Birds are chirping, flowers are blooming, and the nuisance of hay fever is back along with the beautiful spring season. Hay fever, also known as allergic rhinitis or seasonal allergy, can cause runny and/or itchy nose, congestion, sneezing, red eyes, fatigue, and sometimes even a dry cough. Although some of the symptoms of allergic rhinitis are similar to those of the common cold, allergic rhinitis sufferers often have an itchy nose or eyes, accompanied by watery colorless nasal discharge. When someone has a cold, the nose is usually not itchy, and the nasal discharge is often thick or yellow-green in color, and often a sore throat and cough would be present. Compared to a cold that usually lasts around 1 week, the duration of allergic rhinitis is determined by the allergens, and symptoms disappear once the allergens are removed. In addition to spring and summer pollen and grass seeds, which can cause seasonal allergic rhinitis, dust mites, molds, pet hair or saliva in the home can also cause allergic rhinitis throughout the year.
To deal with allergens at home, you must regularly vacuum, wash bed sheets, pillowcases, curtains and stuffed animals in hot water, and stow away furniture or home decors that are prone to accumulating dust. For those who are allergic to pollen or grass clippings, it is advisable to keep windows and doors closed to prevent pollen from coming into the house from the outside. When you return home after a day out, you can wash your hair or take a shower to remove any allergens that may have stuck to your body, and it is also a good idea to use an air purifier at home.
The most common over-the-counter medications for allergic rhinitis are antihistamines, including first-generation antihistamines (e.g., Diphenhydramine or Benadryl) and second-generation antihistamines (Reactine, Claritin, Aerius, Allegra). These medications are effective against almost all allergic rhinitis symptoms involving the eyes and nose (unfortunately, they are weak against nasal congestion, with the exception of Aerius, which is a bit more effective for stuffy nose), and are usually taken once daily, with the effect lasting 12 to 24 hours. Although it only takes around 1 hour for the medication to start working, the most effective way of preventing allergy symptoms is to take the medication BEFORE symptoms start and to continue taking it until the end of the pollen season. Around 1 to 2 people out of 10 Reactine users will become sleepy, otherwise all second generation antihistamines do not cause drowsiness. In contrast, the first generation antihistamines can cause people to be very drowsy, and may also cause dry mouth or rapid heartbeat, hence making it not suitable for people who need to work, drive, or go to school. Thus the second generation antihistamines are usually recommended over first generation antihistamines for allergic rhinitis.
So which allergy medication is the best? In fact, many patients may find that the brand that worked for them last year may not necessarily work for them this year, and the allergens that people are sensitive to may change year to year. Everyone’s reaction to different antihistamine medications may be different, so the only way to find out which one works the best for you is to try them out one by one. It is worth noting that some of the second generation antihistamine products labeled with "sinus" have decongestants added in them. Although these can temporarily relieve nasal congestion, they are not suitable for patients with cardiovascular disease, high blood pressure, prostate problems, closed angle glaucoma, or hyperthyroidism due to the possible side effects of palpitations, elevated blood pressure and urinary retention. Reactine, Claritin and Aerius can all be given to children above 2 years old; the latter two products are also available in syrup forms.
In addition to oral medications, nasal sprays or eyedrops may also be used. Decongestant nasal sprays, such as Otrivin, can temporarily constrict the blood vessels in the nasal cavities, which is a quick and effective way to relieve nasal congestion. However, it is important not to use these sprays for more than three to seven days, as this may cause a rebound effect after discontinuing their use, which may worsen the symptoms of stuffy nose. The same applies to decongestant eyedrops: eyedrops labeled "red eye" usually contain decongestants, which can temporarily reduce the amount of redness in the eyes, but as they do not combat itchy or watery eyes and may cause rebound effects, their use is not recommended.
If itchy eyes are the main problem, one may try over-the-counter Cromolyn eyedrops. They are very safe and have no side effects, and are suitable for children over 2 years of age as well as adults. However, as they are milder and slower-acting than antihistamines, they are only suitable for mild symptoms, and may take up to three days to alleviate the symptoms. Starting June 2023, pharmacists in B.C. can also prescribe prescription anti-allergy medications such as antihistamine eyedrops (e.g. Patanol, Pataday) and corticosteroid nasal sprays (Nasonex, Flonase, Omnaris, Avamys, Beclomethasone, etc.). Although nasal sprays take up to two weeks to be fully effective, they are more effective than oral anti-allergy medications, and most of them can be used by children. If you are a B.C. resident with valid MSP, you are welcome to consult with your pharmacist to see if these prescription allergy medications are suitable for you.
key words: allergy, hay fever, claritin, aerius, reactine, sneezin