Allergy Drug Information: Prescription and OTC

Allergy Drug Information:  Prescription and OTC

The most common reason consumers turn to allergy medications is for seasonal allergy relief from seasonal allergic rhinitis. This condition is sometimes referred to as “hay fever” because it is triggered by the spring through fall appearance of leaves, grasses and weeds. Allergy medications are also used for perennial (year-long) allergy relief. Antihistamines are also useful in treating chronic urticaria, a skin condition characterized by a persistent, itchy hives. Corticosteroid ointments and creams – as well as nonsteroidal topical immunomodulators — may be used for a variety of skin allergy conditions, including eczema or atopic dermatitis. Non-allergy-related uses for antihistamines include treating insomnia, migraine headaches, and motion sickness.

Antihistamines

  • Antihistamines have been used for years to treat allergy symptoms. They can be taken as pills, liquid, nasal spray, or eye drops. Over-the-counter (OTC) antihistamine eye drops can relieve red itchy eyes, while nasal sprays can be used to treat the symptoms of seasonal or year-round allergies.
  • People with allergies demonstrate an exaggerated immune response.  Immune system cells known as “mast cells” release a substance called histamine, which attaches to receptors in blood vessels, causing them to enlarge. Histamine also binds to other receptors causing redness, swelling, itching, and changes in secretions. By blocking histamine and keeping it from binding to receptors, antihistamines prevent these symptoms.
  • Oral antihistamines (pills and liquids) ease symptoms such as swelling, runny nose, itchy or watery eyes, and hives (urticaria). Over-the-counter oral antihistamines include loratadine (Claritin) and cetirizine (Zyrtec). Desloratadine (Clarinex) and levocetirizine (Xyzal) are available by prescription. Fexofenadine (Allegra) is available both over-the-counter and by prescription. Some oral antihistamines may cause dry mouth and drowsiness. Older antihistamines such as diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton) and clemastine (Tavist) are more likely to cause drowsiness and slow your reaction time. These sedating antihistamines shouldn’t be taken when driving or doing other potentially dangerous activities.
  • Antihistamine nasal sprays help relieve sneezing, itchy or runny nose, sinus congestion, and postnasal drip. Prescription antihistamine nasal sprays include azelastine (Astelin, Astepro) and olopatadine (Patanase). Side effects of antihistamine nasal sprays may include bitter taste, dizziness, drowsiness or fatigue, dry mouth, headache, nasal burning, nosebleed, nausea, runny nose, sore throat, and sneezing.
  • Antihistamine eyedrops are often combined with other medications such as mast cell stabilizers or decongestants. Antihistamine eyedrops can ease symptoms such as itching, redness and swollen eyes. You may need to use these medications several times a day, because the effects may last only a few hours. Over-the-counter examples include ketotifen (Zaditor, Alaway, others) and pheniramine (Visine-A, Opcon-A, others). Prescription examples include emedastine (Emadine) and olopatadine (Patanol, others). Side effects of these medications can include red eyes, watery eyes, mild stinging or burning and headache. Antihistamine eyedrops increase the risk of eye inflammation when you’re wearing contact lenses.
  • Side Effects  Many older over-the-counter antihistamines may cause drowsiness. Newer, non-sedating second and third generation antihistamines are available over-the-counter or by prescription.
  1. Over-the-counter: Allegra, Benadryl, Claritin, Chlor-Trimeton, Dimetane, Zyrtec, and Tavist. Ocu-Hist is an OTC eye drop.
  2. Prescription: Clarinex and Xyzal are oral medications. Astelin is a prescription nasal antihistamine spray and prescription antihistamine eye drops include Patanol and Elestat and Optivar.

