Seasonal allergies don’t always manifest as the textbook description of runny nose, sinus congestion, and itchy, watery eyes. Headaches, cough, dizziness, or simply a drop in energy can all represent allergy-related symptoms. Treatment options extend from run-of-the-mill antihistamines to IV therapy drips. While therapeutic remedies should always be discussed with your doctor, here are a few general considerations when choosing the best remedies for you:

• Oral Anti-Histamines:  Zyrtec (cetirizine) and Xyzal (levocetirizine) tend to be most effective, though these are associated with drowsiness in ~20% of the population in spite of their “non-drowsy” classification. Claritin or Allegra, albeit less potent, may be milder in terms of sedating side effects. Dry mouth/eyes is a common side effect, and these should be avoided in those with significant urinary retention issues.

• Decongestants:  It should be noted the pseudoephedrine (sold behind the pharmacy counter) is typically far more effective than its on-the-shelf counterpart phenylephrine (Sudafed PE), though also more likely raise blood pressure or stimulate a faster heart rate. Oral, and even more so nasal (Afrin), decongestants are typically intended for short-term or sporadic use and can result in rebound runny nose when used excessively. Pseudoephedrine (the “real” Sudafed) is  the “D” component of antihistamine combo meds.

• Nasal Sprays:  Steroidal-based nasal sprays such as Flonase (fluticasone) and Nasacort (triamcinolone) are available over-the-counter. These are typically highly effective for the treatment and prevention of sinus inflammation and tend to carry fewer systemic side effects than oral pills. They are most effective when used consistently (i.e, I wouldn’t call it a “treatment failure” if 2 days of Flonase hasn’t saved the day). These can be surprisingly helpful for allergy-related cough, which often stems from nasal drip rather than lung irritation. While typically considered quite safe, regular use of steroidal nasal sprays should be noted to your doctor, since they may be considered sub-optimal for those with glaucoma, osteoporosis, or frequent nosebleeds. Additional anti-histamine-based nasal sprays such as azelastine may be used as adjunctive treatment; these require a doctor’s prescription.

• Eye Drops:  Most antihistamine eye drops are now available over-the-counter:  e.g. Pataday (olopatadine), which may be a hare more effective than Alaway (ketotifen). When using these, one must be careful to ensure that eye irritation is indeed suspected to be from allergies. These can trigger dryness as a side effect, thus potentially hindering rather than helping irritation if caused by another issue.

• Asthma-Based Remedies:  The tried-and-true albuterol inhaler is helpful for those who may have sporadic coughing fits or chest tightness related to allergies. However, albuterol only briefly loosens up the airway; it doesn’t reduce lung inflammation. For those with more chronic, regular asthma symptoms, prescribed steroidal or combination inhalers (eg Flovent, Advair, etc) used on an everyday basis can reduce inflammation and offer substantial benefit during triggering seasons. The oral prescription medication Singulair (montelukast) may also be an option for those who dislike the inhaler route.

• Natural Supplements:  My recommendation for allergic therapy in the homeopathic world is the plant-based flavonoid Quercetin. It reduces the production of pro-inflammatory cytokines and appears to function as an immune modulator, antihistaminic agent, and even potentially as an antiviral remedy. Doses of 250->500 mg up to twice/day are typically effective.

• IV Therapy:  We’ve countlessly seen benefit in allergy, sinus, and even asthma-related symptoms from the Myer’s cocktail, readily available as an option in our IV lounge  IV vitamin C not only results in an immune boost, but triggers and antihistamine effect at high doses, which has been reported in prior studies. The additional Magnesium component of the Myer’s cocktail acts as an anti-inflammatory agent and natural bronchodilator, thus helpful for airway-related symptoms. Caution in vitamin C administration is advised for those who suffer from kidney stones given the potential for this to increase risk of stone formation. For the general population, IV nutritional therapy is otherwise quite safe.