Counter Allergies With Medicine
There are a wide variety of medicines that help to prevent the effects of an allergic reaction. These are available as pills, liquids, inhalers, nasal sprays, eyedrops, skin creams, and injections. Talk with your doctor to come up with a course of action for managing your allergies.
Different medicines target different biological processes that occur during an allergic reaction, where the goal is to disrupt the normal progression of events to keep you feeling well. For example, some medications block inflammatory mediators from communicating, while others prevent the release of these inflammatory mediators altogether.
Antihistamines43
Antihistamines are the most common medicine for preventing allergy symptoms and are generally administered orally as a pill, nasal spray, or eyedrop. These drugs bind to histamine-1(H-1) receptors and block the action of histamine, which reduces allergy symptoms and any related symptoms.
Pills and Liquids
1st Generation H-1 Blockers:
These drugs cross the blood-brain barrier and temporarily impair psychomotor and cognitive function.
Chlorpheniramine
Diphenhydramine (Benadryl)
Doxylamine (Unisom)
2nd-3rd Generation H-1 Blockers: 44
These newer drugs are less likely to cross the blood-brain barrier, so they make you less drowsy.
Cetirizine (Zyrtec) - Faster onset, greater incidence of sedation
Desloratadine (Clarinex) - Less effective, nonsedating, requires a prescription
Fexofenadine (Allegra) - Slower onset, nonsedating
Levocetirizine (Xyzal) - Faster onset, greater incidence of sedation
Loratadine (Claritin, Alavert) - Less effective, nonsedating
Nasal Sprays
Antihistamine nasal sprays help relieve allergic rhinitis symptoms and have been shown to outperform antihistamine pills in improving nasal symptoms.45
Azelastine (Astepro, Astelin)
Olopatadine (Patanase)
Eyedrops
Antihistamine eye drops help relieve allergic conjunctivitis symptoms and are more localized than antihistamine pills for improving eye symptoms.
Cetirizine (Zerviate)
Ketotifen (Alaway, Zaditor)
Olopatadine (Pataday, Patanol, Pazeo) Mast cell stabilizer?
Natural Antihistamines(46, 47, 48, 49, 50, 51, 52, 53)
Astragaloside IV (Astragalus) - Effective agent in the treatment of allergic rhinitis symptoms.
Bromelain (Pineapple) - Effective at treating inflammation and allergy symptoms.
Butterbur Extract (Butterbur) - Effective at treating the symptoms of intermittent allergic rhinitis.
Catechins such as EGCG (Tea) - Have inhibitory effects against allergic reactions and have been shown to alter histamine-producing cells.
Nettle Extract (Stinging nettle) - Has inhibitory effects on inflammatory and allergic responses.
Quercetin (Apple, Onion, Tea, Red Wine) - Has inhibitory effects on histamine and helps relieve allergy symptoms.
Spirulina - Shown to be more effective than cetirizine in improving allergic rhinitis symptoms.
Tinospora cordifolia (Guduchi) - Significantly relieves allergic rhinitis symptoms such as sneezing, runny nose, congestion, and itchy nose.
Decongestants
Decongestants work by narrowing the blood vessels in the nasal passages, temporarily relieving sinus congestion and pressure.
Pills and Liquids
Pseudoephedrine (Sudafed)
Phenylephrine - Has been shown to be ineffective at relieving nasal congestion related to allergic rhinitis. Instead, opt for pseudoephedrine or a nasal spray containing oxymetazoline.54
A number of antihistamines offer a combination of antihistamine + decongestant:
Cetirizine and pseudoephedrine (Zyrtec-D 12 Hour)
Desloratadine and pseudoephedrine (Clarinex-D)
Fexofenadine and pseudoephedrine (Allegra-D)
Loratadine and pseudoephedrine (Claritin-D)
Nasal Sprays
Oxymetazoline (Afrin)
Corticosteroids55
Corticosteroids are anti-inflammatory drugs that decrease allergy-related inflammation and suppress the activity of the immune system, which provides relief from the symptoms of various allergic diseases such as allergic asthma, hay fever, and atopic dermatitis.
Pills and Liquids
Oral corticosteroids are effective at treating severe systemic symptoms caused by allergic reactions, however, there are side effects and safety concerns regarding high-dose and long-term use.