Decongestants

  • Decongestants relieve congestion and are often prescribed along with antihistamines for allergies. They can come in nasal spray, eye drop, liquid, or pill form.
  • Nasal spray and eye drop decongestants should be used for only a few days at a time since long-term use can actually make symptoms worse. Pills and liquid decongestants may be taken longer safely
  • During an allergic reaction, tissues in your nose may swell in response to contact with the allergen. That swelling produces fluid and mucous. Blood vessels in the eyes can also swell, causing redness. Decongestants work by shrinking swollen nasal tissues and blood vessels, relieving the symptoms of nasal swelling, congestion, mucus secretion, and redness.
  • These relieve a stuffy nose by constricting blood vessels, which limits the amount of secretions coming from the inner lining of the nose. They are available as nasal sprays, pills, and liquids. They don’t relieve other allergy symptoms such as itching and sneezing.
  • Oral decongestants (pills and liquids) relieve nasal and sinus congestion caused by hay fever. Many decongestants are available over-the-counter. A common example is pseudoephedrine (Sudafed, others). A number of medications contain a decongestant such as pseudoephedrine combined with other medications. Claritin-D, for example, contains pseudoephedrine and an antihistamine. Oral decongestants can cause a number of side effects, including irritability, fast or irregular heartbeat, dizziness, insomnia, headaches, anxiety, tremors, and increased blood pressure.
  • Nasal decongestant sprays and drops relieve nasal and sinus congestion. Examples include phenylephrine (Neo-Synephrine, others) and oxymetazoline (Afrin, others). Nasal decongestants can cause dryness, burning or stinging inside the nose, runny nose, and sneezing. Taking too much of a nasal decongestant can cause irritability, fast or irregular heartbeat, dizziness, insomnia, headaches, anxiety, tremors, and increased blood pressure. Don’t use a decongestant nasal spray for more than a week or so, or you may develop severe congestion as soon as you stop taking it (rebound congestion).
  • Decongestant eyedrops (or combined decongestant-antihistamine eyedrops) can temporarily ease symptoms such as red, itchy eyes. Available over-the-counter, examples include tetrahydrozoline (Visine others) and naphazoline (Clear Eyes, others). Side effects include persistent eye redness and damage to blood vessels in the eye when overused. In rare cases, decongestant eyedrops can cause a type of sudden (acute) glaucoma.
  • Side Effects  Decongestants may raise blood pressure, so they typically are not recommended for people who have blood pressure problems or glaucoma. They may also cause insomnia or irritability and restrict urinary flow.
  1. Sudafed tablets or liquid, Neo-Synephrine and Afrin nasal sprays, and some Visine eye drops are available over the counter.
  2. Combination decongestant and antihistaminemedications such as Allegra-D or Zyrtec-D can be prescribed or bought over the counter.

Combination Allergy Drugs

  • Some allergy drugs contain both an antihistamine and a decongestant to relieve multiple allergy symptoms. Other drugs have multiple effects aside from just blocking the effects of histamine, such as preventing mast cells from releasing other allergy inducing chemicals.

 

  1. Over-the-counter: Allegra-D, Claritin-D, Zyrtec-D, Benadryl Allergy and Sinus, Tylenol Allergy and Sinus.
  2. Prescription:  Semprex-D for nasal allergies. Naphcon, Vasocon, Zaditor, Patanol, and Optivar for allergic conjunctivitis. Also, Dymista combines an antihistamine with a steroid for in a nasal spray for seasonal nasal allergies.   

