Allergic Rhinitis

Treatment for allergic rhinitis usually starts with over-the-counter medicines. These include antihistamines, decongestants, and eyedrops.

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

• Antihistamines that don't make you sleepy (non-sedating). They generally are very effective in relieving sneezing, runny nose, itching, and watery eyes. They also come in a form with a decongestant to help relieve a stuffy nose.
• 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 considered 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.

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 can make your asthma and sinusitis worse. It is important to discuss this with your doctor, as some medicines might be better for you and your baby than others.

Treating children with medicine may be more difficult than treating adults because of the possible side effects. Some medicines also may not be approved for treating children. Check with the doctor before giving antihistamines or decongestants to your child. Experts say not to give decongestants to children younger than 2.

What to think about

Some people begin using over-the-counter medicines for allergic rhinitis before they see their doctors. These medicines can work well; however, 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.

You may want to consider using different medicines at different times of the day. For example, during the day, it may be important to avoid the drowsiness that some antihistamines cause. However, if you are at home in the evening and this side effect is not a concern, you can think about using a low-cost, over-the-counter antihistamine. You may also try 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.

Most non-sedating antihistamines are taken only once a day.

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 you start using a corticosteroid spray 1 to 2 weeks before the pollen season starts.

Omalizumab (Xolair) is a medicine approved by the U.S. Food and Drug Administration (FDA) for use in allergic asthma. Studies have shown that it works well to 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.