How Do Allergy Medications Work?

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Jun 17
8 min read

Updated: Nov 25

The constant sneezing. That itchy, scratchy feeling in your throat. The watery eyes that make it look like you've been crying for hours. If you deal with seasonal allergies, you know this struggle all too well.

You've probably reached for an over-the-counter allergy medicine, hoping for relief, and found yourself staring at a wall of options. It can feel confusing with so many different types of allergy treatment on the shelf.

You just want the symptoms to stop. But have you ever wondered what's actually going on inside your body when you take that pill or use that spray? Understanding the process can help you find the right relief for your specific misery.

What's Happening During an Allergic Reaction?

Before we can get into how allergy medicines work, you need to know what they're up against. An allergic reaction is your body's immune system overreacting. It mistakes something harmless, like pollen, dust mites, or pet dander, for a dangerous invader.

This substance is called an allergen. When you come into contact with it, your body's defense system springs into action. The body's immune system produces antibodies called Immunoglobulin E, or IgE for short.

These IgE antibodies attach themselves to special cells called mast cells. You have these cells all over your body, in your skin, nose, and lungs. Think of them as tiny alarm systems, just waiting to be triggered by an allergen.

The next time you encounter that same allergen, it binds to the IgE antibodies on your mast cells. This triggers the alarm. The mast cells burst open, releasing a flood of chemicals into your bloodstream, most famously, a chemical called histamine.

Histamine is the main culprit behind most of your allergy symptoms. According to the American Academy of Allergy, Asthma & Immunology, it causes your blood vessels to expand and your nasal passages to swell. This leads to that classic stuffy nose, relentless sneezing, itchy eyes, and the condition often called allergic rhinitis or hay fever.

How Allergy Medications Work

Allergy medications don't cure allergies. What they do is interfere with the allergic reaction at different stages to treat allergies. Let's look at the most common types and see how they stop the chaos.

Antihistamines: The Most Common Allergy Fighters

Antihistamines are probably what you think of first for allergy relief. Their name says it all. Antihistamines block the effects of histamine after it has been released by mast cells. Imagine histamine as a key and the cells in your body having special keyholes, or H1 receptors.

When the histamine key fits into the receptor lock, it causes allergy symptoms. Oral antihistamines work by plugging up those keyholes so histamine can't get in. There are two main groups. Older, first-generation antihistamines, like diphenhydramine (Benadryl), work very well but can cause significant side effects.

Their effects include drowsiness because they can cross the blood-brain barrier. Newer, second-generation antihistamines were developed to avoid that problem. Examples include cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra). They are much less likely to make you drowsy, making them a better choice for daytime use for most people.

You can find antihistamines in several forms. Pills and liquids are common for all-over symptom relief. There are also antihistamine nasal sprays and eye drops that target symptoms like dry eyes in a specific area, providing more direct relief.

Decongestants: Clearing the Stuffiness

If your main complaint is a stuffy, blocked nose, decongestants might be your best friend. Unlike antihistamines, they don't stop the histamine reaction. They focus on fixing the nasal congestion and postnasal drip it causes.

Decongestants work by shrinking swollen blood vessels and tissues in your nasal passages. This opens things up so you can breathe easier. You'll find them as pills, liquids, and nasal sprays.

Common ingredients are pseudoephedrine and phenylephrine. Be aware that these medications can have side effects. They might make you feel jittery or raise your blood pressure and heart rate.

One very important thing to know about nasal decongestant sprays is the risk of a rebound effect. Using them for more than a few days in a row can cause your stuffiness to get even worse when you stop. The U.S. Food and Drug Administration warns about this condition, known as rhinitis medicamentosa, so it's best to use these sprays only for short-term relief.

Nasal & Oral Corticosteroids: Reducing Inflammation

For many people with persistent nasal allergy symptoms, nasal corticosteroid sprays are the top choice. These nasal sprays include options like fluticasone propionate (Flonase) and budesonide (Rhinocort). They are very effective at calming the inflammation caused by allergies in the nose.

These sprays work by suppressing the inflammatory response your immune system kicks off. They reduce the swelling, sneezing, and runny nose. But they are not a quick fix for the symptoms caused by the reaction.

Unlike decongestants, you won't feel immediate relief. It can take several hours to a few days of consistent use to get the full effect. This makes them great for managing chronic symptoms, but not for a sudden allergy attack.

Because the medicine is applied directly in the nose, very little gets absorbed into the rest of your body. This means they have fewer side effects than oral corticosteroids. For very severe allergic reactions, a healthcare provider might prescribe oral corticosteroids.

These prescription oral medications are powerful anti-inflammatories but come with more significant side effects. They are typically used for short periods to get severe symptoms under control.

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Mast Cell Stabilizers: Preventing the Reaction Before It Starts

This group of medications takes a more proactive approach. Instead of just managing symptoms after they appear, mast cell stabilizers try to stop them from happening at all. They work directly on the mast cells.

These drugs, like cromolyn sodium, create a sort of protective coating around the mast cells. This makes them less likely to break open and release histamine when an allergen comes along. This action of these cell stabilizers, mast cell stabilizers, is what defines their role in allergy treatment.

The key with mast cell stabilizers is timing. They are most effective when you use them before you're exposed to your allergy triggers. For someone with seasonal pollen allergies, that might mean starting the medication a week or two before the season begins.

