Table of ContentsView AllTable of ContentsOral AntihistaminesTopical Nasal SteroidsOther Rx Nasal SpraysOral DecongestantsLeukotriene Blockers
Table of ContentsView All
View All
Table of Contents
Oral Antihistamines
Topical Nasal Steroids
Other Rx Nasal Sprays
Oral Decongestants
Leukotriene Blockers
When avoidance measures fail or are not possible, many people will require medications to treat theirallergic rhinitis symptoms. The choice of medication depends on several factors outlined below:
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This is the most common class of medications used for allergic rhinitis.The first-generation antihistamines, which include Benadryl, are generally considered too sedating for routine use. These medications have been shown to affect work performance and alter a person’s ability to operate an automobile.
Newer, second-generation antihistamines have now become first-line therapy for people with allergic rhinitis.These over-the-counter medications include:
These medications have the advantage of being relatively inexpensive and easy to take. They also start working within a couple of hours and, therefore, can be given on an “as needed” basis.
These medications are particularly good at treating sneezing, runny nose, and itching of the nose as a result of allergic rhinitis.
Side effects are rare and include a low rate of sedation or sleepiness, but much less than with the first-generation antihistamines.
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This class of allergy medications is effective at treating allergic andnon-allergic rhinitis, particularly if a person experiences nasal congestion.
There are numerous topicalnasal steroidson the market and most are now available over the counter.
This group of medications includes:
Nasal steroids are excellent at controlling allergic rhinitis symptoms. However, the sprays need to be used daily for the best results; they don’t work well on an as-needed basis.
Side effects are mild and limited to nasal irritation and nose bleeds. The use of these nasal sprays should be stopped if irritation or bleeding is persistent or severe.
Other Nasal Sprays
There are two other types of nasal sprays available, a nasal antihistamine and a nasal anti-cholinergic:
Oral decongestants, with or without oral antihistamines, can be useful medications in the short-term treatment of nasal congestion in people with allergic rhinitis who do not have other underlying disease. This class of medications includes pseudoephedrine (Sudafed), phenylephrine, and numerous combination products.However, oral decongestants with phenylephrine are not considered effective at clearing up congestion.
Decongestant/antihistamine combination products (such as Allegra-D, Zyrtec-D, Clarinex-D, and Claritin-D) are indicated for treating allergic rhinitis in people 12 years of age and older. These can be taken for two to three days to treat acute symptoms; they should not be used daily long-term.
Side effects associated with long-term use can include insomnia, headaches, elevated blood pressure,rapid heart rate, and nervousness.
Those with other chronic diseases should discuss risks and benefits of this class of medications with their physician before use.
Singulair (montelukast) was originally developed for mild asthma but has also been approved for the treatment of allergic rhinitis.
However, two large review studies put forward that montelukast is not as effective as oral antihistamines or nasal steroids at treating allergic rhinitis and should only be considered a second- or third-line treatment option.
The medication must be taken daily for best effects, and it usually takes a few days before it starts working. Side effects include headaches, abdominal pains, and fatigue.
Montelukast also contains aboxed warningdue to risk of mental health side effects, including suicidal ideation in susceptible individuals. The U.S. Food and Drug Administration stresses that montelukast should only be used in cases of allergic rhinitis as a last option when other treatments haven’t worked or aren’t well tolerated.
