Seasonal allergies, also known as allergic rhinitis or hay fever, impact over 25% of the U.S. population, with peak pollen seasons typically occurring from March through May. These allergies often manifest as uncomfortable symptoms such as a runny nose, sneezing, and itchy eyes. While various allergy medications are available to provide relief, understanding which ones are safe for daily use versus those intended for short-term symptom management is crucial for effective and safe allergy control.

According to William Reisacher, MD, an otolaryngic allergist, the primary classes of allergy medications include nasal steroid sprays and antihistamines, available in oral tablets, eyedrops, and nasal spray forms. Some allergy medications are suitable for daily use, while others should be reserved for occasional needs.

Safe Medications for Daily and Long-Term Use:

Nasal steroid sprays are among the medications that require daily use to achieve optimal effectiveness, though they should not be used for more than three months out of the year for allergies. Over-the-counter options like Flonase are available, alongside prescription-strength sprays such as Azelastine. While highly effective, Tonia Farmer, MD, ENT Surgeon, notes potential side effects of daily nasal steroid use, including an increased risk of nasal septal perforation and nosebleeds. There is also a known link to worsening cataracts and glaucoma, requiring caution for individuals with existing eye problems. More research is needed on potential growth issues in children with long-term nasal steroid use.

Another class of medications considered safe for daily and extended use are leukotriene receptor antagonists, such as montelukast (Singulair). These prescription medications have been utilized for asthma and allergies for many years and possess a generally good safety profile, even with prolonged use, as highlighted by Dr. Reisacher. However, it's important to be aware that montelukast has been associated with an increased risk of neurological and psychiatric issues, particularly in younger individuals.

Medications Not Recommended for Daily or Long-Term Use:

Generally, antihistamines and antihistamines combined with decongestants are not advised for daily or long-term administration. Antihistamines can lose their therapeutic efficacy quickly with extended use and may lead to dependency. Dr. Reisacher suggests that antihistamines should be used "on demand, not on schedule," specifically when symptoms like sneezing, itching, and a runny nose significantly impair quality of life.

Antihistamines are categorized into two groups based on their central nervous system effects. First-generation, or sedating, antihistamines like Benadryl and Atarax readily cross the blood-brain barrier, often causing drowsiness. Dr. Farmer points out a concerning link between long-term use of certain first-generation antihistamines, such as diphenhydramine (Benadryl), and an increased risk of dementia. This particular risk is largely avoided with second- and third-generation antihistamines, including cetirizine (Zyrtec), levocetirizine (Xyzal), loratadine (Claritin), desloratadine (Clarinex), and fexofenadine (Allegra).

Second-generation, or nonsedating, antihistamines are less likely to cross the blood-brain barrier, which helps prevent harmful substances from reaching the brain. While all antihistamines are primarily intended for short-term relief, second-generation versions are considered safer due to a reduced likelihood of side effects like sedation, dry mouth, and stomach irritation. Nevertheless, prolonged daily use of even second-generation antihistamines should only occur under the guidance of a healthcare provider.

Furthermore, caution is necessary with antihistamines formulated with decongestants, typically denoted by a "-D" suffix (e.g., Benadryl-D, Claritin-D). Dr. Reisacher warns that these combinations can induce increased blood pressure, heart palpitations, anxiety, and insomnia. Dr. Farmer adds that nasal decongestants can cause rebound congestion, or rhinitis medicamentosa, if used for more than three days, and long-term use can constrict blood vessels in the nose, potentially leading to a nasal septal perforation. For those requiring a decongestant, Dr. Reisacher recommends taking a separate, lower-dose decongestant rather than a combination product.

Non-Medication Strategies for Allergy Management:

For individuals seeking natural alternatives or supplementary methods to manage allergy symptoms, several non-medicated approaches can be effective:

• Keep windows closed in both your home and car to minimize pollen exposure.
• Check local pollen counts and plan outdoor activities when counts are lower.
• Regularly use saline nasal sprays or flushes to clear allergens from nasal passages.
• Utilize an air purifier 24/7 to clean the indoor air.
• Employ a bedside humidifier to hydrate the air you breathe.
• Remove pollen-laden clothes and shoes before entering deeper into your home.
• Opt for hardwood flooring over carpet and reduce clutter to minimize dust and dirt accumulation.
• Keep pets out of the bedroom.
• Maintain a healthy immune system through a balanced diet and adequate rest.
• Keep the nose healthy and hydrated, especially since nosebleeds are common during allergy season due to inflamed and dry nasal passages.

While many can effectively manage allergies without medication, severe symptoms may necessitate professional medical advice. If relief remains elusive, Dr. Reisacher advises consulting an allergy specialist. An allergist can provide an accurate diagnosis and explore advanced management strategies, including specific medications or treatments like allergy immunotherapy.