Allergic Rhinitis

Treatment for allergic rhinitis consists of avoiding the specific allergens that cause your symptoms, using medicines to control symptoms, and, in severe cases, getting allergy shots (immunotherapy). You are more likely to need daily treatment if you have symptoms throughout the year. But if you have allergies during a certain season, you may only need daily treatment at that time.

Because allergic rhinitis cannot be cured and may be frustrating to treat, people may try alternative treatment methods, such as homeopathy. But most of these treatments either have not been studied or have not been proven to work. Such treatments may be expensive, and some can be dangerous to your health.

Avoiding allergens

It is important to avoid allergens that are causing your symptoms. By doing this, you may be able to reduce your allergy symptoms, manage them without medicine or with fewer medicines, and reduce your risk of developing complications such as sinusitis. For more information, see:

Allergies: Avoiding indoor triggers.

Allergies: Avoiding outdoor triggers.

Self-treatment

Some people begin using over-the-counter medicines for allergic rhinitis before they see their doctors. These medicines can work well. But people with other medical problems, older adults, children, women who are pregnant or breast-feeding, and people with more than occasional mild symptoms should see a doctor before beginning self-treatment.

Pregnant women and children

Your symptoms may be worse if you are pregnant. Although you and the baby (fetus) are not in danger, allergic rhinitis may make asthma and sinusitis worse. If possible, do not use medicine for at least the first 3 months of your pregnancy. If you feel you need the medicine, talk to your doctor. If you become pregnant and are already taking allergy shots (immunotherapy), you may continue them, but don't start allergy shots if you are pregnant.

Treatment for children who have allergic rhinitis is much the same as for adults who have allergies. Treating children with medicine may be more difficult because of the possible side effects. Some medicines also may not be approved to treat children.

Initial and ongoing treatment

Treatment for allergic rhinitis usually starts with over-the-counter medicines. These include antihistamines, decongestants, and eyedrops to relieve symptoms. Check with the doctor before giving these medicines to your child. Experts say not to give decongestants to children younger than 2.

If over-the-counter medicines don't work or they cause bothersome side effects, such as drowsiness or decreased coordination, your doctor may prescribe medicine. These include:

• Antihistamines that don't make you sleepy (non-sedating). They generally are very effective at relieving sneezing, runny nose, itching, and watery eyes. You can take them with an over-the-counter decongestant to relieve a stuffy nose. Don’t give decongestants to a child younger than 2 unless you’ve checked with the doctor first. If your child’s doctor tells you to give a medicine, be sure to follow what he or she tells you to do.
• Eyedrops, if you have redness, itching, and watery eyes. Eyedrops can be prescription or over-the-counter and may contain an antihistamine or decongestant.
• Nasal corticosteroid sprays, which you may use with antihistamines. These sprays may reduce all symptoms of allergic rhinitis and are thought to be the most effective treatment for most people. They start working quickly, but it may be several weeks before you get the full effect.

Your doctor may suggest other medicines if these do not work or in special cases, such as if you are pregnant. These include:

• Leukotriene modifiers, which can relieve a stuffy nose, itching and sneezing, and a runny nose.
• Cromolyn sodium, which may reduce sneezing, nasal discharge, a stuffy nose, and eye irritation. Children and pregnant women often use cromolyn because it is very safe.
• Ipratropium bromide, which can relieve a runny nose.

If you do not take your medicine, your symptoms may return or get worse. It can be helpful to explain to children why they are taking medicine and how it can help them, as well as what side effects may occur.

You may use medicine daily for quick relief of symptoms that occur suddenly or are getting worse. Or you may use it in advance if you know you may breathe an allergen. For example, if you have severe pollen allergies, your doctor may suggest that you start using a corticosteroid spray 1 to 2 weeks before the pollen season starts.

You can treat a stuffy nose by cleaning your nasal passages with a saline solution (salt water). You may be able to prevent or manage mild sinus infections at home using over-the-counter medicines or other methods.

Different medicines treat different allergy symptoms. It may take a combination of medicines to relieve all of your symptoms. Talk with your doctor about which symptoms are most important for you to treat and which medicines may work best for you.

Treatment if the condition gets worse

If avoiding allergens and using antihistamines or nasal corticosteroids do not help your symptoms of allergic rhinitis, your doctor may suggest you take pill or injected corticosteroids. They are used only for symptoms that are severe. And they are used only for 3 to 10 days. This is because these types of corticosteroids have severe side effects when you take them for a long time.

If medicines do not help your symptoms or if they cause bad side effects, your doctor may suggest allergy shots (immunotherapy). Allergy shots are small doses of allergens that your doctor injects under your skin. This helps your body "get used to" the allergen, so you may have fewer or less severe symptoms. For more information, see:

Should I take allergy shots for allergic rhinitis or allergic asthma?

Although surgery does not cure allergic rhinitis, you may need it to fix something that makes treating your allergies difficult, such as a physical defect of the nose, or when allergies lead to blockage in the eustachian tube that causes chronic ear infections.

What to think about

If you have long-term (chronic) allergic rhinitis, complications such as sinusitis, and plugged ears or ear infections may occur. A severe complication is one of the few times that you may need to seek extra care from your doctor for allergic rhinitis.

Omalizumab (Xolair) is a medicine for allergic asthma. Studies have shown that it can reduce nasal symptoms of allergic rhinitis, such as sneezing and an itchy, runny, or stuffy nose.³ Some doctors may prescribe omalizumab for allergic rhinitis (unlabeled use). But it's not known if omalizumab works as well as nasal steroids. And it is very expensive.