Nasal Allergy Medications

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• Introduction
• What's the difference between a controller and a reliever?
• What are antihistamines?
• How do antihistamines work?
• What are first generation antihistamines (OTCs)?
• What are second generation antihistamines (prescription)?
• What are common side effects of antihistamines?
• What are decongestants?
• How do decongestants work?
• When should I use topical decongestants?
• What are side effects of decongestants?
• What about combination antihistamine/decongestant preparations?
• Nasal Steroid Sprays
• Other nasal sprays that might help
• Tips for proper use of nasal sprays
• Nasal Allergy Medications At A Glance

Introduction

Although they are the cornerstone of allergy treatment, avoidance measures are not always enough to manage all of the symptoms. When the symptoms of nasal allergies are mild or intermittent, antihistamines with or without decongestants can help. Very often, some relief can be found in taking over-the-counter (OTC) drugs and this is usually the first step an allergy sufferer will take. Self-medication, though, is frequently inadequate since OTC drugs cannot adequately treat the inflammation that develops in the nose. At this stage, anti-inflammatory medications are required, usually in the form of intra- nasal steroid sprays (sprayed into the nose).

The combination of an antihistamine (with or without a decongestant) and a topical nasal steroid spray will usually afford good relief with minimal side effects. The addition of ipratropium bromide nasal spray (Atrovent - an anticholinergic medication) is also very effective for a runny nose that has been unresponsive to prior treatments. Let's look at these medications in more detail to understand their role in the treatment of nasal allergy.

What's the difference between a controller and a reliever?

Throughout this section on allergy management, we will be referring to the various treatments as "controllers" or "relievers" of symptoms. Controllers are used to prevent symptoms by interfering with the underlying causes of the inflammatory response or the actions of chemical mediators. Examples of controllers include:

• Drugs that block the attachment of histamine to special receptors on cells (e.g., antihistamines);
• Drugs that prevent mast cells from releasing chemicals (e.g., Cromolyn); and,
• Drugs that prevent or reduce inflammation that arises from an allergic reaction (e.g., steroids).

Other medications, called relievers, are used to alleviate symptoms without affecting the inflammation. They are also called "rescue" medications and in general provide only temporary relief. Relievers should only be used alone for mild or intermittent symptoms. Examples include:

• Drugs that narrow (constrict) the blood vessels in the nasal membranes, thereby helping "shrink" swollen tissues and relieve congestion (e.g., decongestants); and
• Drugs that reduce mucous production by blocking the nerve supply to the mucous glands (e.g., anticholinergics).

Suggested Reading by Our Doctors

• diphenhydramine, Benadryl - Explains the medication diphenhydramine (Benadryl), a drug used for the relief of nasal and non-nasal symptoms of various allergic conditions such as seasonal allergic rhinitis.
• Chronic Rhinitis and Post-Nasal Drip - Information on post nasal drip and chronic rhinitis includes symptoms such as itchy runny nose, sneezing, itchy eyes, ears, and throat, and nasal congestion.
• fluticasone propionate nasal inhaler-spray, Flonase, Veramyst - Learn about the nasal spray drug fluticasone (Flonase, Veramyst) used to treat non-allergic and allergic rhinitis and its symptoms like a stuffy and runny nose.

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