HE IDEAL WAY TO MANAGE HAY FEVER, or more generally allergic rhinitis, is to practice prevention. This involves first determining with the help of your physician the substance or allergen that causes your allergic reaction and then avoiding exposure to that allergen.
Prevention, however, is not foolproof. It can fail when your control over the environment to prevent exposure to allergens is inadequate. When prevention fails and your symptoms are severe, you may have to resort to medications.
To understand the various treatment options available, it is helpful to understand first how an allergic reaction occurs.
How does an allergic reaction occur?
An allergic reaction occurs when your body’s immune system misinterprets the harmless allergen as a dangerous invader and responds to it defensively by releasing a chemical called histamine into the bloodstream.
Histamine causes inflammation (evident as swelling and redness) of the sinuses, nose, and mucus membranes of the eyes, and triggers sneezing. The swelling reaction is your body’s method of blocking the allergen from entering the body while the sneezing reaction is it’s method to expel the allergen out of the body. Histamine also causes fluids to enter the nasal tissue, resulting in congestion, itching, and a runny nose.
Treatment Options
The following are the main classes of over-the-counter and prescription drugs that can provide relief.
• Antihistamines: Antihistamines do not prevent the release of histamine, nor do they stop the allergic reaction; rather they protect tissues from the effects of the allergic response and thus reduce symptoms. The older over-the-counter (OTC) antihistamines (Benadryl, Chlor-Trimaton, and Dimetapp) frequently cause sleepiness. They should not be taken when driving a car. The newer antihistamines (Allegra, Reactine, and Claritin) induce less drowsiness.

They also have a slower onset of action and are longer acting. Also, many antihistamines are available combined with a decongestant.
• Decongestants: Decongestants shrink the swollen membranes in the nose and make it easier to breathe. They are often marketed as “sinus” medications and can be taken either orally (Sudafed) or by nasal spray (Neosynephrine). Oral decongestants are usually combined with antihistamines, mucus thinners, or anti-inflammatory drugs such as aspirin. Caution: Decongestant nasal sprays can be addictive and often cause a worsening of symptoms when discontinued. They should not be used for more than a few days.
• Cortisone nasal sprays: Unlike decongestant nasal sprays, these nasal sprays do not cause the rebound effect mentioned above. They are very effective in reducing the inflammation that causes swelling, sneezing, and a runny nose. These sprays (Omnaris, Nasonex, Avamys) are available through prescription only.
• Cromolyn: This nasal spray is sold under the brand name Nasalcrom. It is an anti-inflammatory medication that partially inhibits the release of histamine. Although not as potent as cortisone, it has few side effects and is available OTC. It should be used well in advance of anticipated allergy symptoms to be useful, however.
• Eye Drops: Eye drops can be very helpful in reducing symptoms of itchy, red, burning eyes, but OTC eye drops can stop working after a few days and have some side effects. Several eye drops are also available by prescription. Seek the advice of your doctor as to the best treatment option for you. Also, before using any OTC drugs, make sure you discuss with your doctor and/or pharmacist any potential side effects and also how they may interact with other medicines you take.