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Hay fever: Which medications can relieve allergic rhinitis?

Created: ; Last Update: July 13, 2017; Next update: 2020.

People with hay fever often have very severe, but temporary, symptoms – for example during the grass pollen season. Others are allergic to dust mites or animals and have allergy symptoms all year round. Whatever the cause of the allergy, there are medications that offer relief from allergic rhinitis. This is a set of symptoms that affect the upper airways, including itchy or watery eyes, sneezing, and a stuffy or runny nose.

Although medications for the treatment of allergic rhinitis can have side effects, they are usually well tolerated. Various medications can reduce the symptoms. You can talk with your doctor to find the most suitable one for you.

Factors that influence the choice of medication include the severity and type of allergic rhinitis (seasonal or year-round), as well as personal preferences and experiences. For instance, some people would prefer to take tablets rather than use a nasal spray. Others might feel tired when they use a certain medication, and decide to try a different one instead. Age and other things like medical conditions or pregnancy may play a role too.

What medications are available?

If someone has allergic rhinitis, the following medications are typically considered:

  • Antihistamines
  • Steroids (corticosteroids)
  • Leukotriene receptor antagonists
  • Chromones (mast cell stabilizers)
  • Decongestant nasal drops and sprays

Steroid sprays or newer generation antihistamines are usually the treatments of first choice. Many antihistamines and some steroid sprays are available from pharmacies without a prescription. But most steroid sprays are only available on prescription.

Antihistamines

If something triggers an allergic reaction in your body, your immune system releases histamine. Histamine causes allergy symptoms like sneezing, watery eyes and skin rashes. Antihistamines block the action of histamine. To treat allergic rhinitis, they can be used in the form of tablets or nasal sprays. Tablets start working within one hour, and nasal sprays start working within 15 minutes.

Research has shown that tablets and nasal sprays can both provide relief. They are usually well tolerated. The most common side effects of tablets are tiredness and headaches. Newer generation antihistamines work in a similar way to older ones, but they have fewer side effects. For instance, they are a lot less likely to make you feel tired, which can make a big difference if you have to drive a car or do other activities that require concentration. For this reason, older (“first-generation”) antihistamines are generally no longer recommended. Nasal sprays can leave a bitter taste in your mouth.

Steroids (corticosteroids)

Corticosteroids are steroid drugs that contain an anti-inflammatory steroid hormone. Steroid nasal sprays reduce swelling in the mucous membranes and relieve symptoms like a runny or stuffy nose. They can be used over longer periods of time, but it is then advisable to see a doctor regularly for check-ups. Although nasal sprays don’t have an immediate effect, people usually notice a difference within twelve hours. The full effect is reached after a few days. They might cause mild side effects such as nosebleeds, headaches or altered taste.

Leukotriene receptor antagonists

These medications block the action of leukotrienes – chemical messengers that play an important role in the inflammatory response that happens in the airways. In Germany they have been approved for the treatment of asthma when used in the form of tablets. As well as relieving asthma symptoms, they can also relieve the symptoms of hay fever. So doctors can prescribe leukotriene receptor antagonists for people above the age of 15 who have both asthma and hay fever. Possible side effects include respiratory tract infections (infections of the airways) and headaches.

Chromones (mast cell stabilizers)

Mast cell stabilizers prevent histamine from being released by certain cells in the body known as mast cells. This reduces allergic and inflammatory responses in the body. They are used in the form of nasal sprays, and are usually used to prevent symptoms, but they can also relieve symptoms. Possible side effects include irritation of the membranes lining the nose, and an unpleasant taste in your mouth.

Decongestant (anti-swelling) nose drops and nasal sprays

Decongestant nose drops and nasal sprays reduce swelling in the membranes lining the nose and the sinuses, making it easier to breathe through your nose. They are not suitable for the long-term treatment of allergic rhinitis, though. Although they open your nasal passages and make it easier to breathe, your nose might “get used to“ them after a short while, and then they have the opposite effect: The membranes become swollen again and it’s difficult to breathe through your nose. These medications can also cause side effects like nosebleeds. So it is recommended that these medications not be used for longer than 5 to 7 days.

Do some medications work better than others?

There are no big differences between the medications – at least not in the treatment of seasonal hay fever. Steroid nasal sprays are often recommended as the treatment of first choice. They are just as well tolerated as other medications, and they might be somewhat more effective than, for instance, antihistamines. But studies suggest that the differences between the effects of these two types of medications are not very big either.

If the symptoms don’t improve enough, a different medication can be tried out instead, or two medications can be combined: for example, a steroid nasal spray and antihistamine tablets.

Sources

  • Agency for Healthcare Research and Quality (AHRQ). Treatments for seasonal allergic rhinitis. Comparative Effectiveness Review No. 120. July 2013.
  • Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 2010; 126(3): 466-476. [PubMed: 20816182]
  • Carson S, Lee N, Thakurta S, Oregon Evidence-Based Practice Center (OHSU). Drug Class Review: Newer antihistamines. Final Report - Update 2. May 2010.
  • Sheikh A, Singh Panesar S, Salvilla S, Dhami S. Hay fever in adolescents and adults. BMJ Clin Evid 2009. [PMC free article: PMC2907832] [PubMed: 21726475]
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

© IQWiG (Institute for Quality and Efficiency in Health Care)
Bookshelf ID: NBK279486

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