Steroids

  • Steroids, known medically as corticosteroids, can reduce inflammation associated with allergies. They prevent and treat nasal stuffiness, sneezing, and itchy, runny nose due to seasonal or year-round allergies. They can also decrease inflammation and swelling from other types of allergic reactions.
  • Systemic steroids are available in various forms: as pills or liquids for serious allergies or asthma, locally acting inhalers for asthma, locally acting nasal sprays for seasonal or year-round allergies, topical creams for skin allergies, or topical eye drops for allergic conjunctivitis. In addition to steroid medications, your physician may decide to prescribe additional types of medications to help combat your allergic symptoms.
  • Steroids are highly effective drugs for allergies, but they must be taken regularly, often daily, to be of benefit — even when you aren’t feeling allergy symptoms. In addition, it may take one to two weeks before the full effect of the medicine can be felt.
  • These are used in nasal sprays to reduce inflammation and swelling in nasal passageways. Many ointments and creams used for allergic skin reactions also contain corticosteroids. If a person is experiencing a severe allergic response, oral or injectable corticosteroids may be given.
  • Nasal corticosteroid sprays prevent and relieve signs and symptoms of allergies such as allergic rhinitis (hay fever). These medications can help with nasal stuffiness, sneezing, and itchy, runny nose. Examples include fluticasone (Flonase), mometasone (Nasonex), budesonide (Rhinocort Aqua), triamcinolone (Nasacort AQ) and beclomethasone (Beconase AQ), fluticasone (Veramyst) and ciclesonide (Omnaris). Side effects can include unpleasant smell or taste, nasal irritation and nosebleeds.
  • Inhaled corticosteroids are used to relieve symptoms triggered by airborne allergy-triggering substances (allergens). These medications are generally taken on a daily basis as part of asthma treatment. Examples include fluticasone (Flovent Diskus, Flovent HFA), budesonide (Pulmicort Flexhaler), mometasone (Asmanex Twisthaler), beclomethasone (Qvar) and ciclesonide (Alvesco). Side effects are generally minor and can include mouth and throat irritation and oral yeast infections.
  • Corticosteroid eyedrops are used to treat severe eye irritation caused by hay fever and allergic conjunctivitis. Examples include dexamethasone (Maxidex, others), fluorometholone (FML) and prednisolone (Pred Forte, Pred Mild). These medications may cause blurred vision. Prolonged use may increase your risk of eye infections, glaucoma and cataracts.
  • Corticosteroid skin creams relieve allergic skin reactions such as scaling and itching. Some low-potency corticosteroid creams are available without a prescription, but talk to your doctor before using a topical corticosteroid for more than a few weeks. Examples include hydrocortisone (Cortaid, others) and triamcinolone (Kenalog, others). Side effects can include skin irritation and discoloration. Long-term use, especially of stronger prescription corticosteroids, thins the top layer of the skin, resulting in easy bruising where the cream has been applied. Corticosteroids are available in liquid form that can be useful for skin conditions involving the scalp.
  • Oral corticosteroids (pills and liquids) are used to treat severe symptoms caused by all types of allergic reactions. Examples include prednisone (Prednisone Intensol) and prednisolone (Prelone, others). Because they can cause numerous short- and long-term side effects, oral corticosteroids are usually prescribed for short periods of time. Long-term use can cause cataracts, osteoporosis, muscle weakness, stomach ulcers and delayed growth in children. Oral corticosteroids can also worsen hypertension. In some situations, corticosteroids may be given as a shot (injection) rather than pills.
  • Side Effects Steroids have many potential side effects, especially when given orally, systemically, and for a long period of time. Side effects of steroids with short-term use include: Weight gain, Fluid retention, High blood pressure. Potential steroid side effects with long-term use include:Growth suppression . Diabetes, Cataracts of the eyes, Bone thinning osteoporosis, Muscle weakness. Side effects of inhaled steroids may include cough, hoarseness, or fungal infections of the mouth.

Bronchodilators

  • Bronchodilators are inhaled drugs used to control asthma symptoms and are available only with a prescription. A short-acting bronchodilator is used to provide quick relief for asthma symptoms during an attack. Long-acting bronchodilators can provide up to 12-hours of relief from asthma symptoms, which is helpful to people who suffer from nighttime asthma problems.

Immunomodulator:

  • These are topical medications used to treat skin allergies. They are often used if other agents are ineffective or intolerable.

Autoinjectable epinephrine

  • This is used to treat a life-threatening allergic reaction known as anaphylaxis, which may be caused by severe allergic response to foods, drugs, or insect stings.
  • Epinephrine shots are used to stop a severe allergic reaction. These self-injecting syringe and needle (autoinjector) devices include Twinject, EpiPen and EpiPen Jr.
  • Need to carry an autoinjector if you’re likely to have a severe allergic reaction to a certain food, such as peanuts, or if you’re allergic to bee or wasp venom. A severe allergic reaction can cause anaphylaxis — a sudden, life-threatening reaction. Epinephrine is a form of adrenaline that can help slow the reaction while you seek emergency treatment.

