With so many allergy medications out there — and so many of them available over-the-counter — it's not always easy to know which ones are best for your particular brand of misery. And when you do settle on a treatment, it can be tricky to figure out exactly how to use it to make sure it's as effective as possible.
"Many people don't realize that different types of allergy medication work very differently," says David Stukus, MD, a spokesperson for the American College of Allergy, Asthma, and Immunology. "And some are better suited for some symptoms compared to others." Here's what you need to know about each type, how they work, and when to take them.
The allergy meds you're probably most familiar with are the antihistamines, but not all antihistamines are equal. The first generation antihistamines, such as Benadryl, "often have significant side effects...and are also much shorter-lasting," says Dr. Stukus. Benadryl is still a great option for "acute" situations (e.g. developing hives after eating something you're mildly allergic to), but it's not a great long-term solution because it often causes intense drowsiness.
That's why, he says, most people who are dealing with seasonal allergies would benefit from skipping the first generation and heading straight for the second, which includes longer-lasting medications such as Zyrtec and Claritin. These drugs work by blocking the effects of histamine, a compound that your body produces in response to a perceived pathogen (even when that "pathogen" is just, like, grass). All antihistamines work this way, but second-generation ones are much better at targeting specific histamine receptors, so they tend to cause fewer side effects.
That mechanism also means your symptoms are much easier to treat with antihistamines when they're at a two or three (or they haven't started at all) than when they're at a nine or ten. "It's hard to make much improvement [when your nose is already] swollen, inflamed, sensitive, and producing tons of mucus," explains Dr. Stukus. So, yes, you should start taking your antihistamines a few weeks before your usual allergy season starts, and you need to take these every day to get the most significant effects.
Steroid Nasal Sprays
Surprisingly, however, antihistamines aren't the best choice if your main allergy symptoms include congestion, runny nose, or post-nasal drip. For those, Dr. Stukus says you should opt for a nasal steroid spray, such as Flonase, which directly targets your stuffy nose.
The steroids in these sprays are synthetic versions of ones that your body makes naturally, which normally produce anti-inflammatory effects. But it can take a while for your system to fully adjust to the medication, so you won't necessarily feel a change immediately. That's why you also need to start using these early (at least two weeks before your symptoms typically show up).
Although the meds above are great options for dealing with your symptoms, they don't really address the underlying issue with allergies: your overreactive immune system. "The only way to really affect the immune system is through immunotherapy," says Dr. Stukus. The most common version is shots containing very small amounts of whatever you're allergic to. Over time, allergy shots can desensitize your immune system to those particular allergens. They can also help prevent you from developing new allergies later in your life, says Dr. Stukus.
However, this process does need to be done under the supervision of a doctor, and the regimen can be kind of intense. At first, you'll probably get shots once or twice a week, and then they'll decrease to once per month. But you'll still have to hang out in the doctor's office for 20-30 minutes after the shot to make sure you don't have a serious reaction. It might also take up to a year for you to see significant improvements (meaning you'll still have to take your regular allergy meds while undergoing immunotherapy). And, because everyone reacts differently, there's no guarantee you'll be done getting the shots within a few years.
"Many patients can achieve prolonged relief after three to five years [of shots]," says Dr. Stukus, "but there are always exceptions." Some patients do continue receive them for many years or even their entire lives. But, depending on how severe your symptoms are, that might sound like a tiny price to pay for a life without allergies.
Over the last few years, the FDA has also approved a few sublingual immunotherapy options. These are little tablets containing allergens that you can take on your own without having to go to a doctor's office every time. However, they only exist for a few allergens right now (ragweed, grass, and dust mites). So if you, like this author, are allergic to pretty much everything in the outdoors, they aren't going to cut it.
There is one other allergy medication option — decongestant nasal sprays such as Afrin — for which Dr. Stukus has some words of caution: "While those may give pretty good relief in the short term for severe nasal congestion, if they’re used for more than three to five days, they can worsen your symptoms over time and lead to dependency on the medicine," he says.
Yep: You can essentially become addicted to your nasal spray and eventually need to use more and more to get the same results — also known as a "rebound effect." Treating this condition (rhinitis medicamentosa) usually requires steroids (e.g. prednisone) and going cold turkey on the spray.
That said, Dr. Stukus admits that he resorts to these fast-acting sprays when allergy season hits really hard, just so he can get through the work day. "I use it like crazy — for three days," he says.
So if your chosen allergy medications aren't doing the trick, it's worth checking in with your doctor about all of these other options (or possibly using a combination of them). Your perfect match might require a prescription. And if you feel like your fave isn't as effective as it used to be, that's another great reason to check with a doctor or board-certified allergist, says Dr. Stukus, although it's more likely that you're just using one that's not tailored for your major symptoms. As soul-crushing as seasonal allergies can be, you don't have to suffer through them.