These Are the Best Ways to Treat Your Hay Fever

When pollen counts are high, here's how to find relief

Published: April 2014

Oak trees produce lots of pollen.

If spring’s blossoming trees and growing grasses bring on nonstop sneezing and sniffling, you may wish you could stay inside until summer. About 20 percent of Americans suffer from hay fever, which occurs when your immune system overreacts to pollen. As the body attempts to neutralize the pollen, it releases histamines and other substances that cause watery eyes, a runny nose, and congestion.

And those symptoms may be more than just a nuisance: Research published in the February 2014 issue of the journal Otolaryngologic Clinics of North America shows that people with seasonal allergies have a 10-fold greater risk of developing asthma, and they may be more prone to sinus infections. But getting relief doesn’t have to cost a fortune or even require a prescription. The best treatment for you depends on the severity of your allergies. Use this guide to find the right approach.

If your symptoms are annoying but tolerable

Rx to try: “Lifestyle strategies may enable you to avoid medication—or reduce the amount you might need,” said Mark Dykewicz, M.D., professor of internal medicine and chief of allergy and immunology at Saint Louis University School of Medicine. Steer clear of pollen as much as possible. It can collect on your hair and clothing, so after spending time outdoors, take off your shoes and change when you get home to avoid tracking pollen through your house. Consider showering at night so that you don’t transfer pollen to your bedding. Using a saline nasal rinse at the end of the day will help wash pollen out of your nose.

On really high pollen days, you might consider staying inside as much as possible. You can check pollen counts in your area on the National Allergy Bureau’s website.

If your symptoms interfere with sleep or everyday activities

Rx to try: Over-the-counter drugs can provide relief—but treat only the symptoms you have. You can take care of watery, itchy eyes with antihistamine eyedrops. An over-the-counter oral antihistamine will help eye problems, sneezing, and, to some degree, congestion. Despite manufacturers’ claims that one drug is better than another, according to Consumer Reports Best Buy Drugs the newer antihistamines, brand name and generic, are equally effective and safe. So consider choosing by price. Read “Save Money on Antihistamines."

Antihistamines can be taken whenever your symptoms flare (they become effective in 1 to 3 hours) or daily if the pollen count is high or you’re experiencing symptoms more than several days per week. Keep in mind, people respond differently to anti­histamines, so if you don’t get relief from one type, try another.

Antihistamines sometimes cause dry mouth, headaches, and drowsiness, but a bigger drawback is that they tend to become less effective with long-term use. “As the allergy season goes on, your nasal passages become more and more inflamed from daily exposure to pollen,” Dykewicz said. “Antihis­tamines don’t have a significant anti-inflammatory effect.” Inflammation is responsible for congestion.

That’s where antihistamine prescription nasal sprays, such as azelastine (Astelin and generic) and olopatadine (Patanase), come in. “Studies have shown that if antihistamine pills don’t work for you, nasal sprays may,” Rohit Katial, M.D., professor of medicine, allergy and immunology at National Jewish Health in Denver, said. Because they have a higher concentration of the medication and they deliver it directly to nasal passages, sprays are more effective than pills. They also have an anti-inflammatory effect. Sprays work faster (15 to 30 minutes) and have fewer side effects than pills. Unlike over-the-counter decongestant sprays with oxymetazoline (Afrin and generic), they don’t have a rebound effect, so they can be used on an as-needed basis indefinitely.

If you have daily symptoms and antihistamines aren’t enough

Rx to try: A nasal steroid spray is your best bet because it reduces inflammation. It can also relieve watery, itchy eyes and help stave off a congestion-related headache. Steroid sprays include prescription-only versions, such as fluticasone propionate (Flonase) and mometasone furoate (Nasonex). One spray, triamcinolone acetonide, is also available over-the-counter as Nasacort Allergy 24HR. More effective than antihistamines for severe symptoms, steroid sprays are considered the gold-standard treatment for allergies. “They can help prevent the nasal inflammation caused by daily exposure to pollen,” Dykewicz said. For the best results, start using sprays at the beginning of the allergy season (as soon as the weather warms up). The sprays take up to 12 hours to work, and you may not experience the full effect for a week.

Some doctors are concerned that using a steroid spray on your own can increase the chance of side effects, or mask a more serious condition, such as asthma. The side effects include nasal dryness and irritation, sore throat, headache, and bleeding sores in your nose. Improper use can lead to a hole in your septum in rare cases, and long-term use may increase the risk of cataracts or glaucoma. “When I put people on prescription nasal sprays, I like to see them back in the office so I can check the lining of their nose to make sure everything looks OK,” Dykewicz said. See your doctor if you’re using an over-the-counter steroid spray for more than a month, you have side effects, or your symptoms don’t improve.

If you have daily symptoms and no drug seems to help

Rx to try: Consider immunotherapy, also known as allergy shots. They can eliminate the need for medication in some people, but they require a major time commitment. A standard course of immunotherapy—which is customized by the type of allergies you have—involves getting regular injections at a doctor’s office for three to five years.

This allergy season there are three new, more convenient alternatives available that you can ask your doctor about: pills or drops that can be taken at home. Called sublingual immunotherapy, it involves placing purified allergen extracts under the tongue to build up your resistance.

In April the Food and Drug Administration approved Grastek for grass pollen allergies in people age 5 through 65; Oralair for the treatment of certain  pollen allergies in people 10 through 65; and Ragwitek for ragweed pollen allergies in people 18 to 65. Drawback? Some studies show they might not be as effective as traditional shots, and the FDA requires that all three carry a black-box warning that severe allergic reactions—some of which can be life-threatening—can occur.

Save money on antihistamines

You have two choices in antihistamines. The first-generation drugs, such as diphenhydramine (Benadryl Allergy and generic), ease symptoms as well as second-generation drugs including loratadine (Claritin and generic), but they’re more likely to cause drowsiness. All the second-generation antihistamines are equally effective, so Consumer Reports Best Buy Drugs recommends shopping by price.

Over-the-counter antihistamines

 

Drug name

Average cost per month

Cetirizine  
Generic cetirizine 10-mg tablet $11
Zyrtec 10-mg tablet 19
Zyrtec 10-mg liqui-gel capsule 23
Fexofenadine  
Generic fexofenadine 60-mg tablet 36
Allegra 60-mg tablet 56
Generic fexofenadine 180-mg tablet 18
Allegra* 180-mg tablet 24
Loratadine  
Generic loratadine* 10-mg tablet 8
Claritin 10-mg tablet 22
Claritin* 10-mg liqui-gel capsules 26

*This medication comes in dissolving tablet and liquid forms.

Prescription antihistamines

 

Drug name

Average cost per month

Desloratadine  
Generic desloratadine* 5-mg tablet $97
Clarinex* 5-mg tablet 201
Fexofenadine  
Allegra ODT 30-mg dissolving tablet 128
Levocetirizine  
Generic levocetirizine* 5-mg tablet 59
Xyzal* 5-mg tablet 119

*This medication comes in dissolving tablet and liquid forms.

Editor's Note:

This article also appeared in the May 2014 issue of Consumer Reports on Health.



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