Allergy Management and Treatment

Antihistamines work by blocking histamine, which is a chemical released by your immune cells during an allergic reaction that causes symptoms to develop.

Eyedrops

Eyedrops are one option for antihistamine treatment, available over-the-counter or by prescription. These eyedrops help to relieve itchy, red, swollen eyes. Some antihistamine eyedrops may contain a combination of antihistamines and redness relievers.

Examples of antihistamine eyedrops:

• Alcaftadine (Lastacaft) 
• Cetirizine (Zerviate)
• Ketotifen (Alaway, Zaditor)
• Naphazoline and Pheniramine (Naphcon-A, Opcon-A, Visine-A)
• Olopatadine (Pataday Once or Twice Daily Relief [Regular or Extra Strength])

Nasal Sprays

Antihistamines can also be administered in the form of nasal sprays. These help by relieving sneezing, itchy or runny nose, sinus congestion and postnasal drip. Some of the side effects experienced from antihistamine nasal sprays may include a bitter taste or drowsiness. Note, however, that nasal sprays will not sufficiently treat the signs and symptoms of the eye. 

Examples of prescription antihistamine nasal sprays:

• Azelastine (Astelin, Astepro)
• Olopatadine (Patanase)

Pills and Liquids

Antihistamines can be taken orally in either pill or liquid form, available both over-the-counter and by prescription. They can alleviate symptoms such as sneezing, itchy nose and nasal congestion. However, they are not the most effective options for treating itchy, red, swollen or watery eyes. Since some antihistamine drugs can cause drowsiness, they should be taken with caution.

Examples of antihistamines that tend to cause drowsiness:

• Diphenhydramine (Benadryl)
• Chlorpheniramine (ChlorTrimeton)

Examples of antihistamines that are much less likely to cause drowsiness:

• Cetirizine (Zyrtec, Zyrtec Allergy)
• Desloratadine (Clarinex)
• Fexofenadine (Allegra, Allegra Allergy 12 and 24 Hour)
• Levocetirizine (Xyzal, Xyzal Allergy 24 Hour)
• Loratadine (Alavert, Claritin)

Decongestants work to achieve fast, temporary relief of nasal and sinus congestion. However, particularly when administered orally, they can sometimes have side effects such as increased blood pressure, difficulty sleeping, headache and irritability. Because of this, they’re not recommended for those who have a history of cardiovascular disease, high blood pressure, hyperthyroidism or glaucoma.

Nasal Sprays and Drops

Nasal decongestants can be taken in the form of sprays and drops. If used only for a brief time, these can help relieve nasal and sinus congestion, or ocular redness in the case of eyedrops. Use of these drugs repeated for more than three consecutive days may result in a cycle where congestion returns or worsens. 

Examples of nasal decongestant sprays and drops:

• Oxymetazoline (Afrin, Duramist Plus)
• Tetrahydrozoline (Visine, Tyzine)

Pills and Liquids

Decongestants can be taken orally to reduce nasal and sinus congestion caused by allergic rhinitis (hay fever). Several decongestants like pseudoephedrine (Sudafed), are available over-the-counter. Many oral allergy medications consist of both a decongestant and antihistamine. Again, it is important to note that generally speaking, oral medication will not sufficiently treat the signs and symptoms of the eye.

Examples of oral decongestants/antihistamines

• Cetirizine and pseudoephedrine (Zyrtec-D)
• Desloratadine and pseudoephedrine (Clarinex-D)
• Fexofenadine and pseudoephedrine (Allegra-D)
• Loratadine and pseudoephedrine (Claritin-D)

Corticosteroids are used to alleviate symptoms by controlling inflammation related to allergies.

Eyedrops

Corticosteroids can be taken in eyedrop form to treat lasting itchy, red or watery eyes when other therapies are not successful. Since this type of eyedrop has been known to cause glaucoma, cataracts and other infections, its use is monitored by an eye doctor and generally should not persist for more than a couple of weeks.

Examples of corticosteroid eyedrops:

• Fluorometholone (Flarex, FML)
• Loteprednol (Alrex, Lotemax)
• Prednisolone (Omnipred, Pred Forte)

Nasal Sprays

The use of corticosteroid nasal sprays can reduce symptoms of stuffiness, runny nose and sneezing. Some side effects seen with their use may include a bitter taste, nasal irritation and nosebleeds. Nasal steroids in general are also not sufficiently effective for treating the eye.

Examples of corticosteroid nasal sprays:

• Budesonide (Rhinocort)
• Fluticasone furoate (Flonase Sensimist)
• Fluticasone propionate (Flonase)
• Mometasone (Nasonex)
• Triamcinolone (Nasacort Allergy 24 Hour)

Pills and Liquids

Oral corticosteroids can be taken to relieve more severe allergy symptoms. However, long-term use of these can result in cataracts, muscle weakness, stomach ulcers and elevated blood sugar (glucose). Additionally, oral corticosteroids can also worsen high blood pressure. Oral steroids would be prescribed under the direction of a physician.

Examples of prescription oral corticosteroids:

• Prednisolone (Prelone)
• Prednisone (Prednisone Intensol, Rayos)
• Methylprednisolone (Medrol)

Skin Creams

Corticosteroid creams are also available to treat allergic skin reactions including itching, redness or scaling. There are some low-potency corticosteroid creams available over-the-counter, but if using for more than a few weeks, a physician should be consulted. Side effects of corticosteroid creams may include irritation and skin discoloration. 

Examples of corticosteroid creams:

• Betamethasone (Dermabet, Diprolene, others)
• Desonide (Desonate, DesOwen)
• Hydrocortisone (Locoid, Micort-HC, others)
• Mometasone (Elocon)
• Triamcinolone (Cinolar)

While topical corticosteroids and general skincare measures have been the standard of care for patients with atopic dermatitis (eczema), their inadequacy has driven efforts to identify better treatment options. Dupilumab (Dupixent®) is a human monoclonal antibody that has recently been approved for treating atopic dermatitis. Dupilumab offers disease management by reducing the severity of the symptoms associated with atopic dermatitis, in turn improving patients’ quality of life and minimizing the anxiety they often feel as a result of this disease. Additionally, clinical studies have shown that dupilumab has an impressive safety profile, and have further suggested that it may benefit patients with conditions such as chronic rhinosinusitis, eosinophilic esophagitis and other allergic conditions due to its mechanism of action.

Mast Cell Stabilizers

Mast cell stabilizers are used to block the release of certain chemicals that cause allergic reactions. Overall, these drugs are safe to use and should be used for several days to achieve the full effectiveness, but in general have lower efficacy compared to the other options. Mast cell stabilizers are often used when antihistamines are not working well or are not well-tolerated by patients.

Examples of mast cell stabilizer prescription eyedrops:

• Cromolyn (Crolom)
• Lodoxamide (Alomide)
• Nedocromil (Alocril)

Example of mast cell stabilizer nasal spray:

• Cromolyn (Nasalcrom)

For more severe allergies where other forms of treatment are not providing much relief, patients may require allergen immunotherapy (allergy shots). This type of treatment consists of a series of injections of purified allergen extracts, typically given over the duration of a few years. As an alternative to injections, immunotherapy can also be administered in the form of a tablet that is placed under the tongue (sublingual) while dissolving.