Mast Cell Stabilizers

  • Mast cell stabilizers can be used to treat mild to moderate inflammation in the bronchial tubes and other allergy symptoms. These medications can also be used to prevent asthma symptoms during exercise and can be given before exposure to an allergen when it cannot be avoided.
  • These can help prevent allergic reactions from happening when taken regularly. During an allergic reaction, specialized cells in the body known as mast cells release histamine and other substances. Mast cell stabilizers, such as cromolyn sodium, keep these cells intact.
  • Mast cell stabilizers are available as inhalers for asthma, eyedrops for allergic conjunctivitis, and nasal sprays for nasal allergy symptoms. Like with many drugs, it may take several weeks before the full effects are felt.
  • Some examples of mast cell stabilizers include: Intal, Tilade, Crolom, Alomide, Alocril, Opticrom, Alamast, Nasalcrom
  • Mast cell stabilizers work by preventing the release of histamine from mast cells (cells that make and store histamine). Some of these drugs also have important anti-inflammatory effects, but typically they are not as effective as steroids.
  • Mast cell stabilizer eyedrops prevent the release of symptom-causing chemicals such as histamine. These prescription medications reduce allergy symptoms such as red, itchy eyes. Examples include cromolyn (Crolom), lodoxamide (Alomide), pemirolast (Alamast) and nedocromil (Alocril). These medications don’t usually cause significant side effects.
  • Side Effects:  Throat irritation, coughing or skin rashes sometimes can occur with inhaled mast cell stabilizers. Some people associate a bad taste with the use of Tilade. Using a spacer to take the medicine and drinking juice following treatment may decrease the taste. Mast cell stabilizers in the form of eye drops may cause burning, stinging, or blurred vision when they are administered.

Leukotriene Modifiers

  • Leukotriene modifiers are used to treat asthma and nasal allergy symptoms. They can be prescribed along with other drugs.
  • These medications are available only with a doctor’s prescription and come as pills, chewable tablets, and oral granules.
  • Other substances released during an allergic reaction are leukotrienes, which can aggravate allergic conditions and asthma. Some drugs target leukotriene receptors to reduce allergic symptoms.
  • Examples of leukotriene modifiers include:Accolate (zafirlukast), Singulair (monteleukast), Zyflo (zileuton)
  • Montelukast (Singulair) is a prescription medication that blocks symptom-causing chemicals called leukotrienes. This oral medication relieves allergy signs and symptoms including nasal congestion, runny nose and sneezing. Side effects can include upper respiratory infection in adults, and headache, ear infection and sore throat in children. The Food and Drug Administration (FDA) has warned that in some people, leukotriene-blocking medications could possibly cause psychological symptoms, such as irritability, anxiousness, insomnia, hallucinations, aggression, depression, and suicidal thinking or behavior.
  • Leukotriene modifiers block the effects of leukotrienes, chemicals produced in the body in response to an allergic reaction.
  • Side effects of these drugs are rare, especially for Accolate and Singulair, but may include:Stomach pain or stomach upset , Heartburn, Fever, Stuffy nose, Cough, Rash, Headache, Irritability, Behavioral issues

Other Over-The-Counter Products

Some simple over-the-counter products can help with allergy symptoms. They include:

  • Salt-water solution, or saline, is available as a nasal spray to relieve mild congestion, loosen mucus, and prevent crusting. These sprays contain no medicine.
  • Artificial tears, which also contain no medicine, are available to treat itchy, watery, and red eyes.

Immunotherapy

  • Immunotherapy, or allergy shots, may be the most effective form of treatment if you suffer from allergies more than three months of the year. These shots expose you to gradually increasing levels of the offending allergen to help your immune system build tolerance. See our full article on allergy shots for more information.
  • Immunotherapy injections (allergy shots) may relieve hay fever symptoms or allergic asthma that doesn’t improve with medications. Injections may also be an option if you aren’t able to take oral allergy medications without having side effects. Over a period of three to five years, you receive regular injections containing allergen extracts. The goal is to stop your body from reacting to specific allergens and decrease or eliminate your need for medications. Immunotherapy may be especially effective if you’re allergic to cat dander, dust mites, or pollen produced by trees, grass or weeds. In children with allergic rhinitis, immunotherapy may help prevent the development of asthma. Rarely, immunotherapy injections can cause a life-threatening allergic reaction (anaphylaxis).

