Allergy medications - oral medication, nasal sprays, eye drops

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OVERVIEW

Allergy medications can help to reduce allergy symptoms such as nasal congestion, runny nose, sneezing, watery and itchy eyes, post nasal drip, throat scratchy sensation, itchy skin, etc. They are divided into categories listed below based on how they work.

Anti-histamines:

Histamine is the major mediator of allergic reactions. Anti-histamines block histamine receptors on the target organs. They are made into oral pills / liquids, nasal sprays, and eye drops. They are effective in treating:

Sneezing, itchy and runny nose
Eye itching, burning, tearing and redness
Itchy skin, hives, and eczema

The most effective way to use anti-histamines is before symptoms develop. They are not powerful to treat nasal congestion. Side effects include drowsiness (better in newer generation such as Allegra or Claritin) and excessive dryness of the mouth, nose and eyes.

Decongestants:

Decongestants reduce nasal passage swelling and pressure by constricting the blood vessels. They do not work on other allergic symptoms, such as sneezing, runny nose, or post-nasal drip or. Decongestants are available in pill forms, in combination with oral anti-histamine (allergy medications with a “D”), or as nasal sprays. Oral decongestants may cause insomnia. They should also be avoided in patients with high blood pressure. Nasal sprays offer instant relief which does not last long. Long term use leads to rebound congestion, a condition called rhinitis medicamentosa.

Corticosteroids:

Corticosteroids dampen inflammation by suppressing the over-reactive immune system. Systemic use of corticosteroid (by mouth or injections inside muscles or veins) is common when treating severe allergies and asthma. However, due to many serious side effects, long term large dose use of systemic steroid generally is avoided. Intranasal corticosteroids are the most effective class of drug to treat rhinitis, both allergic and non-allergic. They are effective for all symptoms, especially when used on a regular daily basis. They have very little side effects on the whole body if used with right technique. Topical corticosteroids are the mainstay treatment for skin allergies.

Leukotriene Inhibitors:

Cysteinyl leukotrienes are another class of allergic mediators. Leukotriene inhibitors are commonly used in allergic rhinitis and mild to moderate asthma. They are in general well-tolerated. Liver function may need to be monitored when taking Zileuton (Zyflo). Occasionally neuropsychiatric symptoms may occur such as agitation, depression, etc .

Anti-cholinergic:

Iprotopium (Atrovent) nasal spray decreases secretion from the glands lining the nasal passages, thus improves running nose in allergic and nonallergic rhinitis. It is also used for common cold. However, it does not relieve nasal congestion or sneezing. Side effects are generally mild including headache, dry nose / mouth, blurred vision, etc. Inhaled Iprotopium is effective as an asthma rescue medication.

Cromolyn:

Cromolyn blocks immune cells from releasing allergy-causing substances. It may not work in all patients. Nasal cromolyn can help prevent allergic nasal reactions if taken prior to exposure. Cromolyn inhaled may be used for mild asthma. Eye drops for allergic conjunctivitis are also available.

Epinephrine:

Epinephrine is a life-saving medication for severe allergic reactions. It is the medication of choice in anaphylaxis. It supports cardiovascular system, opens up airways, and decreases allergy mediator release from activated cells. It is supplied in auto-injector forms for easy use.

ORAL MEDICATIONS:

Anti-Histamines:

Medication	Age	Dosing	Drug forms	Safety
Benadryl (Dipenhydramine)	<12yo	12.5mg/10kg every 4-6hr as needed	syrup (12.5mg/5ml), tabs, capsules	pregnancy category B
	>=12yo	25 to 50mg every 4-6hr as needed
Atarax (Hydroxyzine)	<6yo	2mg/kg/day divided every 6-8hr as needed	syrup (10mg/5ml), tabs	pregnancy category C
	6-12yo	12.5-25mg every 6-8hr as needed
	>=12yo	25-100mg every 6-8hr as needed
Zytec (Cetirizine)	6m-2yo	2.5mg daily as needed	syrup (1mg/ml), tabs	pregnancy category B
	2-5yo	2.5-5mg daily as needed
	6-11yo	5-10mg daily as needed
	>=12yo	5-10mg daily as needed
Xyzal (Levocetirizine)	6m-5yo	1.25mg daily as needed	syrup (2.5mg/5ml), tabs	pregnancy category B
	6-11yo	2.5mg daily as needed
	>=12yo	2.5-5mg daily as needed
Allegra (Fexofenadine)	6m-2yo	15mg twice daily as needed	syrup (30mg/5ml), tabs	pregnancy category C
	2-11yo	30mg twice daily as needed
	>=12yo	180mg daily as needed
Claritin (Loratadine)	2-5yo	5mg daily as needed	syrup (1mg/ml), tabs	pregnancy category B
	>6yo	10mg daily as needed
Clarinex (Desloratadine)	6-11mo	1mg daily as needed	syrup (0.5mg/1ml), tabs	pregnancy category C
	1-5yo	1.25mg daily as needed
	6-11 yo	2.5mg daily as needed
	>=12yo	5mg daily as needed

