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Spring’s Arrival Means Allergies. Medical Solutions Rise to the Challenge

person sniffling with kleenex and allergy medication on table in front of them

Everything to Know About Nasal Sprays, Eye Drops and Allergy Pills

By Hue Xiong, Doctor of Pharmacy candidate 2022 at the Medical College of Wisconsin with consultation from Beth Coopman Pharm D., pharmacist at Network Health
4/11/2022

A sacred time in the Great Lakes states, spring is our final send-off to the harsh temperatures, intimidating precipitation and long darkness of winter. It’s not all sunshine and rainbows, though. Spring, for millions, means the trading of one discomfort for another. We’re talking about allergies.

Over time, seasonal allergies can be cured. A lot of advice from experts also centers around prevention.

When it comes to treating seasonal allergies, you’ll generally find three ways to do it.

  • Allergy nasal sprays
  • Allergy eye drops
  • Allergy pills

Today, we’re going to look at each of these categories, compare popular medications in each and help you determine which treatment method is the best for you and your unique allergies.

Which allergy nasal spray is best for me?

Steroidal nasal spray

A compelling starting point for minimizing sinus discomfort from allergies, steroid nasal sprays like Flonase, Rhinocort, Nasonex and Nasacort are among the most popular allergy remedies. These nasal sprays also treat sneezing and itchy/watery eyes.

All four of these popular sprays have generic variants. With the exception of Nasonex, all of the above sprays are also available over the counter. When you can purchase a generic, do so. They are comparable to brand-name drugs but save you money.

If you have nasal sensitives, Flonase has a Sensimist variant. Nasacort and Rhinocort are both free of alcohol and any extra scents. Both Rhinocort and Flonase Sensimist have less liquid per spray, minimizing uncomfortable throat-drainage.

Non-steroidal nasal spray options

Some allergy nasal sprays do not rely on steroids as their active ingredient. Popular brand names in the non-steroid category are Afrin and Nasalcrom.

Afrin works quickly and is typically most effective for pure congestion. It is directed to be used only for three consecutive days and can even make symptoms worse if used longer than that. With these dosing challenges, you may want to consider an oral decongestant instead.

Unlike Afrin, which is a decongestant, Nasalcrom is an antihistamine. Generally, Nasalcrom will help prevent sneezing, allergic sinus swelling/congestion and runny nose. Nasalcrom is directed to be taken one to two weeks before allergen exposure, moving it from an allergy symptom treatment method to a prevention method.

A nasal saline solution has very few potential health complications, can be used by allergy symptom sufferers of any age and, due to the lack of medication, is a great choice for those who are pregnant. A saline solution works to eliminate mucus in the nose and can soothe nasal irritation or dryness.

Flonase vs. Nasonex vs. Afrin vs. other allergy nasal sprays

Brand Name

Generic Name

Age Allowed

Onset of Effect

Peak

Duration

Common Side Effects

Cost/Bottle

Flonase

ClariSpray

Fluticasone Propionate

≥ 4 yrs

12 hrs

2 weeks

24 hrs

Headache

Nose irritation

Bloody nose

$15

Flonase Sensimist

Fluticasone Fumarate

≥ 2 yrs

12 hrs

2 weeks

24 hrs

Headache

Bloody nose

$24 (no generic)

Nasonex

Rx only

Mometasone

Rx only

≥ 2 yrs

12 hrs

 

2 weeks

24 hrs

Headache

Bloody nose

$50

Nasacort

Triamcinolone

≥ 6 yrs

12 hrs

 

2 weeks

24 hrs

Bloody nose

Sore throat

$13

Rhinocort

Budesonide

≥ 2 yrs

12 hrs

2 weeks

24 hrs

Bloody nose

Sore throat

$17

Afrin

Oxymetazoline

≥ 6 yrs

Rapid

15 min

12 hrs

Nasal burning or stinging

$8

Nasalcrom

Cromolyn

≥ 2 yrs

1 wk

2-4 weeks

6-8 hrs

Nasal stinging

sneezing

$15

Ocean Saline

Sodium Chloride 0.65%

All

Rapid

Rapid

4-6 hrs

Nasal discharge

Nasal burning

$4

Reference: Micromedex® and pricing estimates from Walmart.com and Goodrx.com. (Cost listed is for generic product and cost decreases per dose as package size increases.)

Allergy eye drops

If your allergy symptoms include itching and burning eyes, eye drops seem like the most straightforward way to treat them. After all, what could work better than a topical medication for the part that is providing the most discomfort? Generally speaking, allergy eye drops are an effective solution. Which one is best?

Before picking the best eye drop, it’s important to know that there are three types commonly prescribed or recommended.

  • Non-medicated eye drops
  • Medicated eye drops/antihistamines
  • Eye decongestants

Non-medicated eye drops

For those with eye redness and dryness, artificial tears and saline eye wash provide a non-medicated option for lubrication and washing the allergen from the eye. All ages can use artificial tears and saline eyewash with few side effects and minimal cost which makes them good choices during pregnancy, during breastfeeding and for children with eye allergies.

In addition to refrigerating lubricating eye drops, placing an ice pack or cold compress on the eyes can also provide relief. Things to avoid include rubbing your eyes, which worsens symptoms, and wearing contact lenses, which allergens stick to.

Medicated eye drops

If non-medicated eye drops are ineffective, antihistamine eye drops are the next best option for itchy and watery eyes. These eye drops are valued for their ability to rapidly relieve allergy symptoms.

