Seasonal Allergies? Itchy Rash? Know your options

Whether you suffer from seasonal allergies or poison ivy, knowing your options is key to getting relief. There are multiple medications over-the-counter and by prescription for these ailments. This is an overview of the top medications used to help with allergies and itching.

Key takeaways:
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    Allergy medications can be grouped into five categories decongestants, antihistamines, corticosteroids, mast cell stabilizers, and epinephrine.
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    Newer antihistamines cause less drowsiness and can be used for daily control of allergic symptoms.
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    Oral corticosteroids cause significant symptoms and are only appropriate for a short course of treatment.
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    Nasal corticosteroids can be safely used for extended periods of time under the guidance of your physician.
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    If you experience symptoms of a severe allergic reaction (shortness of breath, swelling of the throat/tongue) call 911 and use epinephrine if available.

What causes allergies and itching?

Allergies are the result of the body reacting to a foreign substance such as pollen, poison ivy oils, or certain foods. When exposed to these substances the body develops antibodies. These antibodies recognize the foreign substance when exposed and trigger the release of chemicals such as histamine from white blood cells called eosinophils and mast cells.

What symptoms are common with allergies?

The typical symptoms of allergies include a runny nose, itchy eyes/nose, rashes, and hives. However, in the case of severe allergic reactions, one can develop abdominal pain, nausea, vomiting, wheezing, shortness of breath, and swelling of the tongue and throat making it difficult to breathe.

If you experience any of the symptoms of a severe allergic reaction, seek emergency medical treatment.

What medications are available over-the-counter?

There are three main classes of medications available over-the-counter: decongestants, antihistamines, and corticosteroid creams/ointments:

Decongestants — these can help reduce swelling of tissues in the nose. This can improve feelings of congestion and runny nose. They are available in nasal sprays and oral forms.

Side effects of decongestants include difficulty sleeping, high blood pressure, headache, and jitteriness. Do not use decongestant nasal sprays for more than three days as they can cause rebound (worsening) congestion. Common OTC decongestants include: pseudoephedrine and phenylephrine.

Antihistamines — block histamine receptors and reduce the inflammatory effects of histamine. They can typically improve all symptoms of allergies including watery eyes, runny nose, rashes/hives, and itching. They are available in a nasal spray, oral pill form, as well as in topical creams.

Side effects of antihistamines include drowsiness, dry mouth, blurred vision, difficulty urinating, and confusion. The older antihistamines are associated with more drowsiness than the newer options.

Newer Antihistamines (less drowsiness)Older Antihistamines (more drowsiness)
Loratadine (Claritin)Diphenhydramine (Benadryl)
Fexofenadine (Allegra)Chlorpheniramine (Chlor-Trimeton)
Cetirizine (Zyrtec) Most drowsiness of all newer options Bropheniramine (Dimetane)
Azelastine (Astepro) Available only in a nasal spray

Corticosteroid creams/ointments — these are helpful for rashes and areas of skin irritation. The only available OTC option is hydrocortisone, which is only available in strengths up to 1%.

Side effects are typically experienced at the site of application. These may include burning, bruising, skin thinning, and stretch marks. However, if used properly the risk of side effects are minimal.

What medications are available by prescription?

There are three categories of medications available only by prescription. These include corticosteroids, mast cell stabilizers, and epinephrine.

Corticosteroids — these medications reduce inflammation and relieve all symptoms of allergies. They are available in oral forms, creams/ointments, and nasal sprays.

Side effects of oral corticosteroids include high blood pressure, weight gain, fluid retention, and elevated blood sugar levels. Nasal sprays can cause burning, unpleasant tastes, and local irritation. Nasal sprays are better tolerated, have few side effects, and can be used safely for the long-term treatment of allergies.

Due to the severe side effects of oral corticosteroids, they are often used only for severe allergic reactions and used for the shortest duration needed.

Mast cell stabilizers — these medications help to prevent the release of histamine. They are available as eye drops and nasal sprays thus helping with allergic symptoms affecting the eye and nose.

Side effects include local irritation, dry eyes, blurred vision, and nose bleeds. Some of the available options include Alamast, Alocril, Alomide, and Crolom eye drops. Cromolyn sodium (Nasalcrom) is available as a nasal spray.

Epinephrine — this medication is used in only the most severe of allergic reactions known as anaphylaxis. It can quickly reverse swelling and low blood pressure.

If epinephrine is used, call 911 as anaphylaxis is a medical emergency and the epinephrine may wear off after 20–30 minutes.

Allergy symptoms can significantly affect your day-to-day life. Understanding the available medications and their side effects can help you choose the best treatment for your symptoms. In some cases, long-term use may be required and should be discussed with your doctor.

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