Overview of Hay Fever Treatments

Allergy season can be miserable for people living with hay fever, also known as allergic rhinitis. To find relief, people will often turn to home remedies and over-the-counter (OTC) or prescription medications.

Each of these remedies has its benefits, risks, and limitations. Finding what works best for you may take time, particularly if you have severe allergy symptoms. But with patience and input from your health provider, you can be sure to find an effective treatment.

This article gives an overview of the most common allergy treatment options, including home remedies, over-the-counter (OTC) medications, prescriptions, and complementary/alternative treatments.

Home Remedies

People with hay fever will often turn to tried-and-true remedies handed down to them from generations past. For people with mild hay fever, these homespun cures may be all that is needed to relieve sneezing, congestion, runny nose, and watery eyes.

Neti Pot

A neti pot is an age-old remedy used to rinse the sinuses, typically with a sterile saline solution. Also known as nasal irrigation or nasal lavage, the salt-based treatment can help clear congestion by drawing fluid from inflamed nasal passages. This, in turn, helps reduce nasal irritation and may provide short-term relief from sneezing.

Teas

The smell of tea may be comforting enough if you have hay fever, but there is some evidence that certain teas also have anti-allergy properties. Studies suggest that a plant-based substance found in tea, called quercetin, may block the release of chemicals (such as histamine) that trigger allergy symptoms.

Black tea, green tea, hibiscus tea, and rooibos are especially rich in quercetin.

Over-the-Counter Medications

Numerous OTC medications are available for the treatment of nasal allergy symptoms. These include oral medications that treat hay fever systemically (meaning the body as a whole) and nasal sprays and eye drops that relieve local symptoms such as congestion and watery eyes.

Antihistamines

Histamine is a chemical released by the immune system in response to things it considers harmful. During an allergic reaction, histamine release is triggered by an otherwise harmless substance like pollen, causing blood vessels and tissues to swell. This can lead to symptoms commonly recognized as hay fever.

Antihistamines block the effects of histamine and, by doing so, help relieve hay fever symptoms. Older antihistamines like Benadryl are effective but tend to be sedating (that is, make you sleepy), while newer antihistamines tend to be non-sedating.

OTC oral antihistamines include:

• Allegra (fexofenadine)
• Benadryl (diphenhydramine)
• Chlor-Trimeton (chlorpheniramine)
• Claritin (loratadine)
• Tavist (clemastine)
• Zyrtec (cetirizine)

In addition to oral antihistamines, there is an OTC antihistamine eye drop called Alaway (ketotifen fumarate) used to treat eye redness, itching, and tearing. An OTC antihistamine nasal spray called Astepro (azelastine) can help relieve nasal itching, sneezing, and congestion.

Steroid Nasal Sprays

Corticosteroid (steroid) nasal sprays relieve inflammation in the nasal passages. Unlike antihistamines, which are used as needed to relieve symptoms, corticosteroid sprays have to be used on a regular basis to be effective (e.g. best effect is noted after 1-2 weeks of daily use).

OTC steroid nasal sprays include:

• Flonase Allergy Relief (fluticasone)
  
• Nasacort Allergy 24-Hour (triamcinolone)
• Rhinocort (budesonide)
  

OTC steroid nasal sprays are often the first choice recommended to people with severe allergic rhinitis as they are relatively safe for long-term use. Side effects include throat irritation, nasal dryness, headache, and nosebleed.

Decongestants

Decongestants work by causing blood vessels to constrict (narrow), countering the inflammatory effects of histamine. This helps relieve congestion caused by the dilation of blood vessels in the nasal passages. In addition to oral decongestants made with pseudoephedrine, there are nasal spray decongestants that can provide rapid relief of nasal stuffiness.

OTC decongestant options include:

• Afrin (oxymetazoline) nasal spray
• Neo-Synephrine (phenylephrine) nasal spray
• Sudafed (pseudoephedrine) oral
  

Oral decongestants can have side effects, including increased blood pressure, insomnia, irritability, and headache. Decongestant nasal sprays should not be used for more than two or three days at a time because doing so can cause rebound congestion (in which nasal symptoms suddenly worsen rather than improve). Oral decongestants are also not recommended for long-term use due to potential side effects.