Mast-cell stabilizers, another eye drop drug class, have minimal side effects, can prevent allergies and are safe if used long term. Best of all, the dual-action antihistamine and mast-cell stabilizer eye drops, olopatadine (Pataday®) and ketotifen (Alaway®, Zaditor®), work quickly to treat and prevent eye allergies from pet dander, pollen, ragweed and grass. Pataday® is now available over the counter in once-daily and twice-daily formulations.

Eye decongestants

Eye decongestants, like naphazoline, tetrahydrozoline, oxymetazoline and phenylephrine work to reduce eye inflammation and redness. These eye drops should not be used longer than 72 hours because eye redness can worsen from overuse.

NaphconA contains a decongestant and antihistamine to reduce redness and itchy and watery eyes. Lumify® is a new over-the-counter (OTC) eye drop, which reduces eye redness only.

Eye drop comparison

Brand Name

Generic Name

Age Allowed

Onset of Effect

Peak

Duration

Common Side Effects

Cost/Bottle

Pataday®

Once daily

Olopatadine 0.2%

≥ 2 yrs

Rapid

2 hrs

24 hrs

Headache

Eye burning

Eye stinging

$15

Pataday®

Twice daily

Olopatadine 0.1%

≥ 2 yrs

Rapid

2 hrs

12 hours

Headache

Eye burning

Eye stinging

$8

Zaditor®

Twice to three times daily

Ketotifen 0.035%

≥ 3 yrs

Rapid

2-4 hrs

12 hrs

Eye redness

Headache

Runny nose

$12

Alaway®

Twice to three times daily

Ketotifen 0.025%

≥ 3 yrs

Rapid

2-4 hrs

12 hrs

Eye redness

Headache

Runny nose

$10

NaphconA®

Four times daily

Naphazoline 0.025% and Pheniramine 0.3%

≥ 6 yrs

Rapid

Up to 2 hours

6-8 hrs

Eye redness

Eye irritation

Eye pain

$10

Saline Eye Wash

Varies

All

Rapid

Rapid

Varies

Eye discharge

Eye stinging

$3-10

Artificial Tears

Varies

All

Rapid

Rapid

2-4 hrs

Eye discharge

Eye stinging

$3-10

Lumify®

Brimonidine 0.025%

≥ 5 yrs

Rapid

Up to 4 hrs

8 hrs

Itching

Foreign body sensation in eye Tearing

$12

Reference: Micromedex® and pricing estimates from Walmart.com. (Cost listed is for generic product and cost decreases per dose as package size increases.)

Allergy pills

The third, and final, way allergy symptoms are typically treated is with allergy pills.

Allergy medications can be broken down into first- and second-generation products, the latter of which tends to provide longer relief with fewer side effects compared to first-generation medication.

First-generation allergy medication

First-generation oral antihistamines include Benadryl and Chlor-Trimeton®. These medications have more side effects but do tend to have a quicker onset of relief. Some of these side effects include drowsiness, constipation, difficulty urinating and a dry mouth.

As we age, we become more susceptible to these side effects and can experience falls or confusion, which is a good reason to avoid use in older adults or limit to a short duration at the lowest effective dose.

Children may experience opposite side effects such as excitability, anxiety or insomnia.

Second-generation allergy medication

Generally preferred for continuous treatment of seasonal allergies, second-generation oral antihistamines like Allegra and Claritin have a much lower risk of side effects like drowsiness. One exception, Zyrtec, has been shown to cause drowsiness in about ten percent of individuals who take it.

If you wind up taking Allegra, certain foods/drinks, such as those containing grapefruit, orange or apple juice, can decrease its effectiveness. If you find you’re not getting relief from one medication, trying a different second-generation pill may prove to be helpful.

Comparison of allergy pills

Brand name

Generic name

Age allowed

Onset of effect

Peak

Duration

Common side effects

Cost 90ct

Walmart

Claritin

Loratadine

2+ yrs

1-3 hrs

8-12 hrs

24 hrs

Headache

$7

Zyrtec

Cetirizine

2+ yrs

Rapid

1 hr

24 hrs

Headache

Drowsiness

$10

Allegra

Fexofenadine

2+ yrs

1 hr

2-3 hrs

12-24 hrs

Headache

Vomiting

$20

Benadryl

Diphenhydramine

6+ yrs

15-30 min

2-4 hrs

4-6 hrs

Drowsiness

Restlessness

$4

Chlor-Trimeton

Chlorpheniramine

6+ yrs

30-60 min

2 hrs

4-8 hrs

Dry Mouth

$14

Reference: Clinical Pharmacology and pricing from Walmart.com (Cost listed is for generic product and cost decreases per tablet as bottle size increases.)

Which type of allergy medicine is best?

After reading through the different types of allergy medicines and how those are broken down into their own options, it’s clear. The best allergy medicine is the best allergy medicine that works for your symptoms with minimal side effects.

If your allergies tend to manifest primarily as a stuffy nose, you may find yourself trying nasal spray as your first line of defense. However, if itchy or stinging eyes mark your allergies, an eye drop may be the best way to go.

Allergy pills tend to provide the best full-body coverage but have their own pros and cons which can include side effects (for first-generation medication) or a slower onset and less targeted application (for second-generation medication).

Be an informed health care consumer. Know how your prescription choices impact your plan’s costs. Ask your doctor or pharmacist about cost alternatives for your prescriptions or OTC selections.

If you have any questions pertaining to this article, email the pharmacy team at [email protected].

For more information on how your Network Health plan can help with uncomfortable allergies, contact us today.

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