What are the medications for allergic rhinitis?

Allergic rhinitis refers to the nasal manifestation of our allergies. For some people, their allergies are seasonal, and for some their allergies are year around. There are several modalities that go into diagnosis and management of allergy disease. Some of these have to do with avoidance of allergens. Additionally, allergy shots, nasal irrigation, and even acupuncture can play a role in the management of allergies. This article will specifically focus on the medicines available for management of allergic issues.

There are several classes of medications available; each have their own strengths and weaknesses. Additionally, many patients might need to use more than one class of medications for maximal relief. Even within each class of medications, there are several different medicines available, and each person’s individual chemistry might have a better response to one kind of medicine versus the other one in the same class of medications. Therefore, there is room for trial before one settles on the more effective medication for each patient. The classes of medications are as follows:

1. Antihistamines. Antihistamines are perhaps the oldest class of medications available for allergies. Some of the more original ones are Benadryl and Seldane. Benadryl is still available as an over-the-counter item. The first generation of antihistamines that were available were quite effective, but they had significant side effect of drowsiness. Subsequent medications that were developed, such as Claritin, Allegra, and Zyrtec have less side effects of drowsiness, and patients can tolerate using these much better. Technically, Claritin and Allegra are completely classified as non-sedating medications, and they are even safe to use during operation of machinery. A more recent development in antihistamine therapy is the availability in a spray format. Ideally, the spray is applied directly into the nasal passages as necessary, and much lesser amount of the medication is absorbed into the bloodstream to affect other organs. These medications include Astelin, Astepro, and others. The spray formats of the antihistamines are at this moment available by prescription only.

2. Steroids. Steroids are very effective in combating inflammatory and allergic reactions. Oral steroids by definition go to every single organ and affect unnecessary organs when we are trying to specifically focus on nasal allergies. Taking oral steroids is not recommended for long duration due to potential side effects. Nasal steroids can be applied directly into the nasal passages, and therefore much lesser amounts of it are necessary. This also reduces side effects to other organs. Some of the nasal steroids available currently include Flonase, Nasonex, Veramyst, and Nasacort. In the past few months, some of these have become available over-the-counter for use. Many patients still have hesitation about using steroids altogether. When using steroids orally, we measure it in milligrams. When we apply steroids directly to the nose via spray, we measure it in micrograms, which is 1000 times less than orally. Also, about 99% is thought to be absorbed locally into the nasal passages, and only 1% of it may be going to other organs that are not in need of steroid therapy. Another specific notes about nasal steroids is that if patients were only going to use one class of medicines altogether, nasal steroids used in isolation with no other supporting medications have been shown to be the most effective type of treatment for nasal allergy symptoms.

3. Decongestants. Decongestants relieve the vascular engorgement in the nasal passages that sometimes follows allergic reactions. Although they do not directly treat the sources of the allergies, they mask the congestion issues that typically follow allergic reactions. Decongestants are available orally in the form of Sudafed, or via spray in medication with a generic name oxymetazoline. Unfortunately, prolonged use of oxymetazoline causes what is called rebound congestion. Basically, if used more than three days, the nasal passages can actually become habituated to the constant presence of oxymetazoline, and without it the patient cannot function. This could be habitual and almost addictive. Use of oxymetazoline should be limited to only a couple of times a year during severe exacerbations only.

4. Leukotriene Inhibitors. This is perhaps the newest class of medications available for allergy symptoms. Initially designed to combat asthma-type symptoms, medications such as Singulair have also been shown to have significant effect in reduction of allergy symptoms. In patients who suffer both asthma and allergies, Singulair has been an effective single medicine modality to alleviate both types of symptoms.

If you suffer from allergic rhinitis, it is recommended that you see your Allergist or you Ear, Nose, and Throat specialist for initial evaluation and counseling. Based on your individual severity of symptoms, your doctor can come up with a specific plan of care that is best for you.

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Posted in: Nose, Sinuses

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