Medications

Medicines are a key part of treatment for allergic rhinitis.

Over-the-counter medicine

Treatment for allergic rhinitis usually starts with over-the-counter medicines, such as:

• Antihistamines. These help your sneezing, runny nose, itching, and watery eyes.
• Decongestants. These help relieve a stuffy nose.
• Eyedrops. These help red, itchy, and watery eyes.

Prescription medicines

If over-the-counter medicines don't work or if they cause bothersome side effects such as drowsiness, your doctor may prescribe stronger antihistamines, decongestants, or eyedrops. Or your doctor may prescribe nasal corticosteroid sprays, which you may use with antihistamines. These sprays may reduce all symptoms of allergic rhinitis. They work well for most people. They start working quickly, but it may be several weeks before you get the full effect.

Your doctor may suggest other medicines if these don't work or in special cases, such as if you are pregnant. Other medicines include:

• Leukotriene modifiers. These can relieve a stuffy nose, itching and sneezing, and a runny nose.
• Ipratropium bromide. It can relieve a runny nose.

Some doctors may prescribe omalizumab (Xolair) for allergic rhinitis. This is called an unlabeled use, because the medicine has only been approved by the U.S. Food and Drug Administration (FDA) to treat allergic asthma. Studies have shown that it works well to reduce nasal symptoms of allergic rhinitis, such as sneezing and an itchy, runny, or stuffy nose.¹. But it's not known if omalizumab works as well as nasal steroids. It is very expensive, and you have to get the injection from your doctor.

Use medicine safely

Some people begin using over-the-counter medicines for allergic rhinitis before they see their doctors. These medicines can work well. But people who have other medical problems, older adults, children, women who are pregnant or breast-feeding, and people who have more than occasional mild symptoms should see a doctor before starting self-treatment. For example:

• If you are pregnant, talk with your doctor about which allergy medicines are safe when pregnant. Some medicines might be better for you and your baby than others. If possible, don't use medicine for at least the first 3 months of your pregnancy.
• When you treat children with medicine, know that it may be more difficult than treating adults because of the possible side effects. Some medicines also may not be approved for treating children. Be especially careful with antihistamines and decongestants. They may not be safe for young children, so check the label first. If you do give these medicines to a child, always follow the directions about how much to give based on the child's age and weight.

What to think about

You may want to think about using different medicines at different times of the day. For example, during the day it may be important to avoid the drowsiness that some antihistamines cause. But if you are at home in the evening and this side effect is not a concern, you can think about using a low-cost, over-the-counter antihistamine. You may also try a combination of medicines to relieve all of your symptoms. Talk with your doctor about which symptoms are most important for you to treat and which medicines may work best for you.

If you don't take your medicine, your symptoms may come back or get worse. When you give medicine to children, explain to them why they are taking medicine and how it can help them. Also tell them what side effects may occur.

You may use medicine daily for quick relief of symptoms that occur suddenly or are getting worse. Or you may use it in advance if you know you may breathe an allergen. For example, if you have severe pollen allergies, your doctor may suggest that you start using a corticosteroid spray 1 to 2 weeks before the pollen season starts.