Since hay fever is mainly the result of an allergic reaction to pollen, the ideal treatment is to completely avoid pollen. Of course, besides of pollen you should avoid other triggers and allergens too, for example, dust, animal dander, molds, and so on. While currently no cure is available for hayfever, you can rely on some allergies medicine, especially the over-the-counter (OTC) ones, to diminish mild allergy symptoms. And the most commonly used OTC medications are antihistamines, decongestants, cromolyn sodium, and corticosteroids. However, before the introduction let’s first briefly describe the condition hay fever.
What is hay fever?
This is a seasonal rhinitis that usually occurs in early spring and early fall. It mainly includes anaphylactic shock and allergic reactions of respiratory passages, digestive tract, and skin. Main symptoms are paroxysmal nasal itching, continuous sneezing, lots of clear nasal discharge, stuffy nose, headache, itching in ears, eyes, and throat, etc.
Since the first antihistamine was made in 1937, there are more than 50 kinds of H1-receptor antagonists used for clinical applications. The first generation antihistamine refers to those made before the 80s. The OTC antihistamines of the first generation, typified by diphenhydramine and chlorpheniramine, are characterized by strong nervous activity and poor receptor specificity. For that reason, they have sedative and anticholinergic effects, which clinically manifest as quietness, drowsiness, absence of mind, and the like. Therefore, they are also known as sedating antihistamine.
Those invented after the 80s are the second generation of antihistamine, among which the typical OTC ones are loratadine (Alavert, Claritin), desloratadine (Clarinex), cetirizine (Zyrtec), fexofenadine (Allegra), and so on. Since they show high affinity and selectivity for the H1 receptor and no sedation, they tend to cause less adverse reactions to the central nervous system. Thus, the second generation of antihistamine is also known as non-sedating antihistamines (NSA). Thanks to a better performance, they are widely used for allergic rhinitis. By the way, loratadine, one of the best second-generation antihistamines, ranks first among allergy prescriptions around the world.
An OTC nasal decongestant can be used to ease nasal congestion, a common symptom of the upper respiratory tract occurred in allergies, sinusitis, flu, and cold. By constricting blood vessels the decongestants relieve sinus congestion. The main active ingredients of oral decongestants are pseudoephedrine and phenylephrine.
When the virus invades the mucosa, especially the nasal mucosa, it can cause swelling by dilating the blood vessels. And decongestants reduce nasal swelling by combining the adrenergic receptors of the mucus of the inside wall of the nasal cavity. The common ones include Ephedrine, Oxymetazloine, or OTC fexofenadine in severe cases.
However, decongestants can cause side effects like stress, anxiety, palpitations and insomnia. Since these drugs circulate throughout the body, they prompt blood vessels to constrict. For that reason, they may increase blood pressure. So, decongestants are recommended to be used under medical supervision in patients with high blood pressure, heart disease, diabetes, hyperthyroid, and the like.
When it comes to over-the-counter nasal sprays, there are a few popular types of them for patients with seasonal allergic rhinitis to choose from. Nasalcrom (Cromolyn Sodium) is also one of best options available over the counter. Unlike other nasal allergy sprays, it is aiming to prevent the allergens from contacting the mast cell. As a result, you will feel much better because the cells release fewer histamines.
Corticosteroids are recommended to be used only during an attack or in severe cases. As for OTC nasal sprays containing corticosteroid, the recommended ones with fewer side effects are Flonase Allergy Relief and Nasacort Allergy 24HR. In addition, Dymista is another popular choice but it contains both antihistamine and steroid.
Since a corticosteroid nasal spray has potent topical anti-inflammatory and anti-allergic effects, it usually provides 24 hours of non-drowsy allergy relief to hay fever symptoms, including nasal congestion, runny nose, sneezing, itchy nose, and so on.