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Small P, Keith PK, Kim H.Allergic rhinitis.Allergy Asthma Clin Immunol. 2018;14(2):51. doi:10.1186/s13223-018-0280-7Church MK, Church DS.Pharmacology of antihistamines.Indian J Dermatol. 2013;58(3):219–24. doi:10.4103/0019-5154.110832May JR, Dolen WK.Management of allergic rhinitis: a review for the community pharmacist.Clin Ther. 2017;39(12):2410-2419. doi:10.1016/j.clinthera.2017.10.006American Academy of Allergy, Asthma, and Immunology.Over-the-counter nasal steroid sprays: what does it mean for patients?Dykewicz MS, Wallace DV, Baroody F, et al.Treatment of seasonal allergic rhinitis.Ann Allergy Asthma Immunol. 2017;119(6):489-511.e41. doi:10.1016/j.anai.2017.08.012UpToDate.Patient education: nonallergic rhinitis (beyond the basics).Food and Drug Administration.FDA approves a nasal antihistamine for nonprescription use.AlBalawi ZH, Othman SS, AlFaleh K.Intranasal ipratropium bromide for the common cold.Cochrane Database of Syst Rev.2013; 2013(6):CD008231. doi:10.1002/14651858.CD008231.pub3Deckx L, De Sutter AI, Guo L, Mir NA, van Driel ML.Nasal decongestants in monotherapy for the common cold.Cochrane Database Syst Rev. 2016 Oct 17;10(10):CD009612. doi:10.1002/14651858.CD009612.pub2MedlinePlus.Pseudoephedrine.Malone M, Kennedy TM.Review: side effects of some commonly used allergy medications (decongestants, anti-leukotriene agents, antihistamines, steroids, and zinc) and their safety in pregnancy.Int J Allergy Medicat. 2017;3(1):24–7. doi:10.23937/2572-3308.1510024Harvard Health Publishing.Don’t let decongestants squeeze your heart.Paggiaro P, Bacci E.Montelukast in asthma: a review of its efficacy and place in therapy.Ther Adv Chronic Dis. 2011;2(1):47-58. doi:10.1177/2040622310383343Sur DK, Plesa ML.Treatment of allergic rhinitis.Am Fam Physician; 92(11):985–92.MedlinePlus.Montelukast.Food and Drug Administration.FDA requires boxed warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair); advises restricting use for allergic rhinitis.
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Small P, Keith PK, Kim H.Allergic rhinitis.Allergy Asthma Clin Immunol. 2018;14(2):51. doi:10.1186/s13223-018-0280-7Church MK, Church DS.Pharmacology of antihistamines.Indian J Dermatol. 2013;58(3):219–24. doi:10.4103/0019-5154.110832May JR, Dolen WK.Management of allergic rhinitis: a review for the community pharmacist.Clin Ther. 2017;39(12):2410-2419. doi:10.1016/j.clinthera.2017.10.006American Academy of Allergy, Asthma, and Immunology.Over-the-counter nasal steroid sprays: what does it mean for patients?Dykewicz MS, Wallace DV, Baroody F, et al.Treatment of seasonal allergic rhinitis.Ann Allergy Asthma Immunol. 2017;119(6):489-511.e41. doi:10.1016/j.anai.2017.08.012UpToDate.Patient education: nonallergic rhinitis (beyond the basics).Food and Drug Administration.FDA approves a nasal antihistamine for nonprescription use.AlBalawi ZH, Othman SS, AlFaleh K.Intranasal ipratropium bromide for the common cold.Cochrane Database of Syst Rev.2013; 2013(6):CD008231. doi:10.1002/14651858.CD008231.pub3Deckx L, De Sutter AI, Guo L, Mir NA, van Driel ML.Nasal decongestants in monotherapy for the common cold.Cochrane Database Syst Rev. 2016 Oct 17;10(10):CD009612. doi:10.1002/14651858.CD009612.pub2MedlinePlus.Pseudoephedrine.Malone M, Kennedy TM.Review: side effects of some commonly used allergy medications (decongestants, anti-leukotriene agents, antihistamines, steroids, and zinc) and their safety in pregnancy.Int J Allergy Medicat. 2017;3(1):24–7. doi:10.23937/2572-3308.1510024Harvard Health Publishing.Don’t let decongestants squeeze your heart.Paggiaro P, Bacci E.Montelukast in asthma: a review of its efficacy and place in therapy.Ther Adv Chronic Dis. 2011;2(1):47-58. doi:10.1177/2040622310383343Sur DK, Plesa ML.Treatment of allergic rhinitis.Am Fam Physician; 92(11):985–92.MedlinePlus.Montelukast.Food and Drug Administration.FDA requires boxed warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair); advises restricting use for allergic rhinitis.