Treatment of Hay Fever

Oral Medications

Antihistamines

Antihistamines have been available for over 50 years - they work by interfering with the effect of histamine. A major side effect of traditional antihistamines is drowsiness and some types produce more than others. Examples include:

• Diphenhydramine (Benadryl - available over the counter)
• Chlorpheniramine (Usually taken as an ingredient in over the counter combination products such as Alza-Seltzer Plus Cold Medicine, Chlor-Trimeton, and Comtrex)

Second-generation antihistamines are less sedating than other antihistamines. Examples include:

• Loratidine (Claritin) - available over the counter
• Cetirizine (Zyrtec)
• Fexofenadine (Allegra)
• Desloratidine (Clarinex)

Leukotriene-Receptor Antagonists

Leukotriene-receptor antagonists (LTRAs) are non-steroidal oral medications that are available as a chewable tablet or in granules that can be dissolved in liquid or food. They may also be referred to as anti-inflammatory bronchoconstriction preventors. LTRAs work by blocking a chemical reaction that can lead to inflammation in the airways. Although not preferred first choice therapy, LTRAs can be tried when an inhaled steroid cannot be used or if the dose cannot be increased. Side effects include nausea and headache. Examples include:

• Montelukast (Singulair)
• Zafirlukast (Accolate)

Alpha-Adrenergic Agonists

Pseudoephedrine is a decongestant which blocks the engorgement of the sinuses to improve nasal air flow. It is often used in combination with other types of medications for relief of allergy symptoms. Pseudoephedrine is available over the counter but is now sold at the pharmacy counter due to its potential for abuse. It should be used cautiously in people with coronary artery disease, hypertension, diabetes, hyperthyroidism and those receiving monoamine oxidase inhibitors (MAOIs). It may also aggravate narrow-angle glaucoma and certain urinary conditions. Side effects include: stomach upset, trouble sleeping, lightheadedness, headache, nervousness, fast heartbeat, and loss of appetite.

Systemic Corticosteroids

Systemic corticosteroids are available as tablets and solutions but may also be administered as an injection in long-acting form. Corticosteroids may be used short-term for relief of severe or persistent symptoms. It reduces allergic responses by reducing swelling and by changing the way the immune system works. Side effects include stomach irritation, increased appetite and risk of elevation of blood glucose levels in persons with diabetes. Examples include:

• Prednisone
• Solumedrol