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Allergic Rhinitis (Hay Fever): Treatment

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This information was reviewed and approved by Rafeul Alam, Rafeul Alam, MD, PhD (2/29/2020).

The goal of treatment for hay fever (seasonal allergic rhinitis) is to reduce symptoms. This often includes identifying, controlling and/or treating things that make your symptoms worse.

There are three main strategies:

  1. Avoidance

  2. Medication

  3. Allergy shots (immunotherapy)


Avoid Allergens to Reduce Rhinitis

The best way to prevent allergic rhinitis is to avoid the things to which you are allergic. Although it can be difficult to avoid pollen, there are several steps you can take to reduce your exposure. First of all, keep your windows closed and use air conditioning — even on days that are not extremely warm. Next, avoid outdoor activities during peak pollen times of the day. Grass pollens are most prevalent during afternoon and early evening, while ragweed pollens are most prevalent during early midday. Pollen counts are commonly high during dry, windy afternoons. Finally, it can be helpful to take a shower and change your clothes after spending time outside. A shower washes off the pollen that sticks to your skin or hair. Keep your outside clothes in the laundry room and away from your bedroom.

Learn about how to reduce exposure, based on your type of allergy:


Medications for Hay Fever

You should talk to your doctor to decide what allergy medications are best for you. Those medications could include:

Anti-inflammatory medicines: These control inflammation in the body. This inflammation causes redness and swelling (congestion).

Nasal steroid sprays: In many cases of hay fever, prescription nasal steroid sprays are often used to decrease nasal allergy symptoms. These are often more effective than antihistamine or antileukotriene pills. These work well to reduce nasal symptoms of sneezing, itching and runny and stuffy nose. Nasal steroids may also improve eye symptoms. A steroid nasal spray may work after several hours or take several days to work, but the best benefit is usually found after regular extended use. Nasal steroids work best if you take them daily. Nasal steroids are often the most effective medications for nasal allergy symptoms.

Montelukast/Zafirlukast: Another type of medicine that can be used for nasal allergy symptoms is a leukotriene blocker.  There are two of them in the market: Montelukast and Zafirlukast.  They may be beneficial in some people. They are anti-allergy medications that block certain allergy mediators and reduce swelling, sneezing and runny nose.

Cromolyn and Nedocromil: These are anti-inflammatory medicines that are not steroids. They may help prevent nasal and eye symptoms. Unfortunately, these are often not as effective as some other allergy medications.

Nasal wash with salt water: This may help clean out your nose, and, when done routinely, this can also lessen postnasal drip. If you do a nasal wash, do this before using other nasal medicine.

Antihistamines: Antihistamines can reduce runny nose, sneezing and itchy, watery eyes. First generation antihistamines, such as Benadryl, are available over the counter but can cause drowsiness. There are now non-sedating (loratadine, fexofenadine, levocetirizine) and low-sedating (cetirizine) antihistamines that are available over the counter. Itchy eyes can be helped by antihistamine eye drops, also available by prescription. These can help decrease allergy symptoms. They may be used daily during allergy season or just when allergy symptoms occur. There are many different antihistamines. If one doesn't work, another can be tried. Some can make you sleepy, and some do not. They may also affect thinking and your reflexes. Because of this, it is best to avoid a sedating antihistamine, especially if you will be driving or using any kind of machine. If possible, it is best to use a non-sedating or less sedating antihistamine.

Decongestants: These help when your nose is stuffy (congestion). They are available as pills, liquids or nasal sprays. Many are available over the counter. Use caution when taking a decongestant nasal spray. Using one longer than four days can have a severe rebound effect. This may cause you to have a lot more nasal congestion.


Allergy Shots (Immunotherapy) for Allergic Rhinitis

Allergy shots may be very helpful for specific allergies that aren't controlled with medicine. If avoidance and medications fail to control your symptoms, immunotherapy can usually help. Also known as allergy shots, immunotherapy consists of a series of injections containing the allergen that triggers your symptoms. Over time, the shots reduce your sensitivity to the allergens. Immunotherapy usually begins with injections of a very weak solution of the allergen given once or twice a week. The strength of the solution is gradually increased. Once the strongest dose is reached, shots continue about once a month until the allergy symptoms are controlled, often for three to five years. There are now newer approaches that allow the dose of allergy shots to be built up much more quickly; however, the total course of therapy is still usually three to five years.

You should see a board-certified allergist for allergy testing or allergy shots.


Hay Fever Treatment FAQs

Question: Does allergy shots (immunotherapy) cure my seasonal allergies?

Answer: No. Right now, there is no cure for allergies. Allergy shots can, however, have a protective effect for several years. Allergy shots can decrease symptoms, decrease need for other allergy medications and improve quality of life in many individuals.


Question: I have hay fever really bad in the spring and the fall; how soon before my bad season starts should I take my allergy meds?

Answer: Most medications are effective within a matter of days. Allergy shots may take much longer to start working. Talk to your allergist about a plan to help keep you from having bad allergy symptoms before they start.


Question: I am allergic to oak trees, and, of course, I live in the woods with only oak trees around. What is the best thing to take besides moving away?

Answer: Outdoor pollens can get indoors, so keeping the doors and windows shut is important. When conditions are dry and windy, the pollen counts are usually highest in the afternoon so working in the yard may be better in the morning and evening. There is no way to completely avoid the pollen, because even if you moved away, the pollens may be blown for many miles.


Question: What is the cause and how do I get relief for watery eyes? I am a 70-year-old male with asthma. My eyes water constantly, so much so that tears run down my face. This occurs when I go outside (e.g., grocery shopping, walking, etc.).

Answer: Watery, itchy eyes are usually related to allergic conjunctivitis, although other eye conditions can cause these same symptoms. Prescription allergy eye drops can relieve the symptoms of itchy, watery eyes. Usually if allergy is the cause, there will be eye itching as well as the watering you describe. Check with your doctor about your symptoms and to discuss evaluation and treatment options.

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