From the Guidelines
The first line treatment for allergies is typically intranasal corticosteroids, such as fluticasone (Flonase) or triamcinolone (Nasacort), used as 1-2 sprays per nostril daily, as recommended by the 2017 Joint Task Force on Practice Parameters 1. This approach is based on the strong recommendation for initial treatment of seasonal allergic rhinitis in persons aged 12 years or older, which suggests prescribing monotherapy with an intranasal corticosteroid rather than an intranasal corticosteroid in combination with an oral antihistamine. Some key points to consider:
- Intranasal corticosteroids are the most effective medication class for controlling symptoms of seasonal allergic rhinitis.
- Antihistamines, such as cetirizine (Zyrtec) 10mg daily, loratadine (Claritin) 10mg daily, or fexofenadine (Allegra) 180mg daily, can be used alongside intranasal corticosteroids for additional relief of symptoms such as sneezing, itching, runny nose, and watery eyes.
- For eye symptoms, antihistamine eye drops such as ketotifen (Zaditor) or olopatadine (Pataday) may provide additional relief.
- Saline nasal rinses can help clear allergens from nasal passages. It's best to start these treatments before allergy season begins and continue throughout exposure to allergens. If symptoms persist despite these measures, consulting a healthcare provider is recommended for possible prescription options or referral to an allergist for further evaluation and consideration of immunotherapy.
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. The first line treatment for anaphylaxis, a severe and life-threatening allergic reaction, is epinephrine (IM), as stated in the drug label 2.
- Key points:
- Epinephrine is used for emergency treatment of allergic reactions, including anaphylaxis.
- Anaphylaxis can be caused by various allergens, such as insect stings, foods, and drugs. However, for other types of allergies, such as seasonal allergic rhinitis, the first line treatment may be different, and fluticasone (IN) is an option, as mentioned in the drug label 3.
- Important notes:
- Fluticasone is used for treatment of seasonal or perennial allergic rhinitis.
- It is essential to consult a healthcare professional to determine the best course of treatment for a specific allergy.
From the Research
First Line Treatment for Allergies
The first line treatment for allergies depends on the severity and frequency of symptoms.
- For mild intermittent or mild persistent allergic rhinitis, second-generation H1 antihistamines (eg, cetirizine, fexofenadine, desloratadine, loratadine) or intranasal antihistamines (eg, azelastine, olopatadine) are recommended 4.
- For moderate to severe allergic rhinitis, intranasal corticosteroids (eg, fluticasone, triamcinolone, budesonide, mometasone) are the first-line treatment, either alone or in combination with an intranasal antihistamine 5, 4, 6.
- Newer generation antihistamines are preferred over first-generation antihistamines due to their improved safety and efficacy 7, 6, 8.
Treatment Options
Treatment options for allergic rhinitis include:
- Oral and intranasal antihistamines
- Intranasal corticosteroids
- Combination therapy of intranasal antihistamines and corticosteroids
- Allergen immunotherapy (AIT) through subcutaneous (SCIT) or sublingual (SLIT) routes 5, 6.
- Patient-specific treatment based on type, duration, and severity of symptoms, comorbidities, prior treatment, and patient preference 5, 6.