Sneezing and runny nose are the main symptoms for which these medications are often used, but their effectiveness for nasal congestion (blocked nose) is limited. In general, they are said to cause less drowsiness.
In particular, fexofenadine (Allegra®) and desloratadine (Aerius®/Desalex®) are less likely to cause drowsiness.
On the other hand, olopatadine (Allelock®) and cetirizine (Zyrtec®) are more likely to cause stronger drowsiness.
Bilastine (Bilaxten®) and rupatadine fumarate (Rupafin®) are relatively newer medications.
In addition, emedastine fumarate (Alesion®/Alesaga®) is available as a once-daily patch applied to the chest or arm. It is recommended for people whose symptoms return when the effect of oral medication wears off.
It should be noted that stronger drowsiness or being a newer drug does not necessarily mean higher effectiveness. Please consult your doctor if you have any questions.
Histamine is related to sneezing, while leukotrienes are associated with nasal congestion (blocked nose). Therefore, these medications are recommended for people who have strong nasal congestion.
Currently, two types of drugs are available. Examples include pranlukast (Onon®) and montelukast (Singulair® / Kipres®).
The combination of fexofenadine and pseudoephedrine (D Allegra® / Diligen® [Dislegra]) contains pseudoephedrine, which has a vasoconstrictive effect.
Because of this, it should only be used for the shortest necessary period when nasal congestion is severe. In particular, its efficacy and safety have not been established for use beyond two weeks.
Herbal (Kampo) medicines may sometimes be effective for hay fever. In particular, Shoseiryuto (Xiaoqinglong Tang) has been shown to be effective for perennial allergic rhinitis. (Efficacy of Shoseiryuto for perennial allergic rhinitis – A double-blind comparative study. Journal of Otolaryngology Clinical Practice 1995; 88: 389–405.) Please also refer to the separate page “Which Kampo medicines are effective for hay fever?”Which Kampo medicines are effective for hay fever?”
Shoseiryuto is especially effective for people with watery nasal discharge as the main symptom. It is a Kampo medicine with very few side effects such as drowsiness, and it is available in both powder and tablet form.
You can choose to use it either once a day or twice a day. One bottle lasts for about one month.
It is recommended to start treatment from the early stage of symptoms, either with intranasal corticosteroid spray (nasal spray) alone or in combination with antihistamines and other medications.
In particular, we mainly prescribe the following medications, which are effective and require only once-daily use:
Mometasone furoate (Nasonex®)
Fluticasone furoate (Avamys® / Aramist®)
These eye drops are used when you have itchy eyes. One bottle lasts for about two weeks. Usually, eye drops with anti-allergic or antihistamine effects are used. If the effect is insufficient, steroid eye drops may also be used; however, caution is required due to the risk of complications such as infections.
Medications with anti-allergic effects include Intal® (Cromolyn), Alegysal®, Zaditen® (Ketotifen), and Rizaben®.
Medications with antihistamine effects include Livostin® and Zaditen®, which have a rapid onset of action.
Medications with steroid effects include Flumetholon® eye drops.
Immunotherapy is currently considered the only treatment that has the potential to cure hay fever.
However, it is not effective for everyone. Reports show that approximately 20% of patients achieve complete remission, 30% are able to reduce their use of hay fever medications, and another 30% still experience symptoms but find them more manageable than before.
In principle, immunotherapy can be combined with other medications as long as they do not contain oral steroids.
(This is because oral steroids may suppress the immune response, potentially reducing the effectiveness of sublingual immunotherapy.)
Please also refer to the separate page, “Allergen Sublingual Immunotherapy.
In summary, there are many different medications available for the treatment of hay fever. For people who experience symptoms every year, it is recommended to begin treatment about one to two weeks before symptoms usually become severe.
However, it is very important to use the medication appropriate for your symptoms, in the correct dosage, and for the proper duration.
