What are non-sedating medications for seasonal allergies?

From the Guidelines

For patients with seasonal allergies, the most effective non-drowsy medication option is an intranasal corticosteroid, such as Fluticasone (Flonase), as recommended by the 2017 Joint Task Force on Practice Parameters 1. This recommendation is based on the strong evidence that intranasal corticosteroids are the most effective medication class for controlling symptoms of seasonal allergic rhinitis. Some key points to consider when selecting a non-drowsy seasonal allergy medication include:

• Second-generation antihistamines like Cetirizine (Zyrtec), Loratadine (Claritin), Fexofenadine (Allegra), Levocetirizine (Xyzal), and Desloratadine (Clarinex) are available options, but they may not be as effective as intranasal corticosteroids 1.
• Nasal corticosteroid sprays like Fluticasone (Flonase), Triamcinolone (Nasacort), and Budesonide (Rhinocort) are excellent non-drowsy options, often providing better symptom relief than antihistamines alone 1.
• For eye symptoms, ketotifen (Zaditor) or olopatadine (Pataday) eye drops can provide targeted relief without drowsiness 1.
• Starting medications 1-2 weeks before allergy season begins can improve effectiveness, and combining different types of medications (like an antihistamine with a nasal spray) may provide better symptom control for severe allergies 1. It's essential to consult with a healthcare professional to determine the best course of treatment for individual patients, as they can help determine the most effective medication and dosage based on the patient's specific needs and medical history.

From the FDA Drug Label

ADVERSE REACTIONS Seasonal Allergic Rhinitis AdultsIn placebo-controlled seasonal allergic rhinitis clinical trials in subjects 12 years of age and older, which included 2461 subjects receiving fexofenadine hydrochloride capsules at doses of 20 mg to 240 mg twice daily, adverse events were similar in fexofenadine hydrochloride- and placebo-treated subjects Table 1 Adverse experiences in subjects aged 12 years and older reported in placebo-controlled seasonal allergic rhinitis clinical trials in the United States Twice- daily dosing with fexofenadine capsulesat rates of greater than 1% Adverse experienceFexofenadine 60 mgTwice Daily(n=679)PlaceboTwice Daily(n=671) Drowsiness1.3%0. 9%

Seasonal allergy medication that doesn’t cause drowsiness:

• Fexofenadine has a relatively low incidence of drowsiness, with 1.3% of subjects experiencing this adverse event at a dose of 60 mg twice daily, compared to 0.9% in the placebo group 2.
• While fexofenadine may cause some drowsiness, the incidence is relatively low, making it a potential option for patients seeking a seasonal allergy medication with minimal sedating effects.
• However, it is essential to note that individual responses to medication can vary, and some patients may still experience drowsiness while taking fexofenadine.

From the Research

Seasonal Allergy Medication Options

• Fexofenadine is a selective histamine H1 receptor antagonist that does not cross the blood brain barrier, making it a suitable option for patients who want to avoid drowsiness 3.
• Fexofenadine has been shown to be as effective as loratadine and cetirizine in reducing symptoms of seasonal allergic rhinitis, with a rapid onset of action and a long duration of effect 3, 4.
• Compared to cetirizine, fexofenadine has been found to have a similar efficacy in relieving symptoms of seasonal allergic rhinitis, but with less sedation and impairment 4.
• Other second-generation H1 antihistamines, such as desloratadine and levocetirizine, have also been found to be effective in treating seasonal allergic rhinitis, with varying durations of action and potencies 5, 6.

Comparison of Medications

• A study comparing the efficacy of cetirizine and fexofenadine found that cetirizine had a longer duration of effect, with a 33% greater reduction in symptoms over a 21- to 24-hour interval 7.
• Another study found that fexofenadine had the earliest onset of action, while levocetirizine showed maximum inhibition of wheal response after three and six hours 6.
• Desloratadine has been found to have a greater inhibition of wheal size at the end of 24 hours, but this was not statistically significant 6.

Treatment Recommendations

• For mild intermittent or mild persistent allergic rhinitis, second-generation H1 antihistamines such as fexofenadine, cetirizine, or desloratadine may be recommended as first-line treatment 5.
• For persistent moderate to severe allergic rhinitis, intranasal corticosteroids may be recommended as first-line treatment, either alone or in combination with an intranasal antihistamine 5.