Hay fever medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Treatment

The goal of treatment is to reduce allergy symptoms caused by the inflammation of affected tissues. The best "treatment" is to avoid what causes your allergic symptoms in the first place.

Medical Therapy

The most appropriate medication depends on the type and severity of symptoms. Specific illnesses that are caused by allergies (such as asthma and eczema) may require other treatments.

Options include the following:

Systemic therapy

Therapies that have an overall effect on a person's body and therefore thay may help for all of the symptoms include:

Antihistamines

these are taken by mouth and may relieve mild to moderate symptoms. The first-generation (non-selective or classical) antihistamines such as chlorphenamine and promethazine are perhaps the most effective, but their sedative side effects limits their usefulness compared to the newer second-generation and third-generation (selective, non-sedating) antihistamines such as loratadine and cetirizine. Most of these antihistamines are available as over-the-counter drugs.

Glucocorticoids

Corticosteroids administered to the whole body, such as Triamcinolone (Kenalog) by intramuscular injection, are also effective, but their use is limited by their short duration of effect, lasting a few weeks, and the side effects of prolonged steroid therapy.

Leukotriene receptor antagonists

these newer products, such as montelukast (Singulair) and zafirlukast (Accolate), have proven very effective in dealing with allergic rhinitis, without the common side-effects of the first-generation antihistamines, such as drowsiness. These medicines are also long-acting and are taken once-daily.

Topical therapy

Localised treatments may give more effective relief of eye or nasal symptoms.

Nasal treatments

Steroid nasal sprays

are effective and safe, and may be effective without oral antihistamines. These medications include, in order of potency: beclomethasone (Beconase), budesonide (Rhinocort), flunisolide (Syntaris),mometasone (Nasonex), fluticasone (Flonase, Flixonase), triamcinolone (Nasacort AQ). They take several days to act and so need be taken continually for several weeks as their therapeutic effect builds up with time.

Cromoglicate

is a drug that stabilizes mast cells to prevent their degranulation and subsequent release of histamine. It is available as a nasal spray (Nasalcrom) for treating hay fever, although it is generally less effective than nasal steroid sprays.

Antihistamine

Azelastine (Astelin) is the only antihistamine available as a nasal spray.

Topical decongestants

may also be helpful in reducing symptoms such as nasal congestion, but should not be used for long periods as stopping them after protracted use can lead to a rebound nasal congestion (Rhinitis medicamentosa).

Saltwater sprays, rinses or steam

this removes dust, secretions and allergenic molecules from the mucosa, as they are all instant water soluble. A suitable solution is 2-3 spoonful of salt dissolved in one litre of lukewarm water.

Eye treatments

Cromoglicate

is also used as eye drops (Crolom in US and Opticrom in UK being best known brands). Nedocromil is a newer variant of cromoglycate and has essentially the same activity.

Allergy immunotherapy

Allergy immunotherapy is commonly used in patients suffering from allergic rhinitis, allergic asthma, or life threatening stinging insect allergy. This type of therapy has been found to potentially alter the course of all three of the above disorders. Allergen immunotherapy provides long-term relief of the symptoms associated with rhinitis and asthma.

"Allergy shots" (Hyposensibilization, immunotherapy) are occasionally recommended if the allergen cannot be avoided and if symptoms are hard to control. This includes regular injections of the allergen, given in increasing doses, which may help the body adjust to the antigen. These tend to be offered as a last resort as the therapy is more expensive at first, although patients may save money on medications and doctor visits in the long run. They may also increase the risk of triggering a secondary allergic reaction such as an asthma attack.

Allergy shot treatment is the closest thing to a ‘cure’ for allergic symptoms. This therapy requires a long-term commitment.

Over-the-counter treatments

A large number of over-the-counter treatments are sold without FDA approval but are known for their positive effects, including herbs like eyebright (Euphrasia officinalis), nettle (Urtica dioica), and bayberry (Myrica cerifera), which have not been shown to reduce the symptoms of nasal-pharynx congestion. In addition, feverfew (Tanacetum parthenium) and turmeric (Curcuma longa) has been shown to inhibit phospholipase A2, the enzyme which releases the inflammatory precursor arachidonic acid from the bi-layer membrane of mast cells (the main cells which respond to respiratory allergens and lead to inflammation) but this is only in test tubes and it is not established as antiinflammatory in humans.