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Allergic Rhinitis Treatments: Over-the-Counter Medicine continued...

Decongestants. Though antihistamines can control many allergy symptoms, they don’t relieve congestion. That’s where oral decongestants come in, such as phenylephrine hydrochloride (Lusonal, Sudafed PE, Sudogest PE) and pseudoephedrine hydrochloride  (Sudafed, Sudogest). They reduce swelling in the nasal passages, opening them up.  Don't use nasal spray decongestants like naphazoline (Privine), oxymetazoline hydrochloride (Afrin, Dristan, Duramist), or phenylephrine hydrochloride (Neo-Synephrine, Rhinall, Sinex) for more than three days at a time. Used for too long, they can cause a rebound effect, making symptoms worse.

Other drugs. A few other over-the-counter drugs may help too. Nasacort is the only steroid nasal spray available over the counter. Many others are available by prescription, as mentioned below. Cromolyn sodium (NasalCrom) is a nasal spray that can ease a runny or itchy nose, sneezing, and a stuffy nose due to allergies. Allergy eye drops with the ingredients naphazoline and tetrahydrozoline can relieve red eyes. Other eye drops with ketotifen, an antihistamine, help relieve itchy eyes.

Prescription Treatments for Allergic Rhinitis

If over-the-counter medicines aren’t giving you relief, you might need prescription drugs. Prescription treatments for allergic rhinitis include:

Steroid nasal sprays. These have become the standard prescription treatment for allergic rhinitis. They work by reducing the swelling in the nasal passages. “The great thing about steroid sprays is that with just one medication, you can treat the congestion, the itchiness, and the sneezing,” says Corinna Bowser, MD, an allergist in Narbeth, Pa. Examples include budesonide (Rhinocort), fluticasone propionate (Flonase), funisolide (Nasarel), and mometasone (Nasonex). One nasal steroid -- Nasacort -- is available without a prescription.     

If you are concerned about taking a steroid, experts stress that these are very safe drugs. One key advantage of nasal sprays is that they focus the medication on the affected area – in your nose – instead of circulating it throughout the body.

Prescription antihistamines and decongestants. Your doctor may also recommend a prescription antihistamine pill like desloratadine (Clarinex) or levocetirizine (Xyzal). Some prescription antihistamines also contain a decongestant. Astelin is a nasal spray antihistamine that’s often used alongside steroid sprays. Antihistamines also come as prescription eye drops.

Other medications. Singulair, a medication called a "leukotriene modifier" helps relieve symptoms of allergic rhinitis.  Depending on your symptoms, prescription sprays and eye drops are also options. For severe flare-ups, oral steroids can help -- prednisone is the standard. 

Immunotherapy. While other treatments for allergic rhinitis are a temporary fix, immunotherapy -- or allergy shots -- can be a genuine cure. They work by regularly exposing you to tiny amounts of an allergen, so your body slowly becomes used to it. Over time -- a full course takes five years -- even large amounts shouldn’t provoke an allergic reaction. Allergy shots are effective in about 85% to 90% of people.       

If you’re wary of long-term drug use, allergy shots might be the best approach. “What you’re getting in the injection is a tiny amount of the allergen, and your immune system does the rest,” says Bowser. “It’s really the most natural treatment we have.”

A variation of this treatment is called sublingual immunotherapy. You get small amounts of the allergen under your tongue, instead of in a shot. While the approach may work, it has not been studied extensively. 

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