Your online resource for allergy, hay fever, and sneezing relief.

Once the causes and severity of the patient's allergies are determined, the doctor can prescribe a treatment plan. The first, most obvious, step is to avoid the allergen.

The next step in treating allergies is medication. Antihistamines, which interfere with the effect of histamine, are often prescribed. A major side effect of antihistamines is drowsiness, and some types produce more than others. The term "nonsedating" antihistamine is widely used to describe some prescription drugs, but it is not 100 percent accurate and is not a term used by FDA.

"It's really a matter of degrees," says Peter Honig, M.D., a medical officer in FDA's division of pulmonary drug products in the Center for Drug Evaluation and Research. "All the antihistamines produce drowsiness in patients, but some do more so than others." Benadryl (diphenhydramine hydrochloride), for example, is a common brand name oral antihistamine available without a prescription. It is well known to cause drowsiness in about half of people who take it. For those people, it's best taken at night. Two prescription antihistamines that have less sedation are Allegra (fexofenadine) and Claritin (loratidine).

Among nose sprays, there is Astelin (axzelastine hydrochloride), an antihistamine. Other nasal sprays contain steroids to combat congestion. These include Beconase and Vancenase (both contain beclomethasone dipropionate), Flonase (fluticasone propionate), Nasalide (flunisolide), and Nasacort (triamcinolone acetonide). The drawback to these medications is that they may take a week or so to be maximally effective and can sting and even damage the nasal septum (the soft bony division in the middle of the nose) if the spray is directed at it. Tell your doctor if you have any bloody discharge while using these sprays.

Less stinging but still helpful is the nasal spray Nasalcrom (cromolyn sodium). This nasal spray helps turn off the allergic process in the nose before it starts. It must be taken more often than a nasal steroid. Doctors often recommend this for children because it is extremely safe and it is available without a prescription.

Don't be tempted to treat an allergy with an over-the-counter decongestant nasal spray for more than three days. After a few days of use you may get a "rebound" effect, and your nose may become even more congested than before. These drugs are more useful for short-term use to relieve nasal congestion associated with a cold.

What should you do if you've tried every drug in the pharmacy and still sneeze from January to December? Allergy shots, also known as immunotherapy, can offer long-lasting relief for many people.

Getting allergy shots is a long process. Over the span of three to five years, the allergy patient receives a small injection of the offending allergens usually twice a week at first, then less often with larger doses as time goes by. These small doses desensitize the body's immune system to each allergen. After at least six months to a year, the sneezing, itching and hives may begin to subside. After about five years, it's possible for many to stop the shots completely.

"I am more productive, less irritable, and less fatigued since taking allergy shots," says Knoxville, Tenn., resident Beth Crawford, who is allergic to every tree, grass and pollen outdoors, plus dust mites, mold and animal dander indoors. Her allergies occur year-round and have plagued her since childhood.

"Now I have more confidence. I don't have to worry about whether I'm going to have a sneezing attack in public," she says. A clinical social worker, Crawford's job requires occasional public speaking; in addition, she sings in her church's choir. "Now I can sing or give a speech without worrying. I know this sounds silly, but I can get ready in the morning much more quickly because I don't have to spend 30 minutes sneezing. And my husband says we have a substantial savings in Kleenex!"

About a third of patients who get allergy shots are cured after treatment, another third have a partial relapse, and the rest will relapse completely. Those not cured may be helped by resuming the shots.

Another approach to allergy shots is called "rush immunotherapy." Patients spend several days receiving repeated shots to desensitize them against allergens. They then go on the maintenance schedule earlier. Studies have suggested rush immunotherapy can be at least somewhat effective under certain circumstances, but more study is needed to show widespread safety and effectiveness. Currently, no allergen extracts are approved by FDA for this approach.

Rebecca D. Williams is a writer in Oak Ridge, Tenn.