Medications for Allergic Rhinitis

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

There are many types of medications—both over-the-counter and prescription—that can be used to treat symptoms of allergic rhinitis, and each class of medication functions differently in the body. However, once a definite diagnosis of allergic rhinitis is made, the first-line treatment of choice is nasal corticosteroid spray, as it is has been shown to be the most effective with the fewest side effects. Ask you doctor which medications may offer prevention of allergic rhinitis symptoms.

Prescription Medications

Over-the-Counter Medications

  • Antihistamines
    • Diphenhydramine (Benadryl)
    • Loratadine, prescription strength (Claritin)
    • Chlorpheniramine (Chlor-Trimeton)
    • Brompheniramine (Dimetane)
    • Dexbrompheniramine and pseudoephedrine (Drixoral)
    • Clemastine (Tavist)
    • Chlorpheniramine and pseudoephedrine (Triaminic Cold and Allergy)
  • Oral Decongestants
    • Loratadine and pseudoephedrine (Claritin-D)
    • Pseudoephedrine (Sudafed)
    • Triprolidine and pseudoephedrine (Actifed Allergy Daytime)
    • Naphazoline (Allerest)
  • Nasal Decongestants
    • Oxymetazoline (Afrin)
    • Phenylephrine (Neo-Synephrine)
  • Saline Nasal Spray
    • Salinex

Prescription Medications

Antihistamines

Common names include:

  • Fexofenadine (Allegra)
  • Desloratadine (Clarinex)
  • Cetirizine hydrochloride (Zyrtec)

Antihistamines help stop or reduce the production of histamine, a chemical that is released when the immune system reacts to an allergen. The release of histamine leads to the symptoms of allergic rhinitis.

Possible side effects include:

  • Drowsiness
  • Dry mouth, nose, or throat
  • Gastrointestinal upset, stomach pain, or nausea
  • Increased appetite and weight gain
  • Thickening of mucus
  • Increased effects in people with kidney disease due to slower removal from the body

Nasal antihistamine sprays are also available, such as azelastine (Astelin).

Oral Decongestants and Antihistamine Combinations

Common names include:

  • Fexofenadine and pseudoephedrine (Allegra-D)
  • Acrivastine and pseudoephedrine (Semprex-D)
  • Azatadine and pseudoephedrine (Trinalin)

Decongestants help to narrow the blood vessels, which results in a clearing of nasal congestion. Antihistamines help stop or reduce the production of histamine, a chemical that is released when the immune system reacts to an allergen.

Possible side effects of the oral decongestant/antihistamine combinations include:

  • Drowsiness
  • Cough
  • Increase in blood pressure
  • Headache
  • Nervousness, difficulty sleeping
  • Nausea
  • Rapid heart rate

Nasal Corticosteroid Spray

Common names include:

  • Beclomethasone (Beconase)
  • Fluticasone (Flonase)
  • Triamcinolone (Nasacort)
  • Mometasone (Nasonex)
  • Budesonide (Rhinocort)

Nasal corticosteroids are sprayed or inhaled into the nose to help relieve the stuffy nose and discomfort of allergies.

Possible side effects include:

  • Burning, dryness, or other irritation inside the nose (mild, lasting only a short time)
  • Increase in sneezing
  • Irritation of the throat

Nasal Mast Cell Stabilizer

Common name: Cromolyn sodium (Intal)

Cromolyn is unique in that it is preventative. It changes the body's immunological response to allergens. It is most effective when used before coming into contact with substances that cause allergies or before allergy season. Cromolyn may be used alone or with other medicines.

Possible side effects include:

  • Burning, stinging, or irritation inside of nose
  • Flushing
  • Increase in sneezing

Leukotriene Inhibitor

Common name: Montelukast (Singulair)

This medication is also used to prevent allergy symptoms. It works by decreasing how many leukotrienes (chemicals) the body creates in response to an allergen.

Possible side effects include:

  • Flu-like symptoms
  • Nervousness
  • Headache and stomach ache
  • Nausea and vomiting
  • Nasal congestion

The US Food and Drug Administration (FDA) is investigating to see if there is a link between taking this medication and having suicidal thoughts. If you are taking Singulair, do not stop right way. Talk to your doctor first.

Over-the-Counter Medications

Antihistamines

The following medications are available without a prescription, but are considered older, or first-generation antihistamines.

  • Diphenhydramine (Benadryl)
  • Chlorpheniramine (Chlor-Trimeton)
  • Brompheniramine (Dimetane)
  • Dexbrompheniramine and pseudoephedrine (Drixoral)
  • Loratadine (Claritin)
  • Clemastine (Tavist)
  • Chlorpheniramine and phenylpropanolamine (Triaminic Allergy)

Antihistamines help stop or reduce the production of histamine, a chemical that is released when the immune system reacts to an allergen. The release of histamine leads to the symptoms of allergic rhinitis.

Possible side effects include:

  • Drowsiness (Claritin is nonsedating.)
  • Slowed reaction time
  • Dry mouth

Oral Decongestants

Common names include:

  • Pseudoephedrine-containing products (eg, Sudafed, Actifed, Drixoral)

Decongestants help to narrow the blood vessels, which results in a clearing of nasal congestion. One possible side effect is an increase in blood pressure.

Nasal Decongestants

Common names include:

  • Afrin
  • Neo-Synephrine

Nasal sprays help relieve the stuffy nose and discomfort of allergies.

Possible side effects include:

  • Burning, stinging, or irritation inside of nose
  • Flushing
  • Increase in sneezing
  • Rebound (increased nasal congestion) if nasal decongestant sprays are used for more than three days

Saline Nasal Spray

Salinex is a nasal spray that contains a saltwater solution to rinse your nose and help relieve mild congestion, loosen mucus, and prevent crusting. Though it can be useful for relieving symptoms of a stuffy nose and has no side effects, saline can't prevent allergy symptoms from occurring, as some other allergy treatments can.

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take them as directed—not more, not less, not at a different time.
  • Do not stop taking them without consulting your doctor.
  • Don’t share them with anyone else.
  • Know what effects and side effects to expect, and report them to your doctor.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you don’t run out.

References:

Advice from your allergist: Rhinitis. American College of Allergy, Asthma, & Immunology website. Available at: http://www.acaai.org/public/advice/rhin.htm. Accessed September 15, 2008.

Montelukast. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated August 2008. Accessed September 15, 2008.

Montelukast. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81. Updated April 2008. Accessed September 15, 2008.

United States Pharmacopeial Convention. USP DI . 21st ed. Englewood, CO: Micromedex; 2001.



Last reviewed July 2008 by Elie Edmond Rebeiz, MD, FACS

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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