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Treatments and drugs
By Mayo Clinic staffThere are a number of over-the-counter and prescription medications available that help relieve hay fever symptoms. They include pills, liquids, nasal sprays and eyedrops. Many people get the best relief from a combination of allergy medications. You may need to try several medications to identify what works best for you. Over-the-counter medications may be enough to relieve your symptoms; or, you may need a prescription from your doctor.
If your child has hay fever, talk with your doctor about the best treatment. Some medications are approved for use in children, while others are only approved for adults. If you want to try an over-the-counter medication for your child, be sure to read the labels carefully.
Medications for hay fever include:
- Nasal corticosteroids. These nasal sprays help prevent and treat the inflammation caused by hay fever. For many people they're the most effective hay fever medications, and they're often the first medication prescribed. Examples include fluticasone (Flonase), fluticasone (Veramyst), mometasone (Nasonex) and beclomethasone (Beconase). Although these medications can start to work after a few days of treatment, you may not notice any improvement until after you've used them for a week or so. Nasal corticosteroids are a safe long-term treatment for most people. Side effects can include an unpleasant smell or taste and nose irritation.
- Oral corticosteroids. Corticosteroid medications in pill form, such as prednisone, are sometimes used to relieve severe allergy symptoms. Because the long-term use of oral corticosteroids can cause serious side effects such as cataracts, osteoporosis and muscle weakness, they're usually prescribed only for short periods of time.
- Antihistamines. These oral medications and nasal sprays can help with itching, sneezing and runny nose, but have less effect on congestion. They work by blocking histamine, an inflammatory chemical released by your immune system during an allergic reaction. Older over-the-counter antihistamines such as diphenhydramine (Benadryl) and clemastine (Tavist) work as well as newer ones, but can make you drowsy. Newer oral antihistamines are less likely to make you drowsy, but are more costly than the older antihistamines. Over-the-counter examples include loratadine (Claritin, Alavert) and cetirizine (Zyrtec). Fexofenadine (Allegra) is available by prescription. The prescription antihistamine nasal spray azelastine (Astelin) starts to relieve symptoms within minutes of use. It can be used up to eight times a day, but can cause drowsiness. Side effects include a bad taste in the mouth right after use.
- Decongestants. These medications are available in over-the-counter and prescription liquids, tablets and nasal sprays. Over-the-counter oral decongestants include Sudafed, Actifed and Drixoral. Nasal sprays include phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin). Because oral decongestants can raise blood pressure, avoid them if you have high blood pressure (hypertension). Oral decongestants can also worsen the symptoms of prostate enlargement, making urination more difficult. Don't use a decongestant nasal spray for more than two or three days at a time because it can cause rebound congestion when used longer.
- Cromolyn sodium. This medication (NasalCrom) is available as an over-the-counter nasal spray that must be used several times a day. It helps relieve hay fever symptoms by preventing the release of histamine. Cromolyn sodium doesn't have serious side effects, and it's most effective when started before signs and symptoms develop.
- Leukotriene modifiers. 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 has proved effective in treating allergic asthma, and it's also effective in treating hay fever. Possible side effects include headache. Less common side effects include abdominal pain, cough, dental pain and dizziness. Like antihistamines, this medication is not as effective as inhaled corticosteroids. It's often used when nasal sprays cannot be tolerated, or when mild asthma is present.
- Nasal atropine. Available in a prescription nasal spray, ipratropium bromide (Atrovent) helps relieve a 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.
Other treatments for hay fever include:
- Immunotherapy. If medications don't relieve your hay fever symptoms, your doctor may recommend allergy shots (immunotherapy or desensitization therapy). Over a period of three to five years, you receive regular injections containing purified allergen extracts. The goal is to desensitize you to specific allergens, reduce your signs and symptoms, and decrease your need for medications. Immunotherapy may be especially effective if you're allergic to cat dander, dust mites, or pollen produced by trees, grass and weeds. In children, immunotherapy may help prevent the development of asthma.
- Nasal lavage. To help with irritating nasal symptoms, your doctor may recommend that you rinse your nose with salt water. Use an over-the-counter nasal saline spray or prepare your own saltwater solution using 1/4 teaspoon of salt mixed with 2 cups of warm water. Both can be extremely effective at relieving congestion.