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Small P, Keith PK, Kim H.Allergic rhinitis.Allergy Asthma Clin Immunol. 2018;14(2):51. doi:10.1186/s13223-018-0280-7Church MK, Church DS.Pharmacology of antihistamines.Indian J Dermatol. 2013;58(3):219–24. doi:10.4103/0019-5154.110832May JR, Dolen WK.Management of allergic rhinitis: a review for the community pharmacist.Clin Ther. 2017;39(12):2410-2419. doi:10.1016/j.clinthera.2017.10.006American Academy of Allergy, Asthma, and Immunology.Over-the-counter nasal steroid sprays: what does it mean for patients?Dykewicz MS, Wallace DV, Baroody F, et al.Treatment of seasonal allergic rhinitis.Ann Allergy Asthma Immunol. 2017;119(6):489-511.e41. doi:10.1016/j.anai.2017.08.012UpToDate.Patient education: nonallergic rhinitis (beyond the basics).Food and Drug Administration.FDA approves a nasal antihistamine for nonprescription use.AlBalawi ZH, Othman SS, AlFaleh K.Intranasal ipratropium bromide for the common cold.Cochrane Database of Syst Rev.2013; 2013(6):CD008231. doi:10.1002/14651858.CD008231.pub3Deckx L, De Sutter AI, Guo L, Mir NA, van Driel ML.Nasal decongestants in monotherapy for the common cold.Cochrane Database Syst Rev. 2016 Oct 17;10(10):CD009612. doi:10.1002/14651858.CD009612.pub2MedlinePlus.Pseudoephedrine.Malone M, Kennedy TM.Review: side effects of some commonly used allergy medications (decongestants, anti-leukotriene agents, antihistamines, steroids, and zinc) and their safety in pregnancy.Int J Allergy Medicat. 2017;3(1):24–7. doi:10.23937/2572-3308.1510024Harvard Health Publishing.Don’t let decongestants squeeze your heart.Paggiaro P, Bacci E.Montelukast in asthma: a review of its efficacy and place in therapy.Ther Adv Chronic Dis. 2011;2(1):47-58. doi:10.1177/2040622310383343Sur DK, Plesa ML.Treatment of allergic rhinitis.Am Fam Physician; 92(11):985–92.MedlinePlus.Montelukast.Food and Drug Administration.FDA requires boxed warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair); advises restricting use for allergic rhinitis.
Small P, Keith PK, Kim H.Allergic rhinitis.Allergy Asthma Clin Immunol. 2018;14(2):51. doi:10.1186/s13223-018-0280-7
Church MK, Church DS.Pharmacology of antihistamines.Indian J Dermatol. 2013;58(3):219–24. doi:10.4103/0019-5154.110832
May JR, Dolen WK.Management of allergic rhinitis: a review for the community pharmacist.Clin Ther. 2017;39(12):2410-2419. doi:10.1016/j.clinthera.2017.10.006
American Academy of Allergy, Asthma, and Immunology.Over-the-counter nasal steroid sprays: what does it mean for patients?
Dykewicz MS, Wallace DV, Baroody F, et al.Treatment of seasonal allergic rhinitis.Ann Allergy Asthma Immunol. 2017;119(6):489-511.e41. doi:10.1016/j.anai.2017.08.012
UpToDate.Patient education: nonallergic rhinitis (beyond the basics).
Food and Drug Administration.FDA approves a nasal antihistamine for nonprescription use.
AlBalawi ZH, Othman SS, AlFaleh K.Intranasal ipratropium bromide for the common cold.Cochrane Database of Syst Rev.2013; 2013(6):CD008231. doi:10.1002/14651858.CD008231.pub3
Deckx L, De Sutter AI, Guo L, Mir NA, van Driel ML.Nasal decongestants in monotherapy for the common cold.Cochrane Database Syst Rev. 2016 Oct 17;10(10):CD009612. doi:10.1002/14651858.CD009612.pub2
MedlinePlus.Pseudoephedrine.
Malone M, Kennedy TM.Review: side effects of some commonly used allergy medications (decongestants, anti-leukotriene agents, antihistamines, steroids, and zinc) and their safety in pregnancy.Int J Allergy Medicat. 2017;3(1):24–7. doi:10.23937/2572-3308.1510024
Harvard Health Publishing.Don’t let decongestants squeeze your heart.
Paggiaro P, Bacci E.Montelukast in asthma: a review of its efficacy and place in therapy.Ther Adv Chronic Dis. 2011;2(1):47-58. doi:10.1177/2040622310383343
Sur DK, Plesa ML.Treatment of allergic rhinitis.Am Fam Physician; 92(11):985–92.
MedlinePlus.Montelukast.
Food and Drug Administration.FDA requires boxed warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair); advises restricting use for allergic rhinitis.
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