Prednisolone (Prelone)
Prednisone (Prednisone Intensol, Rayos)
Methylprednisolone (Medrol)
Nasal Sprays
Corticosteroids that are administered by nasal spray are effective at treating the symptoms of allergic rhinitis and are generally safer than other forms of corticosteroids due to their localized application.
Budesonide (Rhinocort)
Fluticasone furoate (Flonase Sensimist)
Fluticasone propionate (Flonase Allergy Relief)
Mometasone (Nasonex)
Triamcinolone (Nasacort Allergy 24 Hour)
There are nasal aerosol formulas available for people who are bothered by the feeling of liquid running down their throats or the unpleasant taste of nasal sprays:
Beclomethasone (Qnasl)
Ciclesonide (Zetonna)
Inhalers
Inhaled corticosteroids are primarily used for the management of allergic asthma.
Beclomethasone (Qvar RediHaler)
Budesonide (Pulmicort Flexhaler)
Ciclesonide (Alvesco)
Fluticasone (Flovent)
Mometasone (Asmanex Twisthaler)
Triamcinolone (Azmacort)
Eyedrops
Corticosteroid eyedrops are effective for treating the symptoms of allergic conjunctivitis if other options such as nasal spray corticosteroids were ineffective.
Fluorometholone (Flarex, FML)
Loteprednol (Alrex, Lotemax)
Prednisolone (Omnipred, Pred Forte, others)
Skin Creams
Corticosteroid creams are effective for treating allergic skin symptoms such as contact dermatitis or atopic dermatitis.
Betamethasone (Dermabet, Diprolene, others)
Desonide (Desonate, DesOwen)
Hydrocortisone (Cortizone-10, MiCort-HC, others)
Hydrocortisone butyrate (Locoid)
Mometasone (Elocon)
Triamcinolone
Moisturizers74
Using moisturizers twice daily, after a shower and before bedtime, is the foundation of eczema management. Apply within three minutes of bathing or showering to lock in moisture and protect the skin barrier.
There are a few ingredients that are core to an effective moisturizer for eczema: skin barrier enhancers, skin protectants, and analgesics.
Skin barrier enhancers
Enhancers play an active role in improving skin health by increasing barrier function and reducing dryness and itch. Moisturizers without enhancers provide only temporary relief and require continuous application day after day because they don’t modify the underlying disease.
Aquaphilus dolomiae extract - A bacterial extract shown to be effective at treating itchy and dry skin.75
Ceramides - These are fats or lipids that are found in skin cells and they make up a large part of your outer skin layer. With atopic dermatitis, there can be a deficiency of ceramides, resulting in dry and itchy skin. Moisturizers that include ceramides help to restore a healthy skin barrier.
Colloidal oatmeal - Proven to offer skin barrier protection, moisturization, anti-inflammatory, and soothing properties that improve eczema symptoms. To attest to its efficacy, the US FDA requires that any moisturizer claiming to treat eczema must contain colloidal oatmeal.76
Skin protectants (occlusives)
Protectants help keep moisture on the skin by preventing water evaporation and creating a barrier against allergen exposure.
Beeswax
Castor oil
Cocoa butter
Jojoba oil
Mineral oil
Petrolatum
Shea butter
Sunflower oil
Analgesics
Analgesics are added to moisturizers to provide instant itching and pain relief. Obviously, itching and pain will get better as the skin barrier heals, but that takes time, so analgesics are added to help bridge the gap.
Aluminum acetate
Camphor
Menthol
Pramoxine hydrochloride
Skin Creams
Avène Cicalfate+ Restorative Protective Cream (Aquaphilus dolomiae extract, Mineral Oil, Beeswax) - Contains a bacterial extract
CeraVe Itch Relief Moisturizing Cream (Pramoxine HCL, Ceramides, Petrolatum, Shea Butter) - Contains an analgesic
Eucerin Eczema Relief Cream (Colloidal Oatmeal, Ceramides, Castor Oil, Mineral Oil) - Contains colloidal oatmeal
Bronchodilators56
Bronchodilators make breathing easier by relaxing the muscles in the lungs and widening the airways to prevent or reverse allergic asthma symptoms.
There are two different types of bronchodilators: short-acting and long-acting.
Short-acting bronchodilators provide their benefits quickly, within seconds to minutes, and last for 4 hours. Their immediate impact makes them effective for use in emergencies.
Long-acting bronchodilators typically take more time to provide their benefits but last for at least 12-24 hours. These should not be used in an emergency.
