Hay Fever Treatment
Unfortunately, hay fever, or allergic rhinitis, rarely improves without treatment. Studies suggest that the spontaneous remission rate is only 1 percent of cases per year, or about 10 percent per decade. Since there is no cure for allergies, patients must seek allergy relief with a long-term allergy treatment plan.
A complete program allergy treatment program includes a three-part plan:
- Allergen avoidance or reduction in exposure
- Medication for allergic symptoms, including over-the-counter eye allergy drops, nasal allergy sprays and tablets, and prescription steroid nasal sprays
- Allergen immunotherapy (e.g., allergy shots) to reduce allergic sensitization, which is the underlying cause for hay fever
According to the American Academy of Allergy, Asthma & Immunology (AAAAI), in addition to medical allergy treatment, a number of measures can be used to reduce exposure to outdoor allergens and improve hay fever symptoms. These measures include the following:
- Do not hang clothes outside to dry when the allergy pollen count is high.
- Do not mow or rake the lawn (these activities stir up pollen).
- Keep windows closed to reduce pollen levels inside and use air conditioning.
- Limit outdoor activity when the pollen count is high (e.g., during morning hours, and on dry, windy days).
- Take recommended or prescribed allergy medication regularly and at the correct dose.
Medical treatments for hay fever may include over-the-counter or prescription allergy medication, such as antihistamines and oral and nasal decongestants. First generation antihistamines (e.g., Benadryl®, Dimetapp®) may cause drowsiness, but newer non-drowsy medications (e.g., Allegra®, Claritin®, Zyrtec®) have few side effects. First generation antihistamines also may cause irritability and restlessness in children.
Decongestant and antihistamine combinations (e.g., Actifed®, NyQuil®) also may be used to reduce allergy symptoms. Side effects of these medications include nervousness, difficulty sleeping, and increased heart rate and blood pressure. They should not be used longer than indicated on the package insert.
Nasal allergy sprays (e.g., decongestants, corticosteroids, antihistamines) and eye allergy drops (e.g., Crolom®) may be used to decrease sensitivity of the mucous membranes of the nose and eyes to outdoor allergens. These medications are more effective when used continuously, even when symptoms are not present.
Nasal decongestants (e.g., Afrin®, Neo-Synephrine®) are not used for long-term allergy treatment (i.e., longer than 3 days) because routine use causes rebound nasal congestion when the medication is discontinued. Nasal corticosteroids (e.g., beclomethasone [Beconase®], triamcinolone [Nasacort®], fluticasone [Flonase®]) and nasal antihistamine sprays (e.g., Astelin®) usually take a few days to provide allergy relief and can be used indefinitely.
In October 2012, the U.S. Food and Drug Administration (FDA) issued a warning to consumers to keep OTC and prescription nasal sprays and eye drops out of the reach of young children. Accidentally swallowing these products can cause serious symptoms, such as nausea, vomiting, lethargy (sleepiness), tachycardia (fast heart beat) and coma, that may require hospitalization.
Leukotriene antagonists (e.g., montelukast sodium [Singulair®]) are prescription medications approved by the Food and Drug Administration (FDA) to treat asthma and outdoor and seasonal allergies. These medications inhibit the production of leukotrienes, which are chemicals that produce inflammation during an allergic reaction. Side effects include headache and flu-like symptoms.
Allergies that trigger asthma may be treated with the following:
- Bronchodilators (e.g., albuterol [Ventolin®], Proventil®])
- Corticosteroid inhalers (e.g., Flovent®, Azmacort®)
- Leukotriene antagonists (e.g., Singulair®, Accolate®)
- Omalizumab (Xolair®; for treatment of severe, allergic asthma only)
Immunotherapy (also called allergy vaccine therapy or allergy shots) may be used to treat allergies that last for most of the year. This treatment involves regular injections of small doses of the allergen, once or twice weekly for several months, then less frequently, to reduce allergic sensitivity.
In most cases, it takes several months for allergy vaccine therapy to be effective and treatment must be continued for a long period of time (e.g., 2 to 5 years or more). During the last years of therapy, the allergy shots may be administered as infrequently as once monthly.
Unlike other therapies, allergen immunotherapy can produce a permanent remission in approximately 50 percent of patients who respond to treatment, and long-term remission in 30 percent of those who respond. Thus, while not an allergy cure or total allergy solution, it is often the best long-term allergy treatment for allergic rhinitis.
In 2014, the first oral immunotherapy pill (Oralair) was approved in the United States. This once-daily medication is placed under the tongue and allowed to dissolve (called sublingual administration) to treat allergic rhinitis with or without conjunctivitis. The first dose is giving in a health care provider's officeto monitor for adverse reactions and severe side effectsand subsequent doses can be taken at home. Oralair is approved for children 10 years of age and older and adults 65 years of age and younger with allergies to grass pollen.
Studies show that Oralair can lessen the severity of allergy symptoms and reduce the need for allergy medications in 16 to 30 percent if people who take the drug. It contains the extracts of 5 different grass pollens. Therapy is started about 4 months before grass allergy season and continues throughout the season. Side effects in adults include itching and swelling of the ears, mouth, and tongue, and reactions in children include itching and swelling in the mouth and throat irritation. Oralair has a boxed warning cautioning about the potential for a life-threatening reactioncalled anaphylaxis.
Ragwitekallergen extract administered under the tongue to treat hay fever (with or without conjunctivitis) caused by short ragweed pollenwas approved by the FDA in April 2014. This medication can be used in adults 18 through 65 years of age.
Treatment with Ragwitek is started 12 weeks before the start of ragweed season (late summer and early fall in most areas of the United States) and continues throughout the season. As with Oralair, the first dose is administered in a health care setting and the patient is observed for possible adverse reactions for at least 30 minutes. Ragwitek can then be taken once daily at home.
Studies show that Ragwitek can reduce ragweed allergy symptoms and the need for medication by about 26 percent. Common side effects include itching in the mouth and ears and throat irritation.