With tree pollen counts already at an all-time high in some areas of the United States, now is the time to start preparing for — and dealing with — your spring allergy symptoms.
But before you head to a pharmacy, consider some steps you can take at home. And if you need to resort to medication, here’s what you need to know about the different pills, sprays and shots available.
Your first line of defense
Doctors recommend that you first try to limit your exposure to anything that causes an allergic reaction—for example, tree pollen in the spring.
You can track local pollen levels on weather or allergy apps or on websites like the National Allergy Bureau’s. When readings are high, doctors recommend keeping your windows closed, wearing a well-fitting mask outside, and showering and changing your clothes when you get home. Pets can also bring in pollen from outdoors, so keep them out of your bedroom and wash them regularly. Once inside, you can also rinse your nose with a saline spray or neti pot.
“It’s painful, but people who do this thing find it really helpful,” said Dr. Neeta Ogden, an allergist from New Jersey.
Nasal sprays
Dr. John Mafi, a primary care physician at UCLA Health who often treats allergy patients, said that for those with moderate or severe seasonal allergies, the most effective treatment is usually a corticosteroid nasal spray.
These include fluticasone (Flonase), budesonide (Benacort), triamcinolone (Nasacort), and mometasone (Nasonex).
Allergens trigger inflammation in the nose, eyes, throat, and sometimes the airway. “A topical steroid calms that area of inflammation,” Dr. Mafi said. Because nasal sprays are not absorbed systemically like steroid pills, they are considered low-risk, he added.
Spray with the nozzle pointed towards the ears to get the most benefit and avoid side effects such as nosebleeds. Steroids can take several days to work, so doctors recommend using them from a week or two before pollen season until the pollen count has decreased.
Antihistamines
Antihistamines reduce itching and inflammation caused by histamine, a chemical your immune cells release when triggered by an allergen. They can be taken as pills, nasal sprays or eye drops. They work quickly and are most effective if taken as needed, such as on days when your symptoms are particularly bad.
“It can be like a rescue treatment,” said Dr. Farah Khan, an allergist and immunologist at Nationwide Children’s Hospital in Columbus, Ohio.
For itchy, watery eyes, antihistamine eye drops — often combined with a nasal spray — tend to work best, Dr. Mafi said.
An oral antihistamine can be beneficial when you have multiple symptoms, such as itchy eyes, stuffy nose and hives, said Dr. Rita Kachru, chief of clinical allergy and immunology at UCLA Health.
In 2020, a physician task force issuing allergy treatment guidelines recommended against the use of “first-generation” oral antihistamines, such as diphenhydramine (Benadryl), for allergic rhinitis, especially on a chronic basis. The team reported negative side effects, including sedation, impaired performance, and an increased risk of dementia.
Doctors said the “second-generation” oral antihistamines loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) won’t make most people drowsy, although patients are less likely to experience drowsiness with fexofenadine. said Dr. Kachru. These pills can cause side effects such as dry eyes or mouth and constipation.
If one antihistamine causes unpleasant side effects or stops working well, doctors suggest trying another.
Decongestants
Some antihistamines, such as Claritin-D and Allegra-D, are combined with pseudoephedrine (Sudafed). Doctors do not recommend any products containing pseudoephedrine for children or adults for more than a few days in a row because the ingredient can increase heart rate and blood pressure.
Dr. Kachru also cautioned against using the decongestant nasal spray oxymetazoline (Afrin). While it can provide relief, he said, over time you need more of the drug to get the same response. And stopping the drug can cause inflammation that can make breathing through the nose difficult, he said.
Immunotherapy
Doctors recommend seeing a board-certified allergist if your symptoms get worse, interfere with daily life, or cause other health problems and medications don’t help. Dr. Ogden said patients often come to her when they can no longer tolerate months of medication.
“And then we’re talking about starting allergy shots,” she said.
Allergy shots deliver progressively higher doses of the protein you’re allergic to, teaching your immune system to tolerate it. The treatment, which is FDA-approved and usually covered by insurance, has been shown to significantly reduce symptoms and medication use, and the results can last for several years after treatment ends.
Another option is sublingual immunotherapy, in which you place a tablet containing the allergen under your tongue. FDA approved tablets for ragweed, grasses and dust mites.
Both forms of immunotherapy require a significant investment of time, usually three to five years. Scientists are studying other options. As climate change and air pollution worsen allergy symptoms, Dr. Ogden said, “I think immunotherapy is where we’re going to end up.”
