From the Guidelines
For allergy symptoms, I recommend starting with an intranasal corticosteroid like fluticasone (Flonase) or triamcinolone (Nasacort), using 1-2 sprays per nostril daily, as they are the most effective medications for treating allergic rhinitis, according to the 2017 joint task force on practice parameters 1. These medications reduce inflammation in nasal passages and are effective in treating moderate to severe seasonal allergic rhinitis. Some key points to consider when using intranasal corticosteroids include:
- Allow 1-2 weeks for nasal sprays to reach full effectiveness
- Use the lowest effective dose, especially in children
- Avoid using intranasal corticosteroids with other corticosteroids, such as oral or inhaled corticosteroids, unless recommended by a healthcare provider
- Monitor for local side effects, such as nasal irritation, bleeding, and nasal septal perforation For additional symptom relief, a second-generation antihistamine like cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra) can be used at the standard adult dose of 10mg, 10mg, or 180mg respectively, taken once daily, as they block histamine receptors to reduce sneezing, itching, runny nose, and watery eyes without causing significant drowsiness 1. If eye symptoms persist, add ketotifen (Zaditor) or similar antihistamine eye drops. Avoid first-generation antihistamines like diphenhydramine (Benadryl) for daily use due to sedation and cognitive effects. If symptoms don't improve after 2-3 weeks of consistent treatment, consult a healthcare provider as you may need prescription options or allergy testing.
From the FDA Drug Label
PRINCIPAL DISPLAY PANEL-100'S COUNT Rising® 16571-402-10 Original Prescription Strength Cetirizine Hydrochloride Tablets USP 10 mg 6 yrs & older Antihistamine ALLERGY Indoor & Outdoor Allergies 24 Hour Relief of: •Sneezing •Runny Nose •Itchy, Watery Eyes •Itchy Throat or Nose
1 INDICATIONS & USAGE Adrenalin® is available as a single-use 1 mL vial and a multiple-use 30 mL vial for intramuscular and subcutaneous use. 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.
Medications for allergy treatment include:
- Antihistamines like cetirizine for relief of symptoms such as sneezing, runny nose, itchy, watery eyes, and itchy throat or nose 2
- Epinephrine for emergency treatment of allergic reactions, including anaphylaxis 3
From the Research
Medications for Allergy Treatment
Medications for allergy treatment include:
- Antihistamines, which are considered first-line therapy for the relief of symptoms from allergic rhinitis and chronic urticaria 4
- Second-generation antihistamines, such as loratadine, cetirizine, and fexofenadine, which are preferred due to their low sedation and impairment effects 5, 6, 7
- Intranasal corticosteroids, which are recommended as first-line treatment for moderate to severe allergic rhinitis 8
- Leukotriene receptor antagonists, which are also used to treat allergic rhinitis 8
Types of Antihistamines
There are two generations of antihistamines:
- First-generation antihistamines, which can produce sedation and impairment, and are not preferred for treatment of allergic rhinitis 7
- Second-generation antihistamines, which are non-sedating and non-impairing, and are preferred for treatment of allergic rhinitis 4, 5, 6, 7
Specific Antihistamines
Some specific antihistamines that are commonly used to treat allergies include:
- Loratadine, which is an effective second-generation H1-receptor antagonist with a low dose and convenient once-daily dosing 4
- Cetirizine, which is a potent antihistamine with a rapid onset of action and a low potential for interaction with other drugs 6
- Fexofenadine, which may offer the best overall balance of effectiveness and safety, and is an appropriate selection for initial or switch therapy for most patients with mild or moderate allergic symptoms 5