Allergy Medications:

Older (first-generation) antihistamines:

  • Diphenhydramine (Benadryl)
  • Chlorpheniramine
  • Brompheniramine
  • Carbinoxamine (Palgic)
  • Clemastine (Tavist Allergy)
  • Cyprohepatdine
  • Hydroxyzine (Vistaril)

Newer (second-generation) antihistamines:

  • Cetirizine (Zyrtec)
  • Desloratadine (Clarinex)
  • Fexofenadine (Allegra)
  • Loratadine (Claritin)
  • Levocetirizine (Xyzal)

Antihistamine nasal sprays:

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

Antihistamine/decongestant combination

  • Acrivastine (Semprex-D)
  • Zyrtec-D
  • Allegra-D
  • Claritin-D

Eyedrops:

  • Azelastine (Optivar)
  • Emadastine (Emadine)
  • Naphazoline/pheniramine (Naphcon-A, Opcon-A, Visine-A)
  • Epinastine (Elestat)
  • Ketotifen (Zaditor, Alaway)
  • Olopatadine (Patanol, Pataday)
  • Loteprednol (Alrex, Lotemax)
  • Naphazoline (AK-Con, Casocon, Albalan)
  • Cromolyn (Crolom)
  • Lodoxamine (Alomide)
  • Nedocromil (Alocril)
  • Pemirolast (Alamast)
  • Ketorolac (Acular)

Nasal corticosteroids:

  • Budesonide (Rhinocort Aqua)
  • Ciclesonide (Omnaris)
  • Flunisolide
  • Fluticasone furoate (Veramyst)
  • Fluticasone propionate (Flonase)
  • Mometasone furoate (Nasonex)
  • Triamcinolone acetonide (Nasacort AQ)
  • Beclomethasone dipropionate (Beconase AQ)

Nasal steroids:

  • Beconase, Flonase, Nasocort, Nasonex, Rhinocort, Veramyst, Qnasl, Zetonna, and generic fluticasone are used to treat nasal allergy symptoms.

Inhaled steroids :

  • Azmacort, Flovent, Pulmicort, Asmanex, Q-Var, Alvesco, and Aerobid are used to treat asthma. Advair and Symbicort are inhaled drugs called bronchodilators that combine a steroid with another drug to treat asthma. Inhaled steroids are available only with a prescription.

Eye drops steroid:

  • Alrex and Dexamethasone.

Oral steroids:

  • Deltasone, also called prednisone.

Mast cell stabilizers:

  • Cromolyn sodium (Nasalcrom nasal spray)

Leukotriene drugs used for allergies:

  • Montelukast (Singulair)

Nasal anticholinergics:

  • Ipratropium bromide (Atrovent nasal spray)

Decongestants (Nasal):

  • Oxymetazoline (Afrin)

Decongestants (Oral):

  • Pseudoephedrine (Sudafed)
  • Phenylephrine

Topical steroids for skin allergy:

  • Aclometasone
  • Fluocinolone
  • fluocinonide (Lidex, Vanos)
  • Hydrocortisone
  • triamcinolone (Allernaze, Aristospan 5 mg, Aristospan Injection 20 mg, Kenalog 10 Injection, Nasacort AQ)
  • desonide (DesOwen)
  • flurandrenolide (Cordran Lotion, Cordran Tape)
  • fluticasone (Advair Diskus, Advair HFA, Cutivate Cream, Cutivate Lotion, Cutivate Ointment)
  • mometasone (Asmanex Twisthaler, Elocon Ointment, Elocon, Nasonex, Elocon Lotion)
  • prednicarbate (Dermatop Ointment, Dermatop Emollient Cream)
  • Amcinonide
  • betamethasone valerate (Luxiq, Cultivate Cream)
  • desoximetasone (Topicort)
  • diflorasone (Psorcon E Emollient Cream)
  • halcononide (Halog Cream, Halog-E Cream)
  • betamethasone dipropionate (Halog Ointment)
  • clobetasol propionate (Halog Solution)
  • halobetasol propionate (Ultravate Cream, Ultravate Ointment, Cortaid)

Immunomodulators for skin allergy:

  • Pimecrolimus (Elidel)
  • Tacrolimus (Protopic)

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