Understanding Hay Fever - Treatment

How Do I Know If I Have Hay Fever?

Your doctor may be able to make a diagnosis based on a physical exam and observation of your symptoms. Skin tests may be recommended to determine which pollens cause the most sensitivity.

The doctor (usually an allergist) applies drops containing a small amount of possible allergy-causing substances to your arm or back using small plastic toothpicks. The procedure is painless and draws no blood. If your skin becomes red, raised, and itchy after 20 minutes, the test has pinpointed the offending allergens. A radioallergosorbent test, or RAST, may be used to check your blood for elevated levels of the IgE antibodies produced by your immune system to guard against specific allergens.

What Are the Treatments?

The best approach is avoidance of known allergens and other provoking factors (such as smoke and dust).

Mild cases of hay fever can usually be controlled with an over-the-counter (OTC) non-sedating antihistamine (such as loratadine (Claritin and generic), taken once a day during the allergy season. The older (first generation) OTC antihistamines, such as chlorpheniramine (dozens of brand names) and diphenhydramine (Benadryl and generic) are much more likely than second-generation antihistamines such as loratadine to cause drowsiness at effective daily doses.

This drowsiness can increase the risk an accident when driving or operating other vehicles or tools. Antihistamines are much more effective when taken every day during your allergy season than when taken only when you feel allergy symptoms. Once histamine is released into your nasal passages, an antihistamine pill can't treat the damage done by the histamine release, only prevent further histamine release. Phenylephrine and pseudoephedrine are decongestants that help unblock nasal passages -- also in many over-the-counter products. If you're taking medication for a heart condition or are taking the antibiotic erythromycin or the antifungal drug ketoconazole, be sure to check with your doctor before taking a decongestant or antihistamine to avoid drug interactions. For severe cases, your doctor may also prescribe fexofenadine (Allegra), desloratadine (Clarinex), or cetirizine (Zyrtec), "second-generation" antihistamines which are more effective than loratadine for some patients with allergic rhinitis.

The FDA has approved the antihistamine nasal spray Patanase to relieve the symptoms of seasonal allergic rhinitis. It may be used in patients age 12 and older.

Some over-the-counter nasal sprays may contain both a decongestant and an antihistamine. These sprays help with pain and itching by opening clogged nasal passages and reducing inflammation. These nasal sprays should not be used for more than three days in a row as they can have a rebound effect and cause more severe nasal congestion.

Regular use of the nasal spray NasalCrom -- available over-the-counter -- prevents the lining of the nasal passages from reacting to the allergen affecting you. More severe cases may benefit from a nasal sprays containing steroids, which are strong anti-inflammatories and help with many allergy symptoms.

Another avenue to try is allergy shots, or immunotherapy. This treatment involves a series of injections of increasingly larger amounts of the allergen until your system becomes desensitized to it and no longer overreacts in response to it. Immunotherapy has shown positive results in up to 75% of sufferers with extreme cases of hay fever. Standard treatment lasts from one to three years.