What allergy medications you should take and when
Another round of snow and ice may have gripped large parts of the country recently, but spring is only weeks away. And with spring comes allergies.
In much of the United States, the influx of pollen and mold spores that herald the arrival of spring also signals the return of sneezing, itchy eyes, runny nose, and more. Other allergies can irritate us all year round. Hay fever (also known as allergic rhinitis) affects 10-30% of the world’s population and can strike in any season due to dust mites and other common irritants.
Fortunately, there are several types of allergy medications that can ease symptoms. But, it is important to know the differences between the many options to know when and how long they should be taken. Here are some things allergy experts recommend to keep in mind when preparing for the start of allergy season.
DO NOT make Benadryl a long term solution
Many over-the-counter allergy medications are antihistamines.
These drugs work by blocking your body’s response to histamine, a chemical that the immune system releases when it senses a potential threat. Unfortunately for allergy sufferers, the immune system sometimes overreacts to substances like pollen that aren’t actually harmful. Histamine causes blood vessels to expand and leak and increase mucus production to fight off the intruder, leading to a runny nose and other classic allergy symptoms.
There are two broad categories of antihistamines, says Eric Macy, an allergist-immunologist at Kaiser Permanente in San Diego. In addition to their antiallergic effects, “first generation” antihistamines like Benadryl can cause drowsiness and coordination problems. They belong to a class of drugs called anticholinergics whose long-term use can increase the risk of dementia.
[Related: Does taking allergy medication make my allergies worse?]
“First-generation antihistamines have more cognitive or brain-related effects than second-generation antihistamines, so it’s not a good idea to take them every day,” says Sai R. Nimmagadda, an allergist-immunologist at Northwestern University Feinberg. School of Medicine and Lurie Children’s Hospital of Chicago.
Newer “second generation” antihistamines, including Claritin, Zyrtec, and Allegra, are generally safe to use regularly. However, Nimmagadda says, some people find that a given antihistamine becomes less effective over time. Rather than increasing the dose, he recommends switching to another antihistamine. “I tell my patients to alternate antihistamine therapies every three to six months if they find that they have become tolerant to a particular medication,” says Nimmagadda.
Start your nasal spray before the pollen onslaught
Antihistamines are great for sneezing, itchy eyes, runny nose and hives, but they don’t help much with congestion, Macy says. However, corticosteroid nasal sprays like Flonase treat congestion as well as other allergy symptoms. They contain lab-made versions of natural hormones that calm inflammation.
Corticosteroids can be used daily without losing their benefit, Nimmagadda says. “The only thing is with intranasal steroids it’s important to start them early in the season,” he says.
If you wait for your immune system to get to work against that dreaded pollen and your symptoms get worse, corticosteroids won’t work as well. Nimmagadda likens it to fighting a fire before it gets out of control. “If you have a small fire, it’s easier to put it out with a garden hose,” he says. “If you have a big fire, when you try to use a garden hose, it’s not going to work very well.”
An even simpler remedy is to use a saline solution (i.e. salt water) to remove mucus and debris from your nasal passages. These solutions can be bought at the pharmacy or made at home — and using them will likely reduce the amount of allergy medication you need to control your symptoms, Nimmagadda says.
“The cheapest and best treatment you can do is to wash your nose of all pollen allergens morning and night,” he says. “One of the mainstays of my treatment regimens is the saline rinse.”
DO NOT take decongestants year round
Sudafed and similar drugs fight congestion and pressure by causing blood vessels to constrict. However, they can also cause restlessness, interfere with sleep, and contribute to cardiovascular issues like high blood pressure, Macy says. Additionally, prolonged use of decongestant nasal sprays can actually make congestion worse, an effect known as rebound congestion. Because of these side effects, decongestants should not be used for more than a few days at a time.
[Related: How to tell seasonal allergies from COVID-19 symptoms]
Another thing to keep in mind, Macy says, is that if you have sinus congestion and pressure without other symptoms like itching and sneezing, it’s probably not caused by allergies. Other treatable conditions, including migraines, infections, and nasal polyps, may actually be to blame.
Check with your doctor
If you suffer from nasal symptoms year-round, Macy advises, it’s a good idea to see a doctor and discuss more effective treatment options.
“Basically, it comes down to: seeing an allergist, determining the cause of the problem and treating it [rather] than taking antihistamines to paint the rust,” he says.
Immunotherapy treatments – allergy shots and drops – decrease a person’s sensitivity to pollen, dust mites and other irritants. They work by exposing the immune system to gradually increasing doses of the allergen and can provide long-term relief, Nimmagadda explains.
“All these [allergy] drugs are used after the fact; you have symptoms and you use medication to control the symptoms,” he says. “Immunotherapy prevents symptoms from even starting.”