Allergy medications: The Optum Perks Guide

Table of Contents

1. How antihistamines help allergies
2. What to know about decongestants
3. The scoop on corticosteroids
4. How mast cell stabilizers work
5. Using leukotriene inhibitors
6. What are anticholinergics?
7. What medication should I try first?

If you live with allergies, it can be hard to figure out which medication might be right for you.

There are inhalers, nasal sprays, eye drops, pills and liquids. Some need a prescription and others don’t. And some decongestants are available over the counter (OTC) but you must show identification to buy them.

Here are some of the different medications to consider — and what they do.

(Optum Perks offers a free discount pharmacy card that could save you up to 80% on some prescription medications.)

How antihistamines help allergies

Antihistamines block a substance in your body called histamine, says Alyssa M. Wozniak, PharmD. She’s a clinical assistant professor and director of interprofessional education at the School of Pharmacy at D’Youville University in Buffalo, New York.

“Histamine is released when your body detects a harmful situation, such as an infection. It causes blood vessels and skin to swell and expand to protect your body,” she says.

In people who have allergies, histamine is released in response to harmless triggers. Those might include pollen, grass, animals or indoor dust. The reaction can cause:

• Itchiness
• Watery eyes
• Runny or stuffy nose
• Sneezing
• Rashes

Many antihistamines are available OTC, Wozniak says. Examples include fexofenadine (Allegra), loratadine (Claritin) and diphenhydramine (Benadryl).

“They can cause drowsiness, but it depends on the specific medicine,” Wozniak explains. For example, she says, Benadryl may cause more sleepiness than Claritin.

Other antihistamines, such as desloratadine, are available only by prescription.

There are also some antihistamine nasal sprays on the market. Azelastine is available OTC, but there’s also a stronger prescription version (Astelin). Azelastine nasal spray helps with seasonal or year-round allergy symptoms. Olopatadine (Pataday) is an OTC eye drop that blocks histamines. There’s also a prescription olopatadine nasal spray (Patanase) that’s similar to azelastine.

Recommended reading: Super easy ways to save on your allergy medication.

What to know about decongestants

When you’re exposed to an allergen, your blood vessels can expand and swell, says Tara F. Carr, MD. She’s a board-certified allergist and associate professor of medicine at the University of Arizona College of Medicine in Tucson. Decongestants can reduce some of the swelling in your nose and sinus cavities.

They can work very well. But, she says, they’re not a long-term strategy. These medications are best for patients with short-term symptoms such as a stuffy nose. They include oral phenylephrine (Sudafed PE) and nasal oxymetazoline (Afrin).

Decongestants are often combined with other allergy medications, such as antihistamines. When they’re used in a nasal spray form, such as Afrin, they should not be used for longer than 3 days. “Your nose can get used to them, and the effect may wear off. That can lead to worsening nasal congestion later,” Wozniak says.

Decongestants narrow blood vessels, which in turn can raise blood pressure. So while they may be available OTC, you should still talk to your doctor about whether they’re right for you.

Recommended reading: Allergies can cause hives, but you can calm the itch.

The scoop on corticosteroids

Steroids, sometimes called corticosteroids, often come in nasal spray form, says Wozniak. They can prevent and ease stuffiness, sneezing, and a runny nose. Options include fluticasone (Flonase) and mometasone (Nasonex).

These medicines reduce swelling in the mucous membranes to relieve a stuffy or runny nose. Wozniak says you should start to feel better within 12 hours. And the full effects should kick in after a few days. Possible side effects may include nasal irritation and a bad taste in your mouth.

“An advantage of these medications is their effect on nasal congestion and the fact that many are available over the counter,” she says.

The most common options are triamcinolone (Nasacort) and budesonide (Rhinocort), says Dr. Carr. But Beconase, Omnaris and Zetonna are also options.

How mast cell stabilizers work

Mast cell stabilizers keep histamine from being released by the cells. This can stop your body’s allergic response to things such as grass, animals and indoor dust.

These medications include nasal and eye drop versions of cromolyn (Nasalcrom) and the eye drop ketotifen, Wozniak says.

Nasal sprays such as cromolyn work best when used to prevent allergy symptoms. They can take 1 to 2 weeks to treat existing symptoms, Wozniak says.

Other examples of mast cell stabilizers (available as eye drops) are:

• nedocromil (Alocril)
• bepotastine (Bepreve)
• alcaftadine (Lastacaft)

“These are often classified as antihistamines, but they have mast cell stabilizing properties as well,” Dr. Carr says.

Using leukotriene inhibitors

Leukotrienes are another set of chemicals that your body releases when you are exposed to an allergen. Coughing, wheezing and congestion are among the symptoms that you could have.

For those types of issues, leukotriene inhibitors can be helpful. “These medications block the chemicals that can cause symptoms in the first place,” Dr. Carr explains. “They’re usually well tolerated but can cause mood changes. If you start to feel anxious or depressed, stop the medication immediately and tell your doctor.”

Wozniak adds that they could be a good choice if you also have asthma, because they can help those symptoms, too.

Medications such as montelukast (Singulair) are available by prescription only. (Look for your prescription on the Optum Perks discount app before you head to the pharmacy. Don’t have it? Download it now.)

What are anticholinergics?

Anticholinergics are not often used for allergies. They are usually used for conditions such as an overactive bladder or chronic obstructive pulmonary disease, among others. But they may be given for allergies, Wozniak says. One type of anticholinergic is ipratropium bromide (Atrovent). This medicine can block histamines and open the airways in the lungs. It’s taken by way of a nebulizer, inhaler or nasal spray.

“It has limited use for people with allergies. But it’s really good for runny, drippy noses,” Dr. Carr says.

Diphenhydramine (Benadryl) is sometimes called an anticholinergic. But for allergies, it’s often called an antihistamine. This medicine can cause side effects such as:

• Blurred vision
• Dry mouth
• Retention of urine
• Confusion
• Drowsiness

“So be careful about this one,” says Wozniak. “For example, Benadryl may not be the best choice for elderly people, due to an increased risk of falls.”

Certain patients could benefit from these medications, though. “Younger people whose allergies keep them up at night could benefit. The medication will cause drowsiness and also help them sleep,” Wozniak says.

What medication should I try first?

Often, steroid nasal sprays are the first treatment. But if your symptoms don’t improve, another medication may be needed. So talk to your doctor.

Sometimes combining 2 medications can help. An antihistamine pill and a steroid nasal spray, for example. Or a nasal spray with a steroid and an antihistamine.

The bottom line: Allergies can be frustrating. But there are many medications you can explore to help combat the symptoms. Work with your doctor, and you can breathe easier in just a few days.

Be sure to search for your prescription on the Optum Perks discount app before heading to the pharmacy. You could find medication coupons for up to 80% off.

Additional sources:
Guide to allergy medications: American Academy of Allergy Asthma & Immunology
Olopatadine: Mayo Clinic
Decongestant use: Harvard Health Publishing