Treatments and drugs

By Mayo Clinic Staff

It's best to limit your exposure to substances that cause your hay fever as much as possible. If your hay fever isn't too severe, over-the-counter medications may be enough to relieve symptoms. For worse symptoms, you may need prescription medications.

Many people get the best relief from a combination of allergy medications. You might need to try a few before you find what works best.

If your child has hay fever, talk with your doctor about treatment. Not all medications are approved for use in children. Read labels carefully.

Medications for hay fever include:

  • Nasal corticosteroids. These prescription nasal sprays help prevent and treat the nasal inflammation, nasal itching and runny nose caused by hay fever. For many people they're the most effective hay fever medications, and they're often the first type of medication prescribed.

    Examples include fluticasone propionate (Flonase), triamcinolone (Nasacort AQ), mometasone (Nasonex) and budesonide (Rhinocort Aqua). An over-the-counter version (Flonase Allergy Relief) recently became available. A newer prescription nasal spray combines an antihistamine with a steroid (Dymista).

    Nasal corticosteroids are a safe, long-term treatment for most people. Side effects can include an unpleasant smell or taste and nose irritation. Steroid side effects are rare.

  • Antihistamines. These preparations are usually given as pills. However, there are also antihistamine nasal sprays and eye drops. Antihistamines can help with itching, sneezing and a runny nose but have less effect on congestion. They work by blocking histamine, a symptom-causing chemical released by your immune system during an allergic reaction.

    Over-the-counter examples include loratadine (Claritin, Alavert), cetirizine (Zyrtec Allergy) and fexofenadine (Allegra Allergy). The prescription antihistamine nasal sprays azelastine (Astelin, Astepro) and olopatadine (Patanase) can relieve nasal symptoms. Antihistamine eye drops help relieve eye itchiness and eye irritation caused by hay fever.

  • Decongestants. These medications are available in over-the-counter and prescription liquids, tablets and nasal sprays. Over-the-counter oral decongestants include pseudoephedrine (Sudafed, Afrinol, others). Nasal sprays include phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin).

    Oral decongestants can cause a number of side effects, including increased blood pressure, insomnia, irritability and headache. Don't use a decongestant nasal spray for more than two or three days at a time because it can actually worsen symptoms when used continuously (rebound congestion).

  • Cromolyn sodium. This is available as an over-the-counter nasal spray that must be used several times a day. It's also available in eye drop form with a prescription (Crolom). It helps relieve hay fever symptoms by preventing the release of histamine. Most effective when you start using before you have symptoms, Cromolyn sodium doesn't have serious side effects.
  • Leukotriene modifier. Montelukast (Singulair) is a prescription tablet taken to block the action of leukotrienes — immune system chemicals that cause allergy symptoms such as excess mucus production. It's especially effective in treating allergy-induced asthma. It's often used when nasal sprays can't be tolerated or when you have mild asthma.

    Montelukast can cause headaches. In rare cases, it has been linked to psychological reactions such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away for any unusual psychological reaction.

  • Nasal ipratropium. Available in a prescription nasal spray, ipratropium (Atrovent) helps relieve severe runny nose by preventing the glands in your nose from producing excess fluid. It's not effective for treating congestion, sneezing or postnasal drip.

    Mild side effects include nasal dryness, nosebleeds and sore throat. Rarely, it can cause more-severe side effects, such as blurred vision, dizziness and difficult urination. The drug is not recommended for people with glaucoma or men with an enlarged prostate.

  • Oral corticosteroids. Corticosteroid pills such as prednisone sometimes are used to relieve severe allergy symptoms. Because the long-term use of corticosteroids can cause serious side effects such as cataracts, osteoporosis and muscle weakness, they're usually prescribed for only short periods of time.

Other treatments for hay fever include:

  • Allergy shots (immunotherapy). If medications don't relieve your hay fever symptoms or cause too many side effects, your doctor may recommend allergy shots (immunotherapy or desensitization therapy). Over three to five years, you'll receive regular injections containing tiny amounts of allergens. The goal is to get your body used to the allergens that cause your symptoms, and decrease your need for medications.

    Immunotherapy might be especially effective if you're allergic to cat dander, dust mites, or pollen produced by trees, grass or weeds. In children, immunotherapy may help prevent the development of asthma.

  • Under-the-tongue (sublingual) allergy tablets. Rather than getting shots, you have tiny amounts of allergen in pill form dissolve in your mouth, usually daily.
  • Rinsing your sinuses. Rinsing your nasal passages with distilled, sterile saline (nasal irrigation) is a quick, inexpensive and effective way to relieve nasal congestion. Rinsing flushes out mucus and allergens from your nose.

    Look for a squeeze bottle or a neti pot — a small container with a spout designed for nose rinsing — at your pharmacy or health food store. Use water that's distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller to make up the saline irrigation solution. Also be sure to rinse the irrigation device after each use with similarly distilled, sterile, previously boiled and cooled, or filtered water and leave open to air-dry.

Oct. 17, 2015