RHINITIS AND SINUSITIS: FACTS ABOUT MEDICATIONS FOR ALLERGIC RHINITIS (HAY FEVER)

Antihistamines

· Oral antihistamines are the first-line treatment for most patients with hay fever. They are effective in reducing symptoms of itching, sneezing and runny nose but have little effect on nasal congestion.

· Many of the older so-called first-generation antihistamines (e.g., brompheniramine, chlorpheniramine, diphenhydramine, hydroxyzine and triprolidine) can cause potentially dangerous side effects, including sleepiness, delayed reaction times, problems focusing on tasks, and decreased memory.

· Some first-generation antihistamines have been implicated in fatal auto accidents and occupational injuries, and in learning impairment and poor school performance in children. Even when these first-generation antihistamines are taken only at bedtime, they can still cause considerable impairment on the next day. In the majority of states, patients taking first-generation antihistamines are legally considered "under the influence" of drugs.

· Newer antihistamines (such as Allegra® and Claritin® are considered nonsedating by the Food and Drug Administration. Other products, such as Zyrtec® and the intranasal antihistamine Astelin®, are less sedating than the first-generation antihistamines. The newer agents have significantly fewer side effects and are thus usually considered the treatment of choice.

Other Allergy Medications

· Nasally inhaled corticosteroids are the most effective medication class for controlling symptoms of allergic rhinitis, particularly in severe cases. Side effects may include nasal irritation or bleeding.

· Oral decongestants (e.g., pseudoephedrine and phenylpropanolamine) can effectively relieve nasal congestion, but they can cause insomnia, loss of appetite or excessive nervousness. They are often found in combination with antihistamines.

· Oral corticosteroids may be appropriate for the treatment of very severe nasal symptoms. Since they are associated with long-term side effects, they should be administered as a short (three to seven days) course of therapy.

· Cromolyn sodium nose spray is effective for some patients. Side effects, if any, are minimal. Cromolyn works best when used several times daily, every day, and when started before symptoms become severe.

This fact sheet is compiled from the Diagnosis and Management of Rhinitis: Parameter Documents of the Joint Task Force on PracticeParameters in Allergy, Asthma and Immunology.

The Joint Task Force represents the American College of Allergy, Asthma and Immunology (ACAAI), the American Academy of Allergy, Asthma and Immunology, and the Joint Council on Allergy, Asthma and Immunology.