Medication

​There are different kinds of medication which are used to control the symptoms. Your physician will prescribe the appropriate one according to the severity and duration of the attacks.

These types are:

Anti-histamines:

They act by blocking the histamine receptors, so histamine would not be able to act in the body. They are mainly used to relieve sneezing and itching. They are formed as tablets and nasal sprays. Sprays appear to have some anti-inflammatory effect as well as can improve nasal congestion. They have rapid onset of action (less than 15 minutes) and can be administered on demand.

Anti-histamines are classified as:

• Oral 1st generation - they make you feel drowsy; ‘sedating anti-histamines’ and could be used at night. Also, they may cause some dryness of mouth and eyes. Examples of them, diphenhydramine and chlorpheniramine.
  
  
• Oral 2nd generation - they have less sedating effect compared to 1st generation. They are called ‘Non-sedating anti-histamines’, and examples include loratadine and cetirizine.
  
  
• Oral 3rd generation - they are used to avoid the cardiac effect of anti-histamines and examples are Desloratadine and Levocetirizine.
  
  
• Examples of nasal sprays: Azelastine and olopatadine.

Decongestants:

They let your blood vessels contract, so inflammation will decrease. Be aware you should use them for maximum five days otherwise they will worsen the nasal block. Moreover, adults people with high blood pressure and pregnant ladies have to use them with precautions.

Some types are produced to be used in combination with anti-histamines to control symptoms more effectively.   

Corticosteroids:

Intranasal glucocorticoids are generally the most effective therapy.  They reduce swelling inside the airways and may also decrease mucus production. Some parents have concerns about using inhaled corticosteroids as they cause suppressing growth in children. Studies do not support this theory and have shown no growth inhibition even if they had been taking them for several years (appropriately). They must be used under physician consultation.

Leukotriene Modifiers

Some inflammatory cells produce chemical signals called ‘leukotrienes’, which is an inflammatory mediator like histamine. They lead to more tissue swelling. Leukotriene modifiers are long-term control medications. They decrease congestion, but they are less effective than inhaled steroids.

Common leukotriene modifiers are:

• Singulair® (montelukast)
• Accolate® (zafirlukast)
• Zyflo® (zileuton/ not indicated for children under 12 years)

Mast Cell Stabilizers: (Cromolyn Sodium and Nedcromil)

They control releasing of inflammatory mediators. When used regularly, cromolyn or nedocromil help avoid swelling in the airways. They are used to prevent the rhinitis symptoms.  They are available in inhaled forms. Because cromolyn and nedocromil are preventive, they must be taken on a regular basis to be efficient.

Note:  Inhaled corticosteroids, leukotriene modifiers and mast cell stabilizers are not suitable for quick relief. They may be slow to show beneficial effects and may require several weeks before any major improvement is seen.

Allergy Shots (Immunotherapy)

If actions to avoid exposure and medications are not effective, allergy shots can be considered.

This immunotherapy consists of a series of injections with solutions containing the allergens. The purpose is to decrease sensitivity, which in turn will reduce symptoms. Treatment usually begins with shots of a weak solution given once or twice a weekly. Then, concentration is gradually increased until the strongest dosage is reached. After that they will be given on a monthly basis.  Injections should be given in the health care center/hospital, where trained staff can manage any life threatening reactions. At HMC we have this service available for some allergens, with the requirements for monitoring patients (staff and space) for any post-injection reactions.  Allergy shots have been shown to decrease symptoms associated with pollens, certain molds, dust mites and animal dander.
They do not produce a direct outcome. A period of six months to one year may be necessary prior the improvement is being seen. A normal path of treatment with these shots is three to five years. Although, some people may benefit from a longer course, not everyone responds well.

Indications of using medication in relation to symptoms.

Type of Symptoms	Recommended Treatment Options
Episodic symptoms	Oral or nasal antihistamine, with oral or nasal decongestant if needed
Mild symptoms, seasonal or perennial	Intranasal glucocorticoid, oral or nasal antihistamine, or leukotriene receptor antagonist (singular)
Moderate-to-severe symptoms	Intranasal glucocorticoid, intranasal glucocorticoid plus nasal antihistamine or immunotherapy