The best way to use these stabilizers, mast cell protection in mind, is with consistency.

You'll usually find them as nasal sprays or eye drops. They are very safe with few side effects. But they may not be as potent as some of the other options for severe symptoms.

Leukotriene Modifiers: A Different Approach

Histamine isn't the only chemical your body releases during an allergic reaction. Your body also releases leukotrienes. These substances cause airway tightening and mucus production, especially for those with asthma.

Leukotriene modifiers, such as montelukast (Singulair), work by blocking the action of these leukotrienes. They are prescription-only medications available as pills. They are often used when other allergy medications are not enough.

They can be particularly helpful for people who have both allergies and asthma. They can also be effective in treating some symptoms of atopic dermatitis. They help control symptoms of both conditions and can be combined with antihistamines for better relief.

Comparing Allergy Medication Types

Here's a quick breakdown of how these different allergy fighters stack up.

Medication Type	How It Works	Best For	Onset of Relief
Antihistamines	Blocks histamine receptors	Sneezing, itching, runny nose	Fast (within 1-2 hours)
Decongestants	Shrinks swollen nasal blood vessels	Nasal and sinus congestion	Very fast (within 30 mins)
Nasal Corticosteroids	Reduces inflammation in the nose	Congestion, sneezing, runny nose	Slow (several hours to days)
Mast Cell Stabilizers	Stops mast cells from releasing histamine	Preventing symptoms before exposure	Slow (requires consistent use)
Leukotriene Modifiers	Blocks inflammatory leukotrienes	Allergies and asthma symptoms	Within a day

Allergy Immunotherapy: A Long-Term Solution

What if you want to do more than just manage your symptoms? Allergy immunotherapy, often called allergy shots, aims to change how your immune system reacts to allergens. It is a long-term treatment designed to build your tolerance.

The process involves getting regular injections with tiny, gradually increasing amounts of your specific allergen. By exposing your body to the allergen in a controlled way, you're training your immune system to be less sensitive. The goal is to get it to stop overreacting.

This is not a quick fix. According to the Mayo Clinic, a typical course of treatment lasts three to five years. It requires a significant commitment, with regular visits to an allergist's office.

For people who cannot do shots, there is also sublingual immunotherapy. This involves placing a tablet containing the allergen under your tongue daily. It is a more convenient option for certain types of pollen and dust mite allergies.

Topical Treatments for Allergic Skin Reactions

Allergies don't just affect your sinuses; they can also show up on your skin. Allergic skin reactions, such as hives or atopic dermatitis, can cause redness, itching, and discomfort. These skin reactions may even cause a temporary change in skin color in the affected area.

For mild reactions, over-the-counter hydrocortisone creams can be very effective. They are a type of topical corticosteroid that reduces local inflammation and itching. Following the package directions is important to avoid side effects like skin thinning.

For more persistent or severe conditions like atopic dermatitis, a doctor may prescribe stronger topical steroids or other non-steroidal creams. These medications help calm the immune response in the skin to provide relief. They are an important part of a comprehensive allergy management plan for many people.

Emergency Medications for Severe Reactions

For some people, an allergic reaction is more than just an inconvenience; it can be life-threatening. A severe, whole-body reaction is known as anaphylaxis and requires immediate medical attention. This type of allergic emergency is most common with a food allergy, insect stings, or a latex allergy.

The first-line treatment for anaphylaxis is epinephrine. This is administered using an auto-injector, like an EpiPen. These allergic emergency medications work rapidly to reverse the dangerous symptoms of anaphylaxis, such as airway swelling and a drop in blood pressure.

If you or a loved one has a severe allergy, a healthcare provider will prescribe an epinephrine auto-injector. You should carry it with you at all times. It is crucial to know how and when to use it, as it can be life-saving during an allergic emergency.

Choosing the Right Medication for You

With so many options, how do you pick the right one? The best choice really depends on your specific situation. You need to think about a few key things.

First, what are your worst symptoms? If you have an itchy, runny nose, an antihistamine might be all you need. If a stuffy nose is your biggest problem, a decongestant or nasal corticosteroid could be a better fit.

You should also consider how often you have symptoms. Are they a daily problem during allergy season, or do they only pop up now and then? A daily medication like a nasal steroid might be best for chronic issues, while a fast-acting antihistamine is great for occasional relief.

Finally, always think about potential side effects. If you need to be alert for work or school, a non-drowsy antihistamine is a much better choice than an older one. If you have high blood pressure, you should talk to a doctor or care provider before using a decongestant.

Ultimately, the best thing you can do is talk to a healthcare provider. An allergist can help you figure out exactly what you're allergic to and develop a treatment plan. Creating a personalized plan with a professional is the surest way to find lasting relief.

Conclusion

Fighting allergies can feel like a battle, but you have an arsenal of effective tools at your disposal. The key is understanding that different medications have different jobs.

From blocking histamine with antihistamines to reducing inflammation with corticosteroids and preventing reactions with mast cell stabilizers, each one targets a specific part of the allergic response.

Hopefully, this How Allergy Medications Work guide has cleared up some of the mystery. By knowing what each type of medication does, you can have a much more informed conversation with your care provider and find the strategy that finally brings you relief from your symptoms.