Pharmacologic (Medicine) Treatment for Nasal Allergies
Antihistamines which are prescribed for the treatment of allergies fall into two categories, first generation and second generation. The first generation antihistamines are the oldest ones and date back several decades. Their chemical makeup is such that it gets into brain tissue very easily and, therefore, cause the most side effects. Almost all first generation antihistamines are over-the-counter. Examples are Benadryl, Chlor-Trimeton, Tavist, Allerest, etc.
The more recent advance in antihistamines, the so-called second generation antihistamines, are made up so that they do not get into brain tissue so easily and, therefore, cause less drowsiness. Examples are Claritin, Clarinex, Allegra, Zyrtec, Xyzal, and even Astelin and Patanase which are unique in that they are the only nasal spray antihistamines.
Antihistamines can be combined with decongestants. Pseudoephedrine and Phenylephrine are examples of decongestants that can be combined with antihistamines. Their purpose is to alleviate nasal and sinus congestion which can be a significant part of allergic symptoms in many people. Allegra-D, Clarinex-D, Zyrtec-D and Claritin-D are examples.
Singulair (classified as anti-inflammatory) is another category of medication shown to be effective for both nasal allergies and asthma. If the leukotriene pathway of inflammation is involved in a person’s allergies, then Singulair can be highly effective.
Intranasal steroid sprays are probably the mainstay of treatment for nasal allergies. Examples include Nasonex, Nasacort AQ, Rhinocort AQ, Flonase, Veramyst, Nasarel, Beconase AQ, and Vancenase AQ, and the most recent Omnaris. These are corticosteroids and are true antiinflammatory medicines to combat allergic inflammation. They are universally considered the drug of choice for nasal allergies. They are topically active and, therefore, poorly absorbed, so there is very little risk of systemic steroid side effects from them.
Another category of medication is the anti-cholinergic Atrovent (ipratropium) which is basically a drying agent for people who have significant runny noses.
NasalCrom (Cromolyn Sodium) is an older medication which supposedly prevents histamine from coming out of the allergy cell. It is not a very effective treatment and can be purchased over-the-counter.