Beta-2 Agonists
Beta-2 agonists target the smooth muscles in the bronchioles of the lung and are the most common type of medication used for bronchodilators and are administered through inhalers.
Short-acting:
Albuterol (Ventolin, Proventil, AccuNeb, ProAir)
Levalbuterol (Xopenex)
Metaproterenol
Pirbuterol (Maxair)
Long-acting bronchodilators are combined with corticosteroids:
Budesonide + Formoterol (Symbicort)
Fluticasone furoate + Salmeterol (Advair Diskus)
Fluticasone furoate + Vilanterol (Breo Ellipta)
Fluticasone propionate + Salmeterol (AirDuo RespiClick)
Mometasone + Formoterol (Dulera)
Anticholinergics
Anticholinergics generate a bronchodilatory effect by inhibiting the cholinergic nerves, which release chemicals that cause the muscles lining the airways to tighten. They are administered through inhalers.
Short-acting:
Ipratropium bromide (Atrovent)
Long-acting:
Tiotropium bromide (Spiriva Respimat)
Methylxanthines
Methylxanthines inhibit the phosphodiesterase enzyme, which causes an increase in levels of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). This signal results in the relaxation of the bronchial smooth muscles in the lungs along with other effects. They are administered by the oral route as pills or liquid.
Aminophylline (Phyllocontin)
Caffeine - Modestly improves airway function for up to four hours, but not significantly or quickly enough for use in emergencies.63
Doxofylline
Dyphylline (Dilor, Lufyllin)
Theophylline (Elixophyllin, Theo-24)
Gut Antispasmodics64
Gut antispasmodics help treat symptoms of gut pain caused by allergic IBS, including spasms and cramps, by impacting smooth muscle contraction in the intestines. Medications do this through different mechanisms of action but have shown inconsistent efficacy and safety. For this reason, they are not clinically recommended. However, there are natural gut antispasmodics that carry much more consistency in efficacy and safety for allergic IBS.
Natural Gut Antispasmodics
Apple cider vinegar - There is very little research on apple cider vinegar, but it has personally helped decrease my symptoms of allergic IBS. Mix 1-2 tbsp with a cup of water. If you find it hard to drink, add 2 tsp of honey to balance out the flavor profile.
Fennel seed extract and Curcumin (Enterofytol) - Fennel produces an antispasmodic effect and has been shown to improve the barrier function of the gastrointestinal tract. Combined with the anti-inflammatory effects of curcumin, a substance in turmeric, it was shown to significantly improve the symptoms and quality of life of IBS patients.(65, 66, 67)
Peppermint oil - Shown to be a safe and effective therapy for pain and global symptoms of IBS.68
Psyllium husk (Metamucil) - The only fiber which is soluble (retains water), has good viscous/gel-forming capacity, and is non-fermenting is psyllium husk. Therefore, psyllium is immensely beneficial in all types of IBS as it has a bowel-regulatory effect.69
Probiotics70
The trillions of bacteria in the gut run the show. The reason for allergies in the first place stems from a suboptimal microbiome that promotes inflammation and sensitization. How can we overthrow this abusive leadership? Probiotics allow us to implant trusted bacteria into this community, where they will compete and grow. Over time, the goal is to shift the composition of the microbiome to promote better health.
Selecting probiotics with the right strains of bacteria for your specific microbiome is important. For example, someone with IBS-D (diarrhea) would benefit from a bacteria that helps prevent diarrhea, while someone with IBS-C (constipation) would require bacteria that decrease constipation. Currently, humanity’s ability to fully classify a person’s microbiome and provide the perfect composition of bacteria is nonexistent; this is why probiotics are so hit or miss. As biological data becomes more advanced and available, probiotics will be an effective treatment for all allergic diseases but are currently limited in their therapeutic effect. Despite this, there are several probiotics available today that can help treat the symptoms of allergic IBS.
Single-Strain
Bifidobacterium 35624 (Align) - Reduces IBS disease severity and improves the quality of life, particularly for those with severe disease.71
Lactobacillus rhamnosus GG (Culturelle Digestive Daily) - Has beneficial effects on IBS symptoms, particularly on diarrhoeal and alternating IBS subtypes.72
Saccharomyces boulardii (Florastor) - Helps to prevent symptoms of diarrhea and improves intestinal barrier function.73
+ Many Others
Multi-Strain
Bio-Kult (14 strains)
Jarro-Dophilus EPS (8 strains)
Seed DS-01™Daily Synbiotic (24 strains)
Seed PDS-08™ Pediatric Daily Synbiotic (9 strains)
THER-BIOTIC PRO IBS RELIEF (L. plantarum, L. acidophilus, and B. lactis)
Thorne FloraSport 20B (L. paracasei, L. acidophilus, and B. lactis)
+ Many Others
Mast Cell Stabilizers57
Mast cell stabilizers inhibit the release of inflammatory mediators from mast cells, which inhibits immediate and late allergic reactions.
