DEAR DOCTOR K:

This year I'm suffering from seasonal allergies for the first time. What medications will make allergy season more bearable?

DEAR READER:

Sneezing; itchy, runny, stuffy nose; red, itchy, watery eyes; sore throat. Hay fever can cause great misery. If misery loves company, you'll be pleased to know that I and millions of other people suffer from hay fever. Luckily, many medications can help treat its symptoms.

Nonprescription decongestant pills, such as pseudoephedrine, can relieve nasal congestion. But they can cause congestion to worsen if they are used for more than three days.

Another nonprescription nasal spray, cromolyn sodium, prevents allergy symptoms by blocking the release of an irritating substance called histamine. Antihistamines are also available in pill form. They make some people drowsy. Newer antihistamines, such as fexofenadine (Allegra) and loratadine (Claritin), usually are less sedating but much more expensive.

One thing a lot of my patients don't know is that the older antihistamines are just as potent in relieving allergy symptoms as the newer ones. So if the older antihistamines don't make you drowsy, there's no reason to use the newer ones.

If an older antihistamine makes you somewhat drowsy, taking it at bedtime, and taking a newer antihistamine in the morning, can give you relief from allergy symptoms -- along with a good night's sleep. Work with your doctor to find the antihistamine that best relieves your symptoms with the fewest side effects.

Corticosteroid nasal sprays are probably the most effective treatment for hay fever. Examples include beclomethasone (Beconase), budesonide (Nasonex) and fluticasone (Flonase). They work best if you start using them a week or two before an expected rise in pollen counts.

Montelukast (Singulair) is a leukotriene receptor antagonist. This drug decreases the allergic response in a different way than other medications. For some people, this medicine works best.

If steroid sprays, montelukast and antihistamines fail, your doctor may recommend allergy shots (immunotherapy). You will get regular injections of small doses of the allergen causing your symptoms. The idea is that over time, your immune system will become less sensitive to that allergen.

You can also take steps to prevent symptoms in the first place. Reduce your exposure to the airborne pollens and molds that trