What medications can be taken for allergies?

Medications for Allergies Management

For mild to moderate allergic symptoms, second-generation H1 antihistamines are the first-line treatment due to their efficacy and minimal sedation, while severe allergic reactions require immediate epinephrine administration. 1

First-Line Medications for Different Allergy Severities

Mild Allergic Symptoms

• Non-sedating second-generation H1 antihistamines (cetirizine, fexofenadine, loratadine, desloratadine) are recommended for mild intermittent or persistent allergic symptoms 1, 2
• These medications provide symptom relief with minimal sedation compared to first-generation antihistamines 3
• Loratadine offers once-daily dosing with fast onset of action (within 1 hour) and duration of at least 24 hours 4, 5

Moderate Allergic Symptoms

• Intranasal corticosteroids (fluticasone, triamcinolone, budesonide, mometasone) are the preferred controller medications for persistent moderate symptoms, particularly for allergic rhinitis 1, 2
• For moderate symptoms that don't respond to monotherapy, combination therapy with intranasal corticosteroids plus oral antihistamines may be used 1

Severe Allergic Reactions/Anaphylaxis

• Epinephrine is the only first-line treatment for anaphylaxis with no substitute 1, 6
• Administer intramuscular epinephrine immediately upon recognition of anaphylaxis 1, 6
  • Adults and children ≥30 kg: 0.3-0.5 mg (0.3-0.5 mL) IM into anterolateral thigh 6
  • Children <30 kg: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0.3 mL) IM into anterolateral thigh 6
• Epinephrine doses may need to be repeated every 5-15 minutes if symptoms persist 7

Adjunctive Treatments

For Mild-Moderate Allergies

• Intranasal antihistamines (azelastine, olopatadine) can be used alone or in combination with intranasal corticosteroids for allergic rhinitis 2
• Leukotriene receptor antagonists may be added for patients with concurrent asthma 1

For Severe Allergic Reactions/Anaphylaxis

• H1 antihistamines (diphenhydramine 1-2 mg/kg, max 50 mg) for relieving itching and urticaria 7
• H2 antihistamines (ranitidine 1-2 mg/kg, max 75-150 mg) can be added 7
• Corticosteroids (prednisone 1 mg/kg, max 60-80 mg) may help prevent biphasic or protracted reactions 7
• Bronchodilators (albuterol) for respiratory symptoms 7

Important Considerations

Medication Selection

• First-generation antihistamines (diphenhydramine, chlorpheniramine) should be avoided for routine use due to sedation, impairment, and worsened sleep architecture 3
• Second-generation antihistamines are preferred due to minimal central nervous system effects 3, 4
• For patients at higher risk of adverse effects (elderly, those operating machinery, students), non-sedating antihistamines are strongly preferred 3

Anaphylaxis Management

• Always prescribe epinephrine auto-injectors (2 doses) for patients at risk of anaphylaxis 7, 1
• Antihistamines should not be used in place of epinephrine for anaphylaxis 7, 1
• After epinephrine administration for anaphylaxis, patients should be observed for 4-6 hours or longer based on reaction severity 7

Common Pitfalls to Avoid

• Using first-generation antihistamines as first-line therapy due to their significant sedation and impairment 3
• Relying solely on antihistamines for anaphylaxis management instead of epinephrine 7, 1
• Using standard panels of allergy tests without clinical correlation, which may lead to false positives and unnecessary treatment 7
• Failing to provide patients with an anaphylaxis emergency action plan and proper training on epinephrine auto-injector use 7