That sneezy, itchy, watery-eyed time of year has yet again returned: It’s allergy season. Seasonal allergies are the body’s response to pollen from trees and grass; the immune system releases chemicals, like histamines, leukotrienes, and prostaglandins, which cause all those uncomfortable, familiar symptoms.
Get ahead of allergy season this year
The best regimen starts before you start sneezing.
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Allie Volpe is a correspondent at Vox covering mental health, relationships, wellness, money, home life, and work through the lens of meaningful self-improvement.
The best way to combat the unpleasant barrage is to get ahead of them, says Russell Leftwich, a fellow at the American Academy of Allergy, Asthma, and Immunology and an adjunct assistant professor of biomedical informatics at Vanderbilt University School of Medicine. Since allergy season arrives at roughly the same time every year, Leftwich recommends starting your allergy relief of choice for a few days before pollen levels get too high. (The Weather Channel, AccuWeather, and IQAir provide local pollen monitoring.)
If the dizzying variety of drugs at the pharmacy has you confused, here are a few things to know about the most effective types of over-the-counter allergy medications as well as non-pharmaceutical ways to keep your allergies in check.
Before heading to the drugstore
One of the best ways to alleviate allergy symptoms is to prevent pollen from getting into your body in the first place. This means keeping windows closed and wearing a mask while doing yard work, Leftwich says. If you’ve been outdoors for a while, change your clothes and wash your face when you get home, says Rita Kachru, the chief of allergy and immunology in the department of medicine at UCLA.
Another prevention method includes rinsing your nose with a saline solution: a mixture of baking soda, salt, and distilled or boiled water, Kachru says. The American Academy of Allergy, Asthma, and Immunology recommends mixing three tablespoons of iodide-free salt with one teaspoon of baking soda in a small container. Then add one teaspoon of the salt/baking soda mixture to eight ounces of lukewarm distilled or boiled water. You can also buy nasal saline sprays at the drugstore.
When to take antihistamines
When avoidance strategies aren’t totally effective, you can treat your symptoms with over-the-counter allergy medications. One of the major categories of these treatments are antihistamines, which are available in pill, tablet, eye drop, or nasal spray forms.
Antihistamines help reduce itchiness and sneezing and are your first line of defense, Kachru says. “The reason I always start with an antihistamine is because you may just have a day of a high pollen count,” she says, “and you just need a one-time antihistamine because you’re sneezing and you’re itchy and you’re a little congested.”
Kachru and Leftwich suggest opting for long-acting antihistamines — like loratadine (Claritin), cetirizine (Zyrtec), or fexofenadine (Allegra) — over short-acting ones. People can develop a resistance to short-acting antihistamines, like diphenhydramine (Benadryl), very quickly. Plus, Benadryl often makes people sleepy.
Both short- and long-acting antihistamines provide relief within 15 to 30 minutes, Kachru says. Take them at the start of the day before you are exposed to pollen.
For mild nose itchiness and sneezing, an antihistamine nasal spray, like azelastine (Astepro), might work for you. A common side effect is a metallic taste in the back of the throat, Kachru says.
When to try nasal steroid sprays
If you’re reaching for an antihistamine three to four times a week, Kachru suggests adding a nasal steroid into the mix. Not only do nasal steroids reduce sneezing and itchiness, but they’ll help with congestion, too. These include fluticasone (Flonase), budesonide (Benacort), triamcinolone (Nasacort), and mometasone (Nasonex). Nasal steroids do take a few days until you feel the full effects, Kachru says, so don’t give up if you don’t feel better right away.
To properly administer nasal sprays, insert the tip in your nostril and point it toward your ear. A common mistake when using a nasal spray is pointing it straight up your nose. “It goes up their nose, down their throat and does nothing for them,” Kachru says. “Or they stick it inwards into their nose, and then they get nosebleeds. … So you want to always make sure that when you put it in, you point it out towards your ear, spray, sniff in, and then do the alternate nostril.”
While not a nasal steroid, Kachru advises against using oxymetazoline (Afrin), a nasal spray decongestant. “Patients who use Afrin regularly end up having really, really severe rebound nasal congestion,” she says.
Leftwich advises against decongestants more broadly, as the over-the-counter decongestant medications are not very effective.
After a few weeks of daily nasal spray use, you may consider stopping an antihistamine, if you’re taking both. “That’s usually what I tell people to do,” Kachru says. “Eventually just use that antihistamine as needed” because the nasal spray is more effective.
The protocol Kachru recommends to her patients include a daily nasal rinse and nasal steroid with an antihistamine as needed. With this line of defense, hopefully your allergy season will be a lot less miserable.
