General: Allergy treatment depends on the severity of symptoms. Commonly used allergy medications include antihistamines, cromolyn sodium, decongestants, leukotriene inhibitors, and nasal sprays. Allergen immunotherapy (allergy shots) may also help relieve pollen allergy symptoms. Patients should tell their healthcare providers if they are taking any drugs (prescription or over-the-counter), herbs, or supplements because they may interact with treatment.
Allergen immunotherapy (allergy shots): Allergen immunotherapy, also known as allergy shots, is often used to treat patients who suffer from severe allergies, or for those who experience allergy symptoms for more than three months a year. Allergen immunotherapy involves injecting increasing amounts of a diluted allergen into a patient over several months.
There are two phases of immunotherapy -
the build-up phase and the maintenance phase. During the build-up phase, allergy shots are injected into the upper arm once or twice a week for several months (typically three to six months). The dose is gradually increased until the maintenance dose is reached. The maintenance phase begins once the effective therapeutic dose is reached. This dose is different for each patient because it depends on the patient's level of allergen sensitivity and their response to immunotherapy during the build-up phase. Once the maintenance dose is reached, the patient will continue therapy every two to four weeks for two to five years or more.
Antihistamines: Short-acting antihistamines like diphenhydramine (Benadryl®) have been used to relieve mild to moderate allergy symptoms. Most short-acting antihistamines are available over-the-counter. Use cautiously, especially in children because these medications often cause drowsiness and they have shown to temporarily impair cognition (slow learning) in children, even if they do not cause drowsiness. However, loratadine (Claritin®), another over-the-counter medication, does not usually cause drowsiness or affect learning in children.
Longer-acting antihistamines like fexofenadine (Allegra®) are available by prescription for mild to moderate allergy symptoms. They typically cause less drowsiness than short-acting antihistamines, and they are equally effective. Although these medications usually do not interfere with learning, use cautiously in children. Side effects may include drowsiness, dry mouth, headache, sore throat, stomach pain, vomiting, or diarrhea.
Cromolyn sodium: Cromolyn sodium is available over-the-counter as a nasal spray (Nasalcrom®) for treating hay fever. Eye drop versions of cromolyn sodium are available for itchy, bloodshot eyes. Side effects may include sore throat, bad taste in the mouth, cough, stuffy nose, burning or itching in the nose, sneezing, headache, or stomach pain. They do not cause rebound nasal congestion.
Decongestants: Decongestants may help relieve symptoms, such as nasal congestion (stuffy nose). These drugs shrink the tissues and blood vessels in the eyes and nose that swell in response to contact with an allergen like pollen. Nasal decongestant sprays like oxymetazoline (Afrin®) should not be used more than twice daily for three consecutive days because rebound nasal congestion (significant return of stuffy nose) may result. Oral decongestants such as pseudoephedrine (Sudafed®) are not likely to cause rebound nasal congestion. Common side effects of oral decongestants include increased heartbeat, high blood pressure, anxiety, or insomnia (difficulty sleeping).
Leukotriene receptor antagonists: Leukotriene receptor antagonists block the action of leukotrienes, which are chemicals in the body that are involved in the allergic response. New leukotriene receptor antagonists, such as montelukast (Singulair®) and zafirlukast (Accolate®), can effectively treat hay fever without some of the common side effects like drowsiness. These long-acting medications are taken once daily.
Nasal corticosteroid sprays: Nasal corticosteroid sprays can effectively relieve nasal allergy symptoms (like itchy nose and sneezing) in patients who are not responding to antihistamines. Commonly prescribed corticosteroid sprays include fluticasone (Flonase®), mometasone (Nasonex®) and triamcinolone (Nasacort AQ®). Side effects may include nosebleeds, burning in the nose, runny nose, bloody mucus in the nose, cough, upset stomach, vomiting, diarrhea, or dizziness. Nasal sprays may also irritate the throat.
Butterbur: Good scientific evidence suggests that butterbur may effectively prevent allergic rhinitis (hay fever) in susceptible individuals. Comparisons of butterbur to prescription drugs, such as fexofenadine (Allegra®) and cetirizine (Zyrtec®), have reported similar efficacy. Additional studies are warranted before a firm conclusion can be made.
Avoid if allergic or hypersensitive to Petasites hybridus or other plants from the Asteraceae/Compositae family (ragweed, marigolds, daisies, and chrysanthemums). Raw, unprocessed butterbur plant should not be eaten due to the risk of liver or kidney damage or cancer. Avoid if pregnant or breastfeeding.
Nasal irrigation: Good scientific evidence suggests that nasal irrigation can effectively treat symptoms of allergic rhinitis (hay fever), such as runny nose, sneezing, and nasal congestion. A well-conducted randomized controlled trial that fully reports the data would make the case for allergic rhinitis stronger.
There is also good scientific evidence that nasal irrigation may effectively treat chronic sinusitis. A large randomized double-blinded study would lend strong support to the usage of nasal irrigation for the treatment of chronic sinusitis.
Nasal irrigation is generally well tolerated. Use cautiously with history of frequent nosebleeds. If the irrigation liquid is too hot, the nose may become irritated.
Probiotics : Only a few types and combinations of probiotics have been studied as a possible treatment for allergies. They have been studied mostly in children, teenagers, and young adults. Further research is necessary before a firm conclusion can be made.
Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
Unclear or conflicting scientific evidence
Acidophilus: A small study was conducted to evaluate the effects of Lactobacillus acidophilus strain L-92 (L-92) on the symptoms of Japanese cedar-pollen allergy with positive results. Further research is needed to determine whether lactobacillus acidophilus can effectively relieve pollen allergy symptoms.
