add a corticosteroid nasal spray. OTC versions include budesonide (Rhinocort), fluticasone propionate (Flonase), and triamcinolone (Nasacort).

The downside is that corticosteroid sprays take two weeks or more for their full effect. That can be tough when you’re coping with symptoms.

Next year, start meds early

If you can anticipate seasonal allergy symptoms next time, start using the corticosteroid nasal spray before symptoms typically begin. Potential side effects include nose bleeds and higher eye pressure related to glaucoma.

Non-prescription decongestants, such as pseudoephedrine (Sudafed) or phenylephrine (Neo-Synephrine, Sudafed PE), shrink tiny blood vessels, which decreases fluid secretion in the nasal passages, helping to relieve a stuffy nose.

Check with your doctor if you have heart or blood pressure problems, as decongestants can raise heart rate and blood pressure.

All of the products mentioned above are available as generic versions, which are usually less expensive.

If you’re still having symptoms, or if you’re concerned about side effects, it may be time to consult your primary care physician, an allergist, or an ENT (ear, nose and throat specialist).

Sometimes it takes trial and error to find the best combination of medications to relieve your symptoms.

And if nothing is controlling them, there are still more options, including allergy shots that can change how your immune system responds to allergens.