Treating Seasonal Allergies

Required Disclaimer: This guide is published to assist patients in selecting over-the-counter (OTC) items to aid in treating the symptoms of seasonal allergic rhinitis, also known as hay fever. It is not intended to replace care from your current doctor or healthcare provider. If symptoms worsen or if you experience asthma-like symptoms such as shortness of breath, wheezing, or persistent cough, consult a doctor or nurse practitioner. 

Seasonal allergies are very common in the Willamette Valley and tend to peak in the Eugene area in late spring to early summer. The south valley region has some of the highest pollen counts in the country during the peak season. Because of this, students from other areas who normally don’t experience allergies may experience them while attending the UO. 

There are two primary approaches to dealing with seasonal allergies—avoiding or minimizing pollen contact, and treating symptoms. The main focus of this care guide is the use of over-the-counter (OTC) medications to treat symptoms, but taking steps to minimize exposure to pollen can be very helpful as well. 

Avoiding/Minimizing Strategies

  • Keep windows closed, especially in the evening when air currents can increase pollen circulation. 
  • Wash your face and hair (or shower completely) before bedtime to avoid getting pollen on your bedding (pillows). Change clothes after outside activities like cycling or running. 
  • Wear sunglasses or eye protection when outside and avoid strenuous outdoor activities when pollen counts are high. 
  • Check pollen counts for Eugene frequently. A locally maintained pollen count is available online.

OTC Symptom Management

  • Antihistamines
  • Steroid nasal sprays
  • Opthalmic (eye) drops
  • Miscellaneous other options

The UHC Pharmacy has recommendations for treating seasonal allergies, including preferred first-step agents or medications. (Note: listing of a product brand name does not imply endorsement of any specific manufacturer. Brand names are included to reduce confusion between similar-sounding generic/chemical names.)

Antihistamines

Antihistamines are grouped into generations (first, second, third) based on when they were developed and to a certain extent, their side-effect profile. Our recommendation is to start with second-generation agents because they have a good balance between effectiveness, tolerability, and price.

  • Second-generation antihistamines: The preferred first-step agent is certirizine (Zyrtec); others include loratadine (Claritin), fexofenadine (Allegra). All are taken once per day and are generally cause little to no drowsiness. We recommend cetirizine for initial treatment.
  • Third-generation antihistamines: levocetirizine (Xyzal), desloratadine (Clarinex). ‘Improved’ versions of second-generation products. May work better or have better side effect profile but this has not been proven and the products are generally more expensive. Reserve for when second generation have not worked.
  • First-generation antihistamines: diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist). Older medications that, while effective, must be taken more often and have more prevalent side effects like drowsiness. Best used as a last option if second- or third-generation agents have failed, or when taken in small doses prior to bedtime.

Steroid Nasal Sprays

Steroid nasal sprays are all quite similar in terms of effectiveness and method of use. Some studies imply that steroid nasal sprays may also help with eye symptoms even when used in the nose. (Note: Do not use nasal spray in the eye!) 

The preferred first-step agent is Fluticasone (Flonase), but triamcinolone (Nasacort) and budesonide (Rhinocort) are quite effective as well. The benefits of steroid nasal sprays may take up to a week or more to reach peak effectiveness, so start early and use continuously during the season. 

Antihistamine Eye Drops

The preferred first-step agent is ketotifen (Alaway, Zaditor), but pheniramine/naphazoline (Visine-A, Opcon-A) can also offer additional relief of itching and redness due to pollen allergies. Contact wearers should place the drops into their eyes before applying contacts. We do not recommend plain decongestant eye drops (naphazoline-only products like plain Visine) as they do not address the allergic component of eye irritation and may cause side effects if overused. 

Other Miscellaneous Items

  • Pseudoephedrine (Sudafed, Sudogest): While this product is available without a prescription in most states, it is a controlled substance in Oregon and requires a physician’s prescription.
  • Phenylephrine (Sudafed PE): Although marketed with a similar name to pseudoephedrine products, phenylephrine tends to be less effective for most patients.
  • Decongestant nasal spray (Afrin, Oxymetazoline): Very effective at rapid, short-term treatment of nasal congestion but should not be used longer than three days, to minimize the risk of rebound congestion upon discontinuation.
  • Cromolyn nasal spray (Nasal-Crom): Similar effectiveness to steroid nasal sprays, but requires much more frequent dosing (three to four times per day) for best effect. Consider if steroid sprays fail. 
  • Pollen masks, glasses (physical barriers): Anything that reduces the amount of pollen that directly contacts eyes or the amount inhaled and absorbed systemically can help to reduce allergy symptoms.