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Allergy Relief: Antihistamines Vs. Decongestants
The two most common types of allergy medications are antihistamines and decongestants. Antihistamines and decongestants don't cure your allergies, but they'll give you much-needed relief for a runny or congested nose. They're available both as a prescription and over the counter (OTC) in several forms:
Histamine is a chemical your immune system makes. It does a few things, such as regulating your sleep cycle. But it also helps send signals between cells, which is part of why you have allergy symptoms. Antihistamines are medicines that block histamine from binding to your cells, which can make your symptoms better.
Antihistamines come in several forms, such as pills, liquids, nasal sprays, or eye drops. Pills target itching, sneezing, and runny nose. Nasal sprays work on congestion, an itchy or runny nose, and postnasal drip.
Antihistamines can ease your symptoms, but they work best when you take them before you feel a reaction. They can build up in your blood to protect against allergens and block the release of histamines. Ask your doctor if you should start taking allergy medicine a couple of weeks before you usually have symptoms.
Some common antihistamines you can get OTC as pills or liquids are:
Antihistamine eye drops
These can help ease itchy eyes and problems with your nose. You can try:
Antihistamines are classified as first- or second-generation. First-generation antihistamines can easily cross over from your bloodstream to your brain, so they can make you feel very sleepy. On the other hand, second-generation antihistamines don't tend to cross over into your brain as easily, so they don't make you feel as sleepy.
Examples of first-generation antihistamines include:
Examples of second-generation antihistamines include:
Decongestants work by reducing the swelling in the blood vessels in your nose. This relieves your blocked and stuffy nose and helps open your airways.
Decongestants are available in various forms, such as nasal sprays, eye drops, tablets, capsules, liquids, and powders.
Decongestants aren't recommended for people with high blood pressure, heart disease, glaucoma, or hyperthyroidism.
Examples of common decongestants you can get OTC as tablets or capsules include:
Some medications combine decongestants with other medicines, such as pain relievers and/or antihistamines.
Examples of these include:
Decongestant nasal sprays
These work faster than tablets or capsules. Examples include:
Don't use nasal sprays for more than a few days in a row because they can worsen your swelling and stuffiness. This is called a "rebound reaction." You get temporary relief, but your symptoms come back worse than before. So, if you use nasal decongestant sprays, limit it to a maximum of 3 days.
Corticosteriods (or steroids) are a powerful way to fight stuffiness, as they get to the root of the problem by directly reducing your swelling. They can be especially helpful, for instance, if you have seasonal allergies and you know you're going to be stuffy until the season changes.
These also come in several forms, including sprays, inhalers, eye drops, pills, liquids, and creams.
Steroid nasal sprays
Nasal steroids are a type of nose spray and are often the first drugs recommended for allergies.
They lessen your whole allergic inflammatory process. Plus they target all your allergy symptoms, not just congestion.
You can get these OTC:
If you decide to use one, be patient. You don't get the full effect for several days or even a week. But if you use it daily, it can be very effective. You can also use steroids together with antihistamines or decongestants to get extra relief. Or, use an antihistamine or decongestant for short-term relief while you wait for your steroids to work.
Allergy shots (allergen immunotherapy)
You may want to consider them if you have allergy congestion all year and medication doesn't help much. It gets your body used to the things that trigger your hay fever so you won't have an allergic reaction.
Allergy shots can be very effective, but they don't work quickly. You get a series of injections over several years. Each one has a small dose of the stuff that causes your allergies.
Some allergists are turning to another form of immunotherapy, called sublingual immunotherapy (SLIT), which doesn't use injections. You may be able to take a pill that dissolves after you put it under your tongue. Examples are Grastek, Oralair, and Ragwitek. You need to take the first one at a doctor's office, but after that, you can use them at home.
Mast cell stabilizers
Mast cells are a type of immune system cell. They release chemicals that can cause your allergy symptoms. Mast cell stabilizers keep these cells from releasing their chemicals. Your doctor may prescribe these for you when antihistamines don't work for you or if you have intolerable side effects. You usually need to use these for a few days before they take full effect.
They come as nasal sprays, such as cromolyn sodium (NasalCrom), and eye drops, such as:
Leukotriene inhibitors
Leukotrienes are other chemicals that your immune system releases, causing symptoms. Leukotriene inhibitors block these chemicals from binding to your cells. This eases congestion, runny nose, and sneezing. Only one type is available for hay fever: montelukast (Singulair).
Emergency epinephrine shots
These are used for people with anaphylaxis, which is a potentially life-threatening allergic reaction. Your doctor can prescribe it for you. If you have serious allergies, you should keep at least two of these with you at all times. They come as auto-injecting syringes.
