From the Guidelines
Management for allergy symptoms should prioritize the prompt use of epinephrine to treat anaphylaxis, as it is safe but often underutilized, according to the most recent and highest quality study 1. The first step in managing allergy symptoms is to identify and avoid specific allergen triggers whenever possible. For medication management, the following options can be considered:
- Over-the-counter antihistamines like cetirizine (Zyrtec) 10mg, loratadine (Claritin) 10mg, or fexofenadine (Allegra) 180mg taken once daily to block histamine, the chemical that causes allergy symptoms 1.
- Intranasal corticosteroids such as fluticasone (Flonase) or triamcinolone (Nasacort), using 1-2 sprays in each nostril daily, to reduce inflammation and congestion 1.
- Ketotifen (Zaditor) or olopatadine (Pataday) eye drops for eye symptoms, as they can provide relief 1.
- Decongestants like pseudoephedrine can help with congestion but should be used sparingly due to potential side effects. For severe allergies, a doctor might prescribe stronger medications or recommend immunotherapy (allergy shots) to gradually desensitize the immune system to specific allergens 1. It is essential to stay hydrated and use saline nasal rinses to flush allergens from nasal passages. If symptoms persist or significantly impact quality of life, consulting with an allergist for personalized treatment is recommended. In cases of anaphylaxis, epinephrine should be administered intramuscularly in the mid-outer aspect of the thigh, with a dose of 0.01 mg/kg of a 1:1000 solution, up to a maximum of 0.5 mg in adults and 0.3 mg in children, as stated in the most recent study 1.
From the FDA Drug Label
Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis. For the management of allergy symptoms, specifically anaphylaxis, epinephrine (IM) is used as an emergency treatment. The signs and symptoms of anaphylaxis that epinephrine can help manage include:
- Flushing
- Apprehension
- Syncope
- Tachycardia
- Hypotension
- Convulsions
- Vomiting
- Diarrhea
- Abdominal cramps
- Involuntary voiding
- Airway swelling
- Laryngospasm
- Bronchospasm
- Pruritus
- Urticaria
- Angioedema
- Swelling of the eyelids, lips, and tongue 2
From the Research
Management of Allergy Symptoms
- The management of allergic rhinitis includes allergen avoidance, pharmacotherapy, and immunotherapy 3, 4, 5.
- Pharmacotherapy options include oral and intranasal antihistamines, intranasal corticosteroids, oral and intranasal decongestants, oral and intranasal anticholinergics, and leukotriene receptor antagonists 5.
- Second-generation oral antihistamines and intranasal corticosteroids are the mainstays of treatment, with practice guidelines recommending intranasal corticosteroids as first-line treatment for moderate to severe allergic rhinitis 3, 4, 5.
Treatment Options
- For mild intermittent or mild persistent allergic rhinitis, first-line treatment may include a second-generation H1 antihistamine (eg, cetirizine, fexofenadine, desloratadine, loratadine) or an intranasal antihistamine (eg, azelastine, olopatadine) 4.
- For persistent moderate to severe allergic rhinitis, treatment should be initiated with an intranasal corticosteroid (eg, fluticasone, triamcinolone, budesonide, mometasone) either alone or in combination with an intranasal antihistamine 4.
- Allergen immunotherapy (AIT) is the only disease-modifying option and can be provided through subcutaneous (SCIT) or sublingual (SLIT) routes 6.
Antihistamine Options
- Newer generation antihistamines (eg, cetirizine, fexofenadine, desloratadine, loratadine) have improved safety and efficacy compared to first-generation antihistamines 6, 7.
- Cetirizine has the fastest onset of action among the newer antihistamines, while fexofenadine does not impair psychomotor or cognitive skills and shows no dose-related increase in sedation 7.
- The incidence of sedation with cetirizine is less than that of first-generation antihistamines but is greater than placebo 7.