Each of these medications has a different mechanism of action. Some may be used to treat acute symptoms, while others provide longer-lasting relief. The choice depends largely on the types of symptoms you have, their frequency, and their severity.
Steroid Nasal Sprays
Nasal sprays are most effective for treating symptoms of allergic rhinitis (hay fever). Inhaled corticosteroids reduce inflammation to open the nasal passages so that you can breathe easier.
They are also effective for treating non-allergic rhinitis and may be beneficial for treating eye allergies.
Some of the more commonly prescribed steroid nasal sprays include:
Beconase AQ (beclomethasone) Flonase (fluticasone) Nasacort AQ (triamcinolone) Nasarel (flunisolide) Nasonex (mometasone) Rhinocort Aqua (budesonide)
While effective, nasal sprays do not treat the underlying allergy. They only alleviate the nasal symptoms. People who have allergic rhinitis tend to get the best response if they use the spray on a daily basis. It takes about two weeks before these medications achieve their full effect.
Side Effects
Side effects may include headaches, sore throat, cough, nasal dryness, nausea, and muscle or joint pain.
Antihistamines
Antihistamines are an effective way to treat all forms of mild to moderate allergy.
This class of drug suppresses histamine, the chemical produced by the immune system that triggers allergy symptoms. Older-generation drugs such as Benadryl (diphenhydramine) are used less commonly today because of their sedating effect.
Newer-generation drugs largely avoid this and include over-the-counter (OTC) oral medication choices like:
Allegra (fexofenadine)Claritin and Alavert (loratadine)Zyrtec (cetirizine)
The Food and Drug Administration has also approved the first OTC antihistamine nasal spray, Astepro (azelastine), which became available in 2022.
Side Effects
Side effects may include dry mouth, headache, drowsiness, dizziness, restlessness (mostly in children), difficulty urinating, blurred vision, nausea, vomiting, and confusion. Side effects tend to be mild (particularly with the newer generation antihistamines) and resolve within hours to days.
Antileukotrienes
Antileukotrienes are allergy medications that block inflammatory compounds known as leukotrienes.
The antileukotriene drugs currently approved in the U.S. are:
Accolate (zafirlukast)Singulair (montelukast)Zyflo CR (zileuton)
Antileukotrienes can be used to treat both asthma and allergy, but in some cases, they aren’t enough on their own. As such, they are usually prescribed in combination with other drugs such as antihistamines or nasal or inhaled steroids.
Side Effects
While antileukotrienes may be effective in alleviating congestion, they are less helpful in easing nasal symptoms. Side effects may include headaches, stomach pain, nausea, diarrhea, toothache, fatigue, sore throat, hoarseness, cough, and mild rash.
Singulair also comes with a black box warning due to the fact that it may have dangerous psychiatric side effects.
