What is the best medication for allergies?

Best Medication for Allergies

For allergic rhinitis symptoms, second-generation antihistamines like cetirizine are the best first-line medication due to their effectiveness, once-daily dosing, and minimal sedation compared to first-generation alternatives. 1

Second-Generation Antihistamines

• Cetirizine (10mg once daily) is recommended as a first-line treatment for allergic rhinitis due to its relatively rapid onset of action compared to other second-generation antihistamines 1
• Second-generation antihistamines have been shown to have a very good safety profile in both adults and children 1
• Cetirizine is FDA-approved for relief of sneezing, runny nose, itchy/watery eyes, and itchy throat or nose for indoor and outdoor allergies with 24-hour relief 2
• In comparative studies, cetirizine demonstrated greater effectiveness than loratadine in relieving symptoms of rhinorrhea, sneezing, nasal obstruction, and nasal pruritus 3

Intranasal Corticosteroids

• Intranasal corticosteroids are the most effective medications for treating allergic rhinitis, especially when antihistamines alone are insufficient 1
• They are more effective than the combined use of an antihistamine and a leukotriene antagonist 1
• Fluticasone propionate nasal spray works directly in the nose to block allergic reactions by acting on multiple inflammatory substances, including histamine, prostaglandins, cytokines, and leukotrienes 4
• The clinical response does not appear to vary significantly between different intranasal corticosteroids currently available 1
• Onset of therapeutic effect occurs between 3-12 hours, but it may take several days to reach maximum effectiveness 1, 4

Comparison of Treatment Options

• Cetirizine demonstrated 36.7% mean reduction in total symptom complex scores versus 15.4% with loratadine and 12.0% with placebo in controlled studies 5
• Cetirizine showed faster onset of action (within 1 hour) compared to loratadine (3 hours) 5
• When comparing fexofenadine and cetirizine, both showed similar efficacy, but cetirizine had a higher incidence of drowsiness or fatigue (9%) compared to fexofenadine (4%) 6

Treatment Algorithm

1. First-line: Second-generation antihistamine (cetirizine 10mg once daily) for mild to moderate symptoms 1, 2
2. Alternative first-line options: Fexofenadine or loratadine if cetirizine causes drowsiness 6
3. For inadequate response: Add intranasal corticosteroid (e.g., fluticasone propionate) 1, 4
4. For severe symptoms: Start with intranasal corticosteroid as they are the most effective medications for allergic rhinitis 1

Special Considerations

• For children ages 4-11, appropriate dosing adjustments should be made (typically half the adult dose) 4
• First-generation antihistamines like diphenhydramine should be avoided for routine use due to sedation and cognitive impairment 1
• Topical decongestants should not be used for continuous treatment of allergic rhinitis due to risk of rhinitis medicamentosa (rebound congestion) 1
• Patients with severe allergic reactions (anaphylaxis) require different management with epinephrine as first-line treatment 1

Common Pitfalls to Avoid

• Avoid first-generation antihistamines for daytime allergy control due to sedation 1
• Don't use intranasal corticosteroids for immediate symptom relief; they require several days for maximum effect 1, 4
• Don't stop treatment when symptoms improve if allergen exposure continues 4
• Avoid continuous use of topical decongestants beyond 3 days due to risk of rhinitis medicamentosa 1