Lactobacillus acidophilus (L. acidophilus) may be difficult to tolerate if allergic to dairy products containing L. acidophilus. Avoid if history of an injury or illness of the intestinal wall, immune-disease or heart valve surgery. Avoid with prescription drugs, such as corticosteroids, because of the risk of infection. Use cautiously with heart murmurs. Antibiotics or alcohol may destroy L. acidophilus. Therefore, it is recommended that L. acidophilus be taken three hours after taking antibiotics or drinking alcohol. Some individuals can use antacids, such as famotidine (Pepcid®) or esomeprazole (Nexium®), to decrease the amount of acid in the stomach one hour before taking L. acidophilus.
Aromatherapy: Despite widespread use in over-the-counter agents and vapors, there is not enough scientific evidence to recommend use of eucalyptus oil as a decongestant-expectorant (by mouth or inhaled form). The available studies are of poor quality, and have used combination therapies or 1,8-cineole (eucalyptol), which is a component of eucalyptus. Further studies are needed before a firm conclusion can be made.
Essential oils should be administered in a carrier oil to avoid toxicity. Avoid if history of allergic dermatitis. Use cautiously if driving/operating heavy machinery. Essential oils are not for internal consumption. Avoid direct contact of undiluted oils with mucous membranes, such as those in the nose, eyes, and mouth. Use cautiously if pregnant.
Choline: Oral tricholine citrate (TRI) effectively relieved allergic rhinitis (hay fever) symptoms in one study. However, further research is needed before a firm conclusion can be made.
Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding, it seems generally safe to consume choline within the recommended adequate intake (AI) parameters. Supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
Ephedra: A preliminary study suggests that ephedrine nasal spray, a chemical in ephedra, may help treat symptoms of nasal allergies, such as runny nose, sneezing, and nasal congestion. Additional research is needed before a firm conclusion can be made.
Since ephedra taken by mouth can cause serious side effects, including heart attack, seizure, and stroke, ephedrine nasal sprays should only be used in the nose. Thousands of toxicity reports exist on ephedra, including over 100 deaths. Avoid if history of high blood pressure, abnormal heart rate, heart attack, stroke, seizure, eating disorders, anxiety, prostate disease, mental illness, kidney disease, stomach ulcers, heart disease, eye disease, depression, diabetes, thyroid disease, and/or sleep problems. Avoid if pregnant or breastfeeding.
Honey: Currently, there is insufficient human evidence to recommend honey for the treatment of rhinoconjunctivitis (inflammation of the nose and eyes in response to allergens like pollen). One poor quality trial reported no benefit of the use of honey for the treatment of rhinoconjunctivitis (inflammation of the nose and eyes in response to allergens). Further research is necessary before a firm conclusion can be made.
Avoid if allergic or hypersensitive to honey, pollen, celery or bees. Honey is generally considered safe in the recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (such as C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
Hypnotherapy, hypnosis: It has been suggested that hypnotherapy may help treat the symptoms of hay fever, such as runny nose, sneezing, congestion, and watery eyes. However, further research is necessary to determine whether it is an effective treatment.
Use cautiously with mental illnesses, such as psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders. Use cautiously with seizure disorders.
Perilla: Preliminary evidence suggests some benefit of perilla extract for seasonal allergies. Further clinical trials are required before a firm conclusion can be made.
Avoid if allergic/hypersensitive to perilla or members of the Lamiaciae/Labiatae family. Use cautiously with cancer, low HDL-cholesterol and immune disorders. Use cautiously if taking nonsteroidal anti-inflammatory drugs (NSAIDS) or barbiturates. Avoid if pregnant or breastfeeding.
Stinging nettle: For many years, a freeze-dried preparation of Urtica dioica has been prescribed by physicians and sold over-the-counter to treat the symptoms of allergic rhinitis (hay fever), such as runny nose, sneezing and nasal congestion. Clinical trials demonstrating statistical significance over placebo, and/or equivalence with other available treatments, are needed before a firm conclusion can be made.
Avoid if allergic or hypersensitive to nettle, the Urticaceae family, or any ingredient of nettle products. Use cautiously with diabetes, bleeding disorders, or low sodium levels in the blood. Use cautiously with diuretics and anti-inflammatory drugs. The elderly should also use nettle cautiously. Avoid if pregnant or breastfeeding.
Vitamin E: Although thought to aid in reducing the nasal symptoms of allergies, vitamin E intake may not be effective. However, current evidence is limited, and more studies are needed before a firm conclusion can be drawn.
Avoid if allergic or hypersensitive to vitamin E. For short periods of time, vitamin E supplementation is generally considered safe at doses up to 1,000 milligrams per day. Avoid doses higher than 1,000 milligrams a day. Avoid with Retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders. The recommended dose of vitamin E for pregnant women of any age is 15 milligrams, and the recommended dietary allowance (RDA) for breastfeeding women of any age is 19 milligrams. Use beyond this level in pregnant women is not recommended.
Avoid going outside in the morning and evening because this is when outdoor pollen levels are the highest.
Keep windows closed, and, if possible, use an air conditioner in the house and/or car.
Do not dry clothes outside.
Regularly wash the hands and face to remove pollen.
A humidifier may help remove some of the allergens out of the air.
Consider installing central air conditioning with a high-efficiency particulate air (HEPA) filter attachment. The HEPA filter can trap airborne pollen from outdoor air, preventing it from circulating in the air inside.
Use a vacuum cleaner with a double-layered microfilter bag or a HEPA filter.
Change furnace and air conditioning filters regularly.
Sleep with the windows closed.