Pills and Liquids
Cromolyn (Gastrocrom)
Nasal Sprays
Cromolyn (Nasalcrom)
Eyedrops
Cromolyn (Crolom)
Lodoxamide (Alomide)
Nedocromil (Alocril)
Inhalers
Cromolyn (Intal)
Nedocromil (Tilade)
Natural Mast Cell Stabilizers58
Inotodiol (Chaga mushroom)
Leukotriene Inhibitors59
Leukotriene inhibitors block inflammatory mediators called leukotrienes, which are typically released during allergic reactions, and are used for the chronic management of asthma.
Pills and Liquids
Montelukast (Singulair)
Zafirlukast (Accolate)
Zileuton (Zyflo CR)
The FDA warns that taking leukotriene inhibitors such as Montelukast (Singulair) can result in serious mental health side effects that include suicidal thoughts or actions.
Emergency epinephrine shots60
Epinephrine shots are used to treat anaphylaxis by reversing its symptoms. For guidance on how to properly use epinephrine shots refer to the following link: 61
Epinephrine Auto-Injector
Adrenaclick
Auvi-Q
EpiPen
EpiPen Jr
Symjepi
It is important to call 911 or be checked out at the emergency room after using your epinephrine auto-injector because the allergic reaction requires further monitoring. Reasons for this could include the need for more than one dose of epinephrine or the onset of a late-phase allergic reaction hours later.
Emergency Anaphylaxis Treatments
It is important to note there is no substitute for epinephrine. If you are in an emergency situation where you are experiencing anaphylaxis and don’t have an epinephrine auto-injector, here are some experimental methods with promising pathophysiology:
Submerge yourself in freezing cold water
Monoclonal Antibodies62
Monoclonal antibodies are manufactured antibodies made to target a specific component of an allergic reaction in order to inhibit its effects. For example, the monoclonal antibody drug Dupilumab targets and blockades interleukin 4 and interleukin 13 as these inflammatory mediators have been shown to promote the effects of allergic reactions. Monoclonal antibody drugs help treat the symptoms of various allergic diseases.
Injections
Benralizumab (Fasenra) - Targets IL-5 for the management of eosinophilic asthma.
Dupilumab (Dupixent) - Targets IL-4 and IL-13 for the management of severe asthma, eczema, EoE, and severe hay fever with rhinosinusitis and nasal polyps.
Mepolizumab (Nucala) - Targets IL-5 for the management of eosinophilic asthma.
Omalizumab (Xolair) - Targets IgE for the management of allergic asthma, chronic hives, nasal polyps, and has been granted Breakthrough Therapy Designation for the prevention of severe allergic reactions to food.
Reslizumab (Cinqair) - Targets IL-5 for the management of eosinophilic asthma.
Tezepelumab-ekko (Tezspire) - Targets thymic stromal lymphopoietin (TSLP), an epithelial cytokine for the management of severe asthma.
Tralokinumab (Adbry) - Targets IL-13 for the management of moderate-to-severe eczema.
Since something like interleukin 5 is a self-antigen, how do monoclonal antibodies not teach your body to develop an autoimmune disease against your own interleukin 5?
Fortunately, the monoclonal antibody used for self-antigens is IgG4, which is considered to be non-inflammatory and tolerance-inducing. Since foreign pathogens such as COVID-19 are not self-antigens, IgG1 monoclonal antibodies that better stimulate effector cells can be used.
JAK Inhibitors
JAK inhibitors provide eczema itch relief by inhibiting signaling through a variety of inflammatory mediator receptors through inhibition of Janus Kinases and should be considered last-resort drugs due to the potential side effects. The FDA requires warnings indicating serious infections, increased risk of death, cancer and immune system problems, blood clots, and tears in the stomach or intestines.
Pills and Liquids
Abrocitinib (Cibinqo)
Upadacitinib (Rinvoq)
Skin Creams
Ruxolitinib (Opzelura)