Anti-Histamine / Decongestant Combos:

Medication	Components	Drug forms	Dosing
Zyrtec D	Cetirizine / Pseudoephedrine	12hr (5mg/120mg)	1 tab twice a day as needed
Allegra D	Fexofenadine / Pseudoephedrine	12hr (60mg/120mg)	1 tab twice a day as needed
		24hr (180/240mg)	1 tab daily as needed
Claritin D	Loratadine / Pseudoephedrine	12hr (5mg/120mg)	1 tab twice a day as needed
		24hr (10mg/240mg)	1 tab daily as needed
Clarinex D	Desloratadine / Pseudoephedrine	12hr (2.5mg/120mg)	1 tab twice a day as needed
		24hr (5mg/240mg)	1 tab daily as needed

* All anti-histamine / decongestant combos are used for age >12yo
* Pseudoephedrine is pregnancy category C

Leukotriene Inhibitors:

Medication	Age	Dosing	Drug forms	Safety
Singulair (Montelukast)	1-5yo	4mg daily	Granules 4mg, tab	pregnancy category B
	6-14yo	5mg daily
	>=15yo	10mg daily

NASAL SPRAYS:

Intranasal Anti-Histamines:

Medication	Age	Dosing
Astelin (Azelastine0.1%)	5-11yo	1 spray twice daily as needed
	>12yo	2 sprays twice daily as needed
Astepro (Azelastine 0.15%)	6 -11yo	1 spray twice daily as needed
	>12yo	2 sprays twice daily as needed
Patanase (Olopatadine)	6-11yo	1 spray twice daily as needed
	>12yo	2 sprays twice daily as needed

* All anti-histamine nasal sprays are pregnancy category C.

Intranasal Corticosteroids:

Medication	Age	Dosing
Flonase (Fluticasone propionate)	4-12yo	1-2 sprays daily
	>12yo	2 sprays daily
Nasonex (Mometasone)	2-12yo	1 sprays daily
	>12yo	2 sprays daily
Nasacort (Triamcinolone)	2-5 yo	1 sprays daily
	6-12yo	1-2 sprays daily
	>12yo	2 sprays daily
Rhinocort (Budesonide)	6-12yo	1-2 sprays daily
	>12yo	1-4 sprays daily
Qnasl (Beclomethasone)	>12yo	2 sprays daily
Veramyst (Fluticasone furoate)	>2yo	1-2 sprays daily
Omnaris (Ciclesonide)	>6yo	2 sprays daily
Zetonna (Ciclesonide)	>12yo	1 spray daily

* Rhinocort is pregnancy category B. All other steroid nasal sprays are pregnancy category C.

Anti-Histamine / Corticosteroid Combo:

Medication	Age	Dosing	Safety
Dymista (Azelatine / Fluticasone propionate)	>12yo	1 spray twice daily	pregnancy category C

Anti-Cholinergic (Atropine-like) Nasal Spray:

Medication	Age	Dosing	Safety
Atrovent (Ipratropium bromide)	>5yo	2 sprays 2-4 times daily as needed	pregnancy category B

EYE DROPS:

Medication	Age	Dosing
Elestat (Epinastine)	>3yr	1 drop twice a day as needed
Optivar (Azelastine 0.05%)	>3yr	1 drop twice a day as needed
Patanol (Olopatadine 0.1%)	>3yr	1 drop twice a day as needed
Pataday (Olopatadine 0.2%)	>3yr	1 drop daily as needed
Pazeo (Olopatadine 0.7%)	>2yo	1 drop daily as needed
Zaditor / Alaway (Ketotifen 0.025%)	>3yr	1 drop twice a day as needed
Bepreve (Bepotastine)	>2yo	1 drop twice a day as needed

* All listed eye drops are pregnancy category C.

EMERGENCY MEDICATIONS – Epinephrine Auto-injectors:

Medication	Weight	Dosing
Epipen	>30kg	Epipen 0.3mg
	15-30kg	Epipen Jr 0.15mg
Auvi-Q	>30kg	0.3mg
	15-30kg	0.15mg

* Inject once into upper outer thigh for severe allergic reaction. May repeat 1 dose in 5-15 minutes. Call 911. See Emergency Action Plan for indications.
* Epinephrine is pregnancy category C.

For more information, visit:

http://www.aaaai.org/conditions-and-treatments/drug-guide.aspx

http://www.acaai.org/allergist/allergies/Types/rhinitis/Pages/rhinitis-hay-fever-treatment.aspx