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Antihistamines provide relief from congestion, itchy/runny nose, sneezing and postnasal drip by blocking the effects of histamine. Examples include:

• Axzelastine hydrochloride (Astelin) is a steroid-free antihistamine nasal spray (available by prescription only)

Steroids - These are often recommended as first-line therapy for moderate to severe allergic rhinitis. Side effects are few - the most common is nosebleed (epistaxis) which occurs in 10% of users. These preparations may take a week to be maximally effective. Examples include:

• Beclomethasone dipropionate (Beconase, Vancenase)
• Fluticasone propionate (Flonase)
• Flunisolide (Nasalide)
• Triamcinolone acetonide (Nasacort)

Anticholinergic Agents - Examples include:

• Ipratropium (Atrovent) - relieves rhinorrhea (runny nose)

Topical Decongestants - These act directly on the blood vessels in the nasal tissues to cause constriction leading to drainage of these areas and a decrease in congestion. These preparations should not be used for extended periods (> 3 days) because of the risk of rebound congestion. Examples include:

• Oxymetazoline (Afrin) is available over the counter

Mast-Cell Stabilizers - Available without a prescription, these medications are usually most effective when given prior to exposure to known allergens. They have been proven to be safe for use in children. Examples include:

• Cromolyn sodium (NasalCrom)