Medications and Sprays for Allergy Relief

While we extensively discuss the benefits of allergy immunotherapy, including allergy shots, allergy drops, and allergy tablets, on this website, it is essential to remember that decongestants, antihistamines, and nasal allergy sprays remain front-line therapies to help patients through their symptoms. While they do not offer preventative benefits, they are more immediate solutions for runny nose, sneezing, stuffy nose, and itching. Let’s discuss some of the most common medications that control the symptoms of allergies and how they should be used:


Decongestants are used for various conditions that cause nasal congestion and are often marketed for treating allergic reactions and sinusitis. Decongestions work by reducing swelling in the blood vessels of the nose, thereby opening up the airway and allowing for better breathing. You will probably know the brand Sudafed, a well-known pseudoephedrine pill brand. This is safe for many patients and is available over the counter in a variety of formulations (often combined with antihistamines, e.g. Claritin-D). However, that does not mean they are without risk. Patients should speak to their doctor before taking any decongestant. This is especially true for people with hypertension or high blood pressure, thyroid concerns, liver or kidney problems, heart problems, diabetes, and glaucoma, to name a few because pseudoephedrine can . Pregnant women and those breastfeeding should also speak to their healthcare professionals, as the safety of these products in those circumstances has not been proven.

You may be familiar with the nasal spray Afrin, which contains fast-acting oxymetazoline. It is very effective, but has significant drawbacks. If used for more than a few days, there is a distinct possibility of a rebound effect that worsens the stuffiness. Not only that, but this risk can persist (becoming “addicted” to the nasal spray and requiring it more frequently to avoid rebound congestion). This is NOT true of the allergy sprays (Flonase, Astelin, Nasacort etc). Patients should read the warning labels on the packages carefully and speak to an experienced ENT like Dr. Boger to understand more. Patients should also be aware of interactions with other drugs, like anti-depressants and other all-in-one medications that include a decongestant and can cause an overdose. There is a relatively long list of possible side effects and adverse events, which will be discussed in detail on the paperwork with the product.

Decongestant Abuse

Dr. Boger notes that while the effects of these decongestants can be dramatic and rapid, something with such excellent results often comes with significant drawbacks. In other words, this is not a free lunch. There is a substantial risk of decongestant abuse if patients do not follow directions carefully. Many will start with a spray every eight hours, for example, but will need it more and more often (even every 2 hours) over time. In addition to this tolerance, the mucosal membranes of the nose may begin to deteriorate as these medications restrict blood flow. Ultimately surgery to open the nasal passage can be required if the patient can’t get off the spray.

A Note on Phenylephrine

As an aside, phenylephrine, a common ingredient in over-the-counter cold and allergy medicines, has recently been designated ineffective (in tablet form) by an advisory committee to the FDA. There is some debate in the ENT community regarding this. Therefore, we suggest that patients not buy any new medicine containing this compound. The FDA may decide to reclassify phenylephrine, eventually ending its commercial sale.


Corticosteroids are a proven and effective treatment for asthma, allergic rhinitis, and atopic dermatitis, amongst other allergic conditions. Corticosteroids act as an anti-inflammatory and have rapid and lasting effects. A deep data pool shows corticosteroid nasal sprays are even more effective than antihistamines for seasonal allergies. They can be administered in several ways, including nasal, subcutaneous (shot), and oral routes.

Oral and injection-based corticosteroids do not just affect the nose but have a systemic or body-wide effect. Sometimes, these can be beneficial, but we typically prefer nasal steroids when possible. Oral corticosteroids can also cause growth concerns in children and bone density problems in those of advanced age. Corticosteroids may also affect the developing child when taken by a pregnant or breastfeeding mother. Short courses (5-10 days) are generally safe in healthy patients, whereas longer courses (weeks to months) are more prone to cause complications.

You will have probably seen the brands Flonase and Nasacort. These are both effective corticosteroid products. While original Flonase is indicated for itchy and watery eyes, which Nasacort is not, Dr. Boger prefers Nasacort (or Sensimist) because it does not use an alcohol-based agent.


Antihistamines (e.g., Claritin, Allegra, Zyrtec, Benadryl) are prescription and over-the-counter medications that block histamine production in the body. Histamine is a natural chemical that regulates several essential functions but is also secreted when the body senses the presence of an allergen. Antihistamines are divided into two categories. The first is an H–1 receptor antagonist used to treat the symptoms of allergies. H-2 receptor antagonists are approved to treat GI issues, including reflux, nausea, and vomiting. Antihistamines have been around since the 1930s and have an excellent track record. They can still be used with other allergy therapies like immunotherapy but should be part of a larger treatment plan discussed with Dr. Boger. The benefits, potential risks, and drug interactions of antihistamines are extensive and can be discussed during your consultation. You should also refer to the product labeling to understand what to expect.

Deciding between over-the-counter and prescription antihistamines largely depends on the severity of symptoms. Mild symptoms are often treated with over-the-counter drugs. Moderate allergic reactions may be best treated with prescription medication. Most importantly, speak to an ENT like Dr. Boger about which medicine is the best for your circumstance.