Some of these drugs need a prescription. Others don't. First, try an OTC brand. But check with your doctor or pharmacist to make sure you have the right medication for your symptoms. If you don't get relief, ask for something stronger.
Check drug labels for more information about side effects.
Antihistamines side effects
You shouldn't drive when you take antihistamines , especially first-generation antihistamines, as they can make you drowsy. These include brompheniramine (Nasahist B), chlorpheniramine (Chlor-Trimeton), clemastine (Dayhist, Tavist), and diphenhydramine (Benadryl). Second-generation antihistamines usually don't make you drowsy. Examples include desloratadine (Clarinex), fexofenadine (Allegra), and loratadine (Alavert, Claritin).
Decongestants side effects
Decongestants can also cause side effects, such as:
You shouldn't take decongestants if you have certain health issues, including high blood pressure or heart problems. If you have prostate problems that make it hard to pee, these drugs can make the problem worse.
Antihistamines and decongestants are the two most commonly used types of allergy medications. They don't cure your allergies, but they can make your symptoms go away for a while. You can even combine them (or buy a combination medication) if you don't get relief from one or the other.
What Is Allergic Rhinitis?
Allergic rhinitis is the inflammation of nasal passageways that occurs when your immune system overreacts to allergens such as pollen, pet dander, or dust mites that are in the air. When it's pollen causing the nasal inflammation, allergic rhinitis is referred to as hay fever or seasonal allergies.
In people with allergic rhinitis, exposure to allergens can trigger uncomfortable symptoms like sneezing; runny or stuffy nose; red or watery eyes; and itchiness around the mouth, nose, and eyes.
More than 400 million people worldwide experience allergic rhinitis. Treatments, including over-the-counter (OTC) and prescription medications and allergen immunotherapy, can help control symptoms and reduce their impact on your daily life.
There are two main types of allergic rhinitis: seasonal and perennial. The type of allergic rhinitis you have depends on how frequently you experience symptoms and how long the symptoms last. Seasonal Allergic Rhinitis Also known as hay fever—though it is not specific to hay and does not cause a fever—seasonal allergic rhinitis occurs at specific times of the year when pollen counts are high. People with allergies to pollen from grasses, weeds, and trees can experience seasonal allergic rhinitis, usually in the spring and fall. In addition to hay fever, seasonal allergic rhinitis may be referred to as seasonal allergies. Perennial Allergic Rhinitis The word "perennial" means year-round. As such, perennial allergic rhinitis refers to allergy-related nasal inflammation that can last year-round. People allergic to dust mites, pet dander, cockroach debris, and mold spores can have perennial allergic rhinitis. Symptoms of allergic rhinitis develop shortly after exposure to a substance to which you are allergic and can include: Runny nose with clear-colored mucus Sneezing Red, watery eyes Itchy eyes, nose, or mouth Untreated or prolonged allergic rhinitis can lead to additional symptoms, such as: Nasal congestion (stuffiness) Postnasal drip (mucus drainage down the back of the throat) Cough Sore throat Headache Reduced sense of smell Clogged ears or ear-popping sensations Sinus pressure (pressure around the cheeks and nose) Fatigue Facial puffiness Dark circles under the eyes Difficulty sleeping Allergic rhinitis develops when the immune system overreacts to an allergen, which are normally harmless substances like pollen or dust mites that trigger an immune response in people with allergies. When people with allergies breathe in an allergen, the immune system mistakenly identifies it as a threat, triggering the release of histamine and other chemicals. Histamine causes inflammation in the lining of the nose and increases mucus production, leading to symptoms of allergic rhinitis. Common allergens that trigger allergic rhinitis include: Pollen from grasses, weeds, and trees Pet dander from furry pets like dogs and cats Dust mites Mold spores Cockroach debris Risk Factors Several factors can increase your risk of developing allergic rhinitis, including: Family history: If you have a family member with allergies, you're more likely to experience allergic rhinitis. Eczema: People with eczema, a chronic inflammatory skin condition, are more prone to allergies and allergic rhinitis. Early life exposures: Exposure to air pollution, indoor allergens like dust mites, secondhand smoke, and antibiotic use in early childhood can increase the risk of allergic rhinitis. Lifestyle habits: Smoking and having poor sleep quality are associated with an increased risk of allergic rhinitis. When you visit a healthcare provider for symptoms of allergic rhinitis, they will likely begin by reviewing your medical history and asking about your symptoms. They may ask about the following: What triggers your symptoms How frequent and severe your symptoms are Whether anyone else in your family has a history of allergies What your work and home environments are like, such as whether you have a pet at home or your workplace involves exposure to chemicals Your healthcare provider will probably perform a physical examination and may recommend allergy testing to identify what is triggering your allergic rhinitis symptoms. The most common type of allergy test is a skin prick or scratch test. This involves scratching or pricking (poking) small amounts of possible allergens into your skin and observing whether an allergic reaction occurs in response. If