Which medications can relieve allergic rhinitis?

Photo of someone taking tablets out of the package
PantherMedia / Andrey Popov

People with hay fever often have very severe, but temporary, symptoms – for example during the grass pollen season. Others are allergic to dust mites or animals and have symptoms all year round. Whatever the cause of the , there are medications that provide relief from allergic rhinitis. This is a set of symptoms that include sneezing, a stuffy or runny nose, and itchy or watery eyes.

Although medications for the treatment of allergic rhinitis can have side effects, they are usually well tolerated. Various medications can reduce the symptoms. You can talk with your doctor to find the most suitable one for you.

Factors that influence the choice of medication include the severity and type of allergic rhinitis (seasonal or year-round), as well as personal preferences and experiences. For instance, some people would prefer to take tablets rather than use a nasal spray. Others might feel tired when they use a certain medication, and decide to try a different one instead. The choice of medication is sometimes also influenced by other medical conditions people have.

What medications are available?

If someone has allergic rhinitis, the following medications are typically considered:

  • Antihistamines
  • Steroids (corticosteroids)
  • Leukotriene receptor antagonists
  • Chromones (mast cell stabilizers)
  • Decongestant nasal drops and sprays

Steroid sprays or newer generation antihistamines are usually the treatments of first choice. Many antihistamines and some steroid sprays are available from pharmacies without a prescription. Higher-dose steroid sprays have to be prescribed by a doctor, though.

Antihistamines

If something triggers an allergic reaction in your body, your immune system releases a chemical messenger called histamine. Histamine causes symptoms like sneezing, watery eyes and rashes. Antihistamines suppress this effect. When treating allergic rhinitis, antihistamines can be used in the form of tablets or nasal sprays. Tablets start working within one hour, and nasal sprays start working within 15 minutes.

Research has shown that tablets and nasal sprays can both provide relief. They are usually well tolerated. The most common side effects of tablets are tiredness and headaches. They can make it more difficult to drive a car and do other activities. How tired you feel may also depend on the specific medication. So it's important to follow the instructions in the package insert and find out about the various kinds of medications beforehand. Nasal sprays can leave a bitter taste in your mouth.

Steroids (corticosteroids)

Corticosteroids are steroid drugs that contain an anti-inflammatory steroid hormone. Steroid nasal sprays reduce reduce swelling in the mucous membranes and relieve symptoms like a runny or stuffy nose. Because only a small amount of the steroid medication enters the bloodstream when you use a nasal spray, they are considered to be low-risk. They can be used over longer periods of time, but it is then advisable to see a doctor regularly for check-ups.

Although steroid nasal sprays don’t have an immediate effect, people usually notice a difference within twelve hours. The full effect is reached after a few days. They might cause mild side effects such as nosebleeds, headaches or altered taste.

Combination products

Some nasal sprays contain both an antihistamine and a steroid. This combination is more effective than a treatment with just one of the drugs. It's a suitable option if treatment with one medication doesn't provide enough relief from the symptoms.

Unlike many of the products that just have one drug, combination nasal sprays are prescription-only.

Leukotriene receptor antagonists

These medications block the action of leukotrienes. Leukotrienes are chemical messengers that play an important role in the inflammatory response that happens in the airways. In addition to relieving asthma symptoms, they can also relieve the symptoms caused by hay fever – but not as well as antihistamine or steroid nasal sprays do. Leukotriene receptor antagonists are usually well tolerated. Sometimes they cause temporary side effects such as tiredness or headaches.

Chromones (mast cell stabilizers)

Mast cell stabilizers prevent histamine from being released by certain cells in the body known as mast cells. This reduces allergic and inflammatory responses in the body. They are used in the form of nasal sprays, and are usually used to prevent symptoms, but they can also relieve symptoms. Possible side effects include irritation of the membranes lining the nose, and an unpleasant taste in your mouth.

Decongestant (anti-swelling) nose drops and nasal sprays

Decongestant nose drops and nasal sprays reduce swelling in the membranes lining the nose and the sinuses, making it easier to breathe through your nose. They are not suitable for the long-term treatment of allergic rhinitis, though. Although they open your nasal passages and make it easier to breathe, your nose might “get used to“ them after a short while, and then they have the opposite effect: The membranes become swollen again and it’s difficult to breathe through your nose. These medications can also cause side effects like nosebleeds. So it is recommended that these medications not be used for longer than 5 to 7 days.

Do some medications work better than others?

Steroid nasal sprays are often recommended as the treatment of first choice. They are just as well tolerated as other medications, and they are somewhat more effective than, for instance, antihistamine tablets.

If the symptoms don’t improve enough, a different medication can be tried out instead, or two medications can be combined: for example, a steroid nasal spray and antihistamine tablets. Or you could use a nasal spray that combines both types of drugs (a steroid and an antihistamine) in one product.

Agency for Healthcare Research and Quality (AHRQ). Treatments for seasonal allergic rhinitis. July 2013. (AHRQ Comparative Effectiveness Reviews; Volume 10).

Carson S, Lee N, Thakurta S. Drug Class Review: Newer antihistamines. Final Report - Update 2. May 2010. (Oregon Evidence-Based Practice Center).

Debbaneh PM, Bareiss AK, Wise SK, McCoul ED. Intranasal Azelastine and Fluticasone as Combination Therapy for Allergic Rhinitis: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2019; 161(3): 412-418.

Feng S, Fan Y, Liang Z, Ma R, Cao W. Concomitant corticosteroid nasal spray plus antihistamine (oral or local spray) for the symptomatic management of allergic rhinitis. Eur Arch Otorhinolaryngol 2016; 273(11): 3477-3486.

Juel-Berg N, Darling P, Bolvig J, Foss-Skiftesvik MH, Halken S, Winther L et al. Intranasal corticosteroids compared with oralantihistamines in allergic rhinitis: A systematic review and meta-analysis. Am J Rhinol Allergy 2017; 31(1): 19-28.

Liu G, Zhou X, Chen J, Liu F. Oral Antihistamines Alone vs in Combination with Leukotriene Receptor Antagonists for Allergic Rhinitis: A Meta-analysis. Otolaryngol Head Neck Surg 2018; 158(3): 450-458.

Seresirikachorn K, Chitsuthipakorn W, Kanjanawasee D, Khattiyawittayakun L, Snidvongs K. Effects of H1 antihistamine addition to intranasal corticosteroid for allergic rhinitis: a systematic review and meta-analysis. Int Forum Allergy Rhinol 2018; 8(10): 1083-1092.

Wei C. The efficacy and safety of H1-antihistamine versus Montelukast for allergic rhinitis: A systematic review and meta-analysis. Biomed Pharmacother 2016; 83: 989-997.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on April 23, 2020
Next planned update: 2023

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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