Allergic Rhinitis - Decongestants

Medications

Antihistamines

Histamine is one of the chemicals released when antibodies overreact to allergens. It is the cause of many symptoms of allergic rhinitis. Antihistamines can help relieve:

• Itching, sneezing, and runny nose (unless combined with a decongestant, antihistamines do not work well for relieving nasal congestion).
• Other allergy symptoms unrelated to rhinitis, including hives and some rashes

If possible, patients should take antihistamines before an anticipated allergy attack.

Many antihistamines are available. They include short-acting and long-acting forms, and come in oral pill and nasal spray forms.

---

---

Antihistamines are generally categorized as first- and second-generation. First-generation antihistamines, which include diphenhydramine (Benadryl, generic) and clemastine (Tavist, generic) cause more severe side effects (such as drowsiness) than most newer second-generation antihistamines. For this reason, second-generation antihistamines are generally preferred and recommended over first-generation antihistamines.

There are some notes of caution when taking any antihistamine:

• Antihistamines may thicken mucus secretions and can worsen bacterial rhinitis or sinusitis.
• Antihistamines can lose their effectiveness over time, and a different one may need to be tried.

Second-generation antihistamines are sometimes referred to collectively as nonsedating antihistamines. However, cetirizine (Zyrtec, generic) and the nasal spray antihistamines (Astelin, Patanase) can cause drowsiness when taken at recommended doses. Loratidine (Claritin, generic) and desloratadine (Clarinex) can cause drowsiness when taken at doses exceeding the recommended dose.

Brand Names. Second-generation antihistamines in pill form include:

• Loratadine (Claritin, generic). Loratadine is available over-the-counter and is approved for children ages 2 and older. Loratine-D (Claritin-D) combines the antihistamine with the decongestant pseudoephedrine. Desloratadine (Clarinex) is similar to Claritin but stronger and longer-lasting. It is available only by prescription.
• Cetirizine (Zyrtec, generic). Cetirizine is approved for both indoor and outdoor allergies. It is the only antihistamine to date approved for infants as young as 6 months. It is available over-the-counter. Cetirizine-D (Zyrtec-D) is a pill that combines the antihistamine with the decongestant pseudoephedrine.
• Fexofenadine (Allegra, generic) is also available over-the-counter.
• Levocetirizine (Xyzal) is a prescription medication approved to treat seasonal allergic rhinitis in patients age 2 years and older. It is available in both pill and liquid form.
• Acrivastine and pseudoephedrine (Semprex-D) is a pill that combines an antihistamine and decongestant.