you are allergic to one of the tested allergens, you will likely develop a raised itchy bump where your skin was scratched with that allergen. Your healthcare provider may also have you do an allergy blood test, such as an ImmunoCAP test. Allergy blood tests measure the amount of immunoglobulin E (IgE) in your blood. IgE are antibodies your body makes against specific allergens. Higher IgE levels can mean you have an allergic disorder like allergic rhinitis. The goal of allergic rhinitis treatment is to manage symptoms so you can reduce discomfort and improve your quality of life. Your healthcare provider will develop a treatment plan based on the type of allergic rhinitis you have (seasonal vs. Perennial) and the severity of your symptoms. Medications Several over-the-counter (OTC) and prescription medications effectively reduce allergic rhinitis symptoms. These include: Nasal steroid sprays: Intranasal corticosteroid sprays are the most effective medication for allergic rhinitis. These sprays help reduce inflammation and swelling in the nose, making it less stuffy. They also relieve symptoms like a runny nose, sneezing, and itchiness. Daily use of nasal steroid sprays typically yields the best results, and it may take up to two weeks to notice improvements in your symptoms. Antihistamines: These medicines block the action of histamine to help reduce symptoms like sneezing, itchiness, watery eyes, and runny nose. They come in many forms, including eye drops, oral tablets, syrups, and nasal sprays. Antihistamines are most effective when taken before exposure to an allergen and on a short-term basis; many people find they become less effective over time or as pollen counts increase in the air. Decongestants: These medicines, available in nasal spray or pill form, temporarily relieve nasal congestion to help make breathing easier. Decongestants work quickly and can relieve stuffiness for hours, but you should only use them three days at a time. Overusing nasal spray decongestants can cause rebound swelling and worsen nasal congestion after you stop using them. Leukotriene pathway inhibitors: Prescription medications such as Singular (montelukast) block leukotrienes, which are inflammatory chemicals the body releases during an allergic reaction to help reduce symptoms such as runny nose and congestion. Allergen Immunotherapy Allergen immunotherapy offers a long-term solution for managing allergic rhinitis when other treatments are ineffective. It involves gradually increasing doses of identified allergens to help your body build a tolerance to the allergens and reduce the severity and frequency of allergy symptoms. Depending on your allergies, your healthcare provider may recommend immunotherapy in the form of allergy shots or sublingual (under the tongue) tablets. Allergy shots are injections containing diluted allergen extracts. A healthcare provider administers the shots on a regular basis to help your body build a tolerance to the allergen. The injection schedule varies, depending on your allergies and symptom severity. You may notice your symptoms improve within several months of injections, and you will likely require fewer injections over time as your body's reaction to allergens improves. Sublingual tablets can be effective if you are allergic to grass or ragweed pollen or dust mites. This treatment involves dissolving a tablet containing allergen extracts under your tongue daily to reduce allergy symptoms. Usually, you will begin taking sublingual tablets several months before allergy season begins. Treatment can continue for up to three years. Self-Care Measures Self-care measures may help relieve allergic rhinitis symptoms. This might include nasal washes, which involves rinsing your nasal passages with saline or a saltwater solution from a neti pot or nasal spray bottle. Doing this can help clear mucus from your nose. You can purchase nasal saline in a store or make a saline solution following the instructions on a pre-mixed packet for nasal saline rinses. Be sure to use distilled or boiled-and-cooled water to avoid the risk of life-threatening infections that can occur using unboiled tap water. You can also try your best to avoid triggers, if possible. You may need to keep a symptom journal for a while to help you identify what specific allergens are causing your symptoms. Once you know your allergens, avoiding these triggers may include keeping windows closed during high-pollen days, washing your hands after petting animals, or using allergen-proof bedding. There is no known way to prevent allergic rhinitis entirely, but along with doing your best to avoid known allergens, there are ways to prevent symptoms. You can try to prevent allergic rhinitis symptoms by doing the following: Monitor allergy index forecasts: Weather and plant growth stages can increase the release and spread of pollen in the air. Following your area's allergy index forecast can help you keep track of high pollen count days so you can adjust your activities accordingly. Minimize allergen exposure: Steps to minimize exposure to allergens may include keeping windows closed during high pollen seasons such as the spring, summer, and early fall or keeping pets out of your bedroom. Wash hands regularly: Wash your hands with soap and water frequently, and avoid touching or rubbing your nose and eyes. Use eye protection: Wear sunglasses and a wide-brimmed hat outdoors to prevent pollen from reaching your eyes. Use air filters: To help remove allergens from your home environment, use air purifiers with high-efficiency particulate air (HEPA) filters. People with allergic rhinitis are more likely to develop certain other conditions. Many of these conditions have similar inflammatory processes