Nasalcrom (Cromolyn Sodium)

Nasalcrom (cromolyn sodium) is an OTC nasal spray used to treat nasal allergy symptoms. As opposed to antihistamines that block the effects of histamine, cromolyn sodium inhibits the release of histamine. As such, it is most effective before hay fever symptoms start.

Nasalcrom is usually used three to six times a day to prevent allergy symptoms, although it may take up to four weeks for the drug to fully work. Side effects include nasal burning or itching, sneezing, headache, and stomach pain.

Prescriptions

If your hay fever symptoms are severe and interfering with your quality of life, speak with your doctor about prescription medications that may help. Some treatments are only intended for short-term use and need to be closely monitored to avoid potentially serious side effects.

Antihistamine Nasal Sprays

There are two antihistamine nasal sprays available by prescription only that can provide rapid relief of nasal symptoms in people with severe allergic rhinitis:

• Astelin (azelastine) nasal spray
• Patanase (olopatadine) nasal spray

Astelin and Patanase can be used in adults and children as young as 5 and 6, respectively. Side effects include nasal irritation, nosebleeds, dizziness, and a bitter taste in the mouth.

Steroid Nasal Sprays

For people unable to get relief from OTC steroid sprays, there is prescription-strength fNasonex (mometasone). This may soon be offered OTC.

Side effects include dizziness, changes in vision, nausea, fatigue, and oral thrush, particularly if overused.

Singulair (Montekulast)

Singulair (montelukast) is a once-daily prescription drug originally developed for the treatment of asthma. Montelukast works by blocking the action of leukotrienes, a group of chemicals released by the immune system that cause allergy symptoms such as excess mucus production.

Taken by mouth, Singulair may be prescribed if nasal sprays cannot be tolerated or if allergies trigger asthma symptoms, however, it is not considered a first-line treatment for most people with hay fever. Singulair can cause headaches, agitation, and depression in some people.

Atrovent (Ipratropium)

Available as a prescription nasal spray, Atrovent (ipratropium) helps relieve severe runny nose by reducing the secretion of excess fluid. It is not effective in treating sneezing, nasal congestion, or postnatal drip.

Side effects tend to be mild and include throat irritation, nasal dryness, and nosebleed. Atrovent is also available as an inhalant for use in the treatment of chronic obstructive pulmonary disease (COPD).

Oral Corticosteroids

Oral corticosteroids like prednisone are reserved for only the most severe cases of allergic rhinitis. Even then, they are prescribed for a short time to rein in the acute symptoms. The long-term use (or overuse) of oral steroids can cause cataracts, osteoporosis, muscle weakness, and other severe side effects.

Specialist-Driven Procedures

If medications fail to provide relief, ask your doctor for a referral to a specialist known as an allergist. There is a procedure they can perform called allergen-specific immunotherapy, in which you are exposed to tiny amounts of pollens or other substances that trigger allergy symptoms (called allergens).

With ongoing treatment, you will eventually become less sensitive to your specific allergens and less likely to develop severe allergy symptoms. The treatment can take anywhere from three to five years to complete.

Immunotherapy for allergic rhinitis is delivered in one of three forms:

• Allergy shots, delivered into the arm
• Sublingual (under the tongue) allergy drops
• Dissolvable sublingual allergy tablets

Complementary and Alternative Medicine (CAM)

In addition to standard medical treatments, there are certain complementary and alternative treatments that may benefit people with allergic rhinitis. Although there is a general lack of evidence to support their use, they are embraced by many who prefer a more "natural" approach to treatment.

According to the National Center for Complementary and Integrative Health (NCCIH), some of the more popular complementary and alternative remedies for seasonal allergies include:

• Acupuncture
• Butterbur (Petasites hybridus)
• Probiotics

Based on the current body of research, the NCCIH has suggested there may be some benefit to the use of acupuncture and butterbur in relieving hay fever symptoms, but there are some safety concerns with butterbur use. There is also limited evidence to support the use of probiotics in the treatment of allergic rhinitis.

Summary

If you struggle with seasonal hay fever allergies, know that there are many treatment options available that can help. Over-the-counter medications such as antihistamines, corticosteroid nasal sprays, and decongestants are the mainstay for many people. But prescription drugs, home remedies, alternative treatments, and immunotherapy can also be helpful.