Patients, friends, and acquaintances often ask, “what is the best over-the-counter medication for nasal allergy symptoms?” Adults and children with mild to moderate allergy symptoms are fortunate in that most of the best allergy medications are now available over-the-counter. Over the past several years and in part due to efforts by consumer advocacy groups, safe and effective medications for allergies including long-acting, nonsedating antihistamines and nasal steroid sprays have been made available without prescription. While there are still a few types of allergy medications that require a prescription, these prescription medications are not always superior in efficacy to the over-the-counter medicines.
The most commonly used medications to treat nasal allergy symptoms are antihistamines. Older antihistamines such as diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton) have been available over-the-counter for decades but these medications have significant drawbacks. They tend to cause drowsiness which can hinder productivity at school and work. These medications can even interfere with the ability to drive safely. Older antihistamines are short acting with efficacy lasting 4-6 hours in most cases. Because of this, they must be taken several times a day to maintain efficacy throughout the day and night, which is less than ideal.
Newer nonsedating antihistamines including fexofenadine (Allegra), loratadine (Claritin), and the minimally sedating antihistamines cetirizine (Zyrtec) and levocetirizine (Xyzal) have only recently become available over-the-counter. These medications are safer because of their low incidence of drowsiness and they are more effective because they last for 24 hours and only have to be taken once a day in most cases. There are a few antihistamines that still require prescription but these are not proven to be significantly more effective than antihistamines that are available over-the-counter.
A number of studies have shown that the most effective medications for treating nasal allergy symptoms are nasal sprays that contain corticosteroids. Fluticasone monoproprionate nasal spray (Flonase), budesonide nasal spray (Rhinocort), triamcinolone nasal spray (Nasacort), and fluticasone furoate nasal spray (Flonase Sensimist) have all become available without prescription over the past couple of years. These medications are considered to be safe for long-term use and are extremely effective for nasal allergy symptoms if used on a regular daily basis.
There are still a few types of medications for treatment of nasal allergies that require a prescription. Montelukast (Singulair) treats nasal symptoms by blocking leukotriene receptors, it is not an antihistamine. Montelukast can be used alone or in combination with antihistamines or corticosteroid nasal sprays and some patients find this to be extremely effective for nasal allergy symptoms. Azelastine is available by prescription either alone (Astelin, Astepro) or in combination with a corticosteroid (Dymista). Azelastine and olpatadine (Patanase) are antihistamine nasal sprays which work differently than nasal corticosteroids or oral antihistamines and can often be effective for nasal symptoms that are resistant to other therapy. Beclomethasone HFA nasal spray (Qnasl) is a corticosteroid nasal spray in an aerosol formulation that can be very effective for treating nasal symptoms but requires a prescription. Hydroxyzine, cyproheptadine, promethazine, and brompheniramine are antihistamines that require prescription, occasionally we find patients who respond well to these medications but they can all cause drowsiness and they are all relatively short acting medicines that last for 4-6 hours.
A board-certified allergist can help you to determine appropriate use of both over-the-counter and prescription medications. Combinations of these medications can also be used to treat difficult to control symptoms. Allergy testing to determine specific triggers for nasal symptoms can help to guide prescription therapy and also allow recommendations for environmental controls to avoid contact with these triggers. Specific allergen immunotherapy (allergy shots) works differently than prescription or over-the-counter medication. Patient’s undergoing immunotherapy are exposed to small amounts of their relevant allergy triggers (identified by allergy testing) over long periods of time to build immunity or tolerance. Studies have shown that patients undergoing this therapy have long-term benefits with decreased reactivity to allergy triggers and decreased need for medication. Immunotherapy should be prescribed by a board-certified allergist. Allergists have received 2-3 years of specific training regarding appropriate use of immunotherapy to treat allergies.
If you think are suffering from allergies and your over-the-counter medicines don’t seem to be working, give us a call to schedule an appointment for an allergy evaluation.