and shared risk factors with allergic rhinitis. These conditions include: Asthma: About 38% of people with allergic rhinitis also have asthma, which causes breathing difficulties in response to allergens and other factors. Eczema: Many people with eczema also have allergies and allergic rhinitis. Exposure to certain allergens can trigger eczema and allergic rhinitis symptoms. Obstructive sleep apnea (OSA): Allergic rhinitis symptoms, such as nasal congestion, can disrupt sleep and contribute to the development of OSA. OSA is a sleep disorder that occurs when the airways are partially or completely blocked, obstructing the flow of oxygen while you sleep and leading to frequent awakenings and broken sleep. Allergic conjunctivitis: Allergic rhinitis and allergic conjunctivitis frequently occur together. Allergic conjunctivitis is when allergens cause the conjunctiva (the transparent, thin membrane covering your eyeball) to get inflamed and swollen, causing redness, itching, watering, and pain. Allergic rhinitis can significantly impact your quality of life. Many people with allergic rhinitis report that symptoms disrupt their sleep and cause daytime fatigue and headaches that impact their emotional well-being and ability to engage in work, school, and social activities. The good news is that treatments and lifestyle modifications can effectively control symptoms. Talk to a healthcare provider if you have allergic rhinitis symptoms or your treatments are no longer working. They can discuss treatment options that effectively reduce symptoms so you can enjoy and participate in your daily activities.Thanks for your feedback!
Immunotherapy And Hay Fever
For many people, the arrival of spring heralds hefty doses of antihistamines, nasal sprays and eye drops to relieve hay fever symptoms.
Allergic reactions to pollen typically include a runny nose, itchy eyes and persistent sneezing, but for some, the symptoms can be debilitating and life-altering, and common remedies may have little effect.
Hope is at hand, however, in the form of immunotherapy. The most acute hay fever sufferers are sometimes referred for the treatment, and now new research "highlighting its effectiveness" may lead to immunotherapy becoming "more widely available on the NHS", said the Daily Mail.
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What is immunotherapy?In essence, immunotherapy aims to "induce a shift in the immune response" of a patient, said Samuel J. White and Philippe B. Wilson from Nottingham Trent University on The Conversation. So instead of producing histamines that cause the classic symptoms of hay fever, the body produces "antibodies that can neutralise the allergen" and prevent an allergic reaction from occurring.
The process of immunotherapy trains the body to "avoid its overreaction" to a specific allergen, said Healthnews, and instead build a "tolerance" to it.
That usually begins with a three- to six-month "build-up phase", during which small doses of the allergen are administered to induce T-regulatory cells, which prevent the release of histamines. Doses are then gradually increased until the target dose is reached, at which point the "maintenance phase" begins, lasting for three to five years or longer.
Immunotherapy can be administered in two ways: under the skin via an injection (subcutaneous), or via the newer method of under the tongue using liquid drops or tablets (sublingual).
How effective is it?Both types of immunotherapy treatment have demonstrated effectiveness in research. Subcutaneous has been used for much longer and so has a greater history of evidence showing it works. While it is considered safe, uncommon side effects include allergic reactions and a rash around the injection site.
The oral method has be shown to be "marginally less effective" than injections, said White and Wilson, but is considered "slightly safer".
The treatment usually begins a few months before the pollen season starts. Research has shown that treatment over three to five years can have longer-lasting benefits and is "effective in reducing symptoms and use of medications such as antihistamines". Sublingual treatment has been shown to be "particularly effective for hay fever caused by grass or tree pollens".
How do people access the treatment?Despite the evidence of the effectiveness of immunotherapy in treating hay fever, it is currently "not available to the majority of people" with the condition in Britain, said The Sun.
Only 2,839 people in the UK out of the estimated 13 million hay fever sufferers are receiving three years of immunotherapy treatment, according to research by the British Society for Allergy & Clinical Immunology. The use of immunotherapy in the UK "severely lags behind the US and Europe", consultant paediatrician Dr Tom Dawson told the Daily Mail, despite the UK being "at the forefront of allergy research".
Most people need to demonstrate severe hay fever symptoms that can't be relieved with standard treatments before a GP may refer them for immunotherapy.
The treatment costs around £2,000 a year per patient, but supporters argue that in the long term, immunotherapy could save the NHS money, by resulting in fewer people succumbing to more severe conditions such as seasonal asthma.
Despite evidence of its efficacy, not all patients will experience a complete relief of symptoms through immunotherapy, and it "may not be a suitable option for everyone", said White and Wilson. It also requires a long-term commitment to regular treatment and can often take "several months or even years to see the full benefits". For many people, though, immunotherapy could prove a "valuable tool" in easing their hay fever symptoms.
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