Allergy

How is it treated?

The main goals for treating allergic rhinitis are to minimize or prevent allergy symptoms and help allergy sufferers maintain normal daily activities and lifestyles.

The most effective treatment for allergies is to avoid what is causing the symptoms. If this is not possible, then medication selection should be based on the symptoms the individual is experiencing.

Generally speaking, if you have nasal congestion, an oral or nasal spray decongestant should be used. For symptoms such as runny nose, sneezing, or itchy/watery eyes, an antihistamine should be used. A combination of these medications can be used if you have both symptoms.

Most physicians try to follow a stepwise approach to treating allergies based on the severity and frequency of allergy symptoms:

For Mild, Infrequent Allergic Rhinitis Symptoms:

For allergy symptoms such as a runny nose, watery/itchy eyes, or sneezing that occur infrequently, most individuals can be treated sucessfully with an oral non-sedating antihistamine such as loratadine (Claritin), desloratadine (Clarinex), fexofenadine (Allegra), or cetirizine (Zyrtec) or an antihistamine nasal spray such as azelastine (Astelin) to be taken on an as needed basis when allergy symptoms arise. Another option may be to try to prevent allergy symptoms before the anticipated allergen exposure by using cromolyn (Nasalcrom) nasal spray prior to exposure to the allergen. Cromolyn nasal spray is also recommended for kids. Cromolyn (Nasalcrom) nasal spray and loratadine (Claritin) are products that are available over-the-counter without a prescription.

For infrequent nasal decongestion, over-the-counter oral decongestants such as psuedoephedrine or nasal spray decongestants such as phenylephrine (Neo-Synephrine products) or oxymetolazone (Afrin products) can be tried. Nasal spray decongestants will provide quicker relief but oral decongestants may provide longer relief of congestion. These products should be used on as as needed basis for no longer than 3 to 5 days.

For Persistent, Mild-to-Moderate Allergic Rhinitis Symptoms:

Treatment options include oral non-sedating antihistamines as listed above but taken on a daily basis. For individuals who have nasal congestion along with a runny nose, itchy/watery eyes, or sneezing, a combination non-sedating antihistamine/decongestant product can be tried such as Claritin-D, Allegra-D, or Zyrtec-D. Nasal corticosteroids such as beclomethasone (Beconase, Vancenase), budesonide (Rhinocort), flunisolide (Nasalide, Nasarel), fluticasone (Flonase), triamcinolone (Nasacort), or mometasone (Nasonex) may also be tried as separate therapy or added to antihistamines and decongestants. For children with persistent, mild-to-moderate allergy symptoms, cromolyn (Nasalcrom) nasal spray or an oral non-sedating antihistamine approved for use in children may be tried.

For Severe Allergic Rhinitis Symptoms:

For patients with severe allergy symptoms, nasal corticosteroids will most likely be needed along with a non-sedating antihistamine (with or without a decongestant). Cromolyn (Nasalcrom) nasal spray should be used in children. If needed, a short course (meaning 3 to 10 days) of oral corticosteroids can be used. For individuals with severe allergies, referral to an allergy/immunolgy specialist or an "ear, nose, and throat" allergy specialist is recommended.

Other allergy therapies include ipratropium nasal (Atrovent), a nasal spray sometimes used for individuals who have a runny nose from allergies. Older antihistamines such as diphenhydramine (Benadryl), brompheniramine (Brovex), chlorpheniramine (Chlor-Trimetron), and clemastine (Tavist) are also available and can be used to treat allergy symptoms like runny nose, itchy/watery eyes, and sneezing, but these older antihistamines can cause drowsiness and sedation more so than the newer non-sedating antihistamines.

Immunotherapy may also be considered but it is expensive, has certain risks, and requires a significant time commitment by the individual suffering from allergies. Immunotherapy is a series of injections where gradually increasing doses of antigens (substances that are responsible for triggering an allergic response) are injected into the patient in hopes to build tolerance to the allergen.

5 Ways to Control Allergies

1. Find your allergy triggers.
Note all the details surrounding your allergy flare-ups: where you are, what you've been doing, what time of day and year it is. Then report them to your doctor, telling her exactly how the symptoms feel.

2. Change your environment.
Ask your doctor how to minimize exposure to substances that prompt your flare-ups. Keeping pets out of certain rooms, covering your mattress, or running the air conditioner to filter out pollens are some commonly used and effective allergy countermeasures.

3. Ask about corticosteroid sprays.
Low-dose prescription corticosteroid nasal sprays can be extremely effective for relieving chronic congestion with minimal side effects.

4. Get the latest treatment.
Ask your doctor if she's familiar with the state-of-the-art treatment guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma, and Immunology. If she's not, direct her to the website of the Joint Council of Asthma, Allergy, and Immunology.

5. Be persistent.
Go back to your family doctor if symptoms don't improve. Or ask for a referral to an allergist.