Sneezing, runny nose, and watery eyes, oh my! When your environmental allergies flare up, your immediate reaction is to start taking your allergy medicine. Even when you take your allergy medication, your symptoms may not go away. Now what? We will explore what to do when your allergy medication no longer treats all of your symptoms, alternate treatment options, and what you can do to help reduce allergy symptoms.

What Are the Side Effects of My Allergy Medication?

Just as there are many different allergy symptoms, there are several options for treating allergies. Some options are over-the-counter, and some are by prescription. These medications and treatments can improve allergy symptoms but do carry the risk of side effects. Not everyone will get side effects, but knowing how a medication may affect you is crucial.

Let's look at each class of allergy medication and some common side effects:

• Antihistamine: Drowsiness (some antihistamines are non-drowsy), dizziness, blurred vision, dry mouth, feeling irritable, and decreased appetite
• Leukotriene Modifiers: Nausea, headaches, abdominal pain, cough, and upset stomach
• Nasal Sprays (steroid, decongestant, or antihistamine): Pain in the nose, headache, bloody nose, cough, and bitter taste
• Eye Drops (antihistamine, mast cell stabilizer, steroid, or anti-inflammatory): Side effects often include stinging or burning, dry eyes, and increased risk of infection, glaucoma, or cataracts (with steroid eye drops only)
• Oral Corticosteroids (side effects depend on the length of treatment and how often they are used): weight gain, increased appetite, increased infection risk, cataracts, and mood swings
• Decongestants (pill or nasal spray): Restlessness, headache, increased heart rate, nausea, and weakness
• Sublingual Immunotherapy (SLIT) or allergy shots: mouth, lip, and tongue irritation, abdominal pain, nausea/vomiting, irritated eyes, skin or injection site reactions, and nasal symptoms

How Long Should I Wait Before Considering Other Options?

Each treatment has its own expectations for when you should start feeling relief. Most medications will begin to work within hours, lasting anywhere from a few to twenty-four hours. One important point to remember about nasal decongestants is that you should not use them for more than three days. Using these for longer than three days can worsen nasal congestion after stopping.

Long-term medications, such as sublingual immunotherapy or allergy shots, must start at minimal doses and slowly increase over time to reach a maintenance dose. You won't fully experience the effects of this treatment until you reach a maintenance dose.

Sometimes your allergy medication will stop working or become less effective over time. Trying a similar medication may be helpful. You can combine some allergy medications to get maximal relief. It is best to talk with your healthcare provider or allergist to discuss your personalized medication plan and when you should consider other options.

What Should I Do If I Experience Any Adverse Reactions to My Allergy Medication?

The most significant adverse reaction to watch for with any medication is a severe allergic reaction called anaphylaxis. Symptoms of anaphylaxis include swelling of the tongue, lips, or face and hives, vomiting, or difficulty breathing. This reaction is an emergency, and you must seek immediate treatment by calling 911 or going to your nearest Emergency Room.

Typically, less severe reactions can occur. These side effects range from mild to moderate. 

• Mild reaction: If the reaction is mild, like a bitter taste in the mouth or dry eyes, you can continue taking the medication, as these reactions aren't too troubling.

• Moderate reaction: If the reaction is moderate, like headaches, nausea, or abdominal pain, it is best to stop the medication and alert your healthcare provider to discuss alternate options.

Are There Other Treatments Available for My Allergies?

There are many options available for treating allergies. Most people start with over-the-counter options like antihistamines, decongestants, nasal sprays, or eye drops. If those medications don't work, your healthcare provider may recommend a prescription medication like the leukotriene modifier or steroids. If these or a combination of these options still don't fully resolve your symptoms, it may be time for allergy testing with an allergist.

Below are some additional options for treating allergies from the American Academy of Allergy, Asthma, and Immunology:

• Sublingual Immunotherapy: This treatment gives a small dose of allergens under the tongue daily to sensitize the immune system so it does not overreact.

• Injectable Immunotherapy: This treatment increases allergens in a serum injected just under the skin. It also sensitizes the immune system so it does not overreact.

• Immune Modulators: These medications directly affect the body's immune system

• Alzair Allergy Blocker: This device creates a barrier in the nose to block allergens. 

• Tivic Nerve Stimulator: This device uses microcurrents to stimulate the nerves to block pain signals from the sinuses.

Are There Any Lifestyle Changes I Can Make to Reduce the Severity of My Allergies?

The best way to reduce the severity of allergies is to avoid the allergy trigger. Unfortunately, this is not always possible. Here are a few tips on lifestyle changes you can make to reduce your exposure to allergens:

• Avoid pets, even removing them from the home if necessary.
• Wash pets twice a week.
• Get rid of dust mites.
• Use a tight cover over bedding.
• Make sure you use a good air filtration system.

Environmental allergies can be a real headache, but you can often manage them with one or a combination of medications. Being aware of side effects, additional options, and how to make lifestyle changes to reduce allergies can make allergy season more bearable. Be sure to partner with your healthcare provider to discuss your medical history and symptoms to ensure your treatment plan is safe and effective.

References

American Academy of Asthma, Allergy, and Immunology. (n.d.). Anaphylaxis. https://www.aaaai.org/Conditions-Treatments/Allergies/Anaphylaxis

American Academy of Asthma, Allergy, and Immunology. (n.d.). Drug Guide Overview. https://www.aaaai.org/Tools-for-the-Public/Drug-Guide/Drug-Guide-Overview

American College of Allergy, Asthma, and Immunology. (n.d.). Eye Allergy. https://acaai.org/allergies/allergic-conditions/eye-allergy/

American Family Physician. (2020, April). Clinical Practice Guidelines: Allergic Rhinitis. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/allergic-rhinitis.html

Asthma and Allergy Network. (n.d.). Oral Corticosteroids (OCS) for Asthma. https://allergyasthmanetwork.org/what-is-asthma/how-is-asthma-treated/oral-corticosteroids-for-asthma/

Boltansky, H. (n.d.). Sublingual Immunotherapy - Allergy Drops. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/seasonal-allergies/could-allergy-drops-be-the-key-to-allergy-relief

Choi, J., & Azmat, C.E. (2022, December 3). Leukotriene Receptor Antagonists. National Library of Medicine, StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK554445/

National Library of Medicine, Medline Plus. (2018, February 15). Pseudoephedrine. https://medlineplus.gov/druginfo/meds/a682619.html

National Library of Medicine, Medline Plus. (2022, April 10). Antihistamines for allergies. https://medlineplus.gov/ency/patientinstructions/000549.htm

Sideman, M.D., Grugel, R.K., Lin, S.Y., et. al. (2015, February 2). Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology–Head and Neck Surgery, 152(1_suppl):S1-S43. doi:10.1177/0194599814561600. https://journals.sagepub.com/doi/full/10.1177/0194599814561600 

Sarah Beattie DNP, APRN-CNP, CDCES is a Nurse Practitioner in Ohio. She has twenty years of nursing experience. The first ten years of her career were in critical care. She then advanced her career as a Nurse Practitioner in Family Practice and Endocrinology. She has a passion for the management and education of patients with diabetes. She is a Certified Diabetes Care and Education Specialist and is certified in Plant-Based Nutrition. She has now combined her love of nursing and healthcare with writing as a freelance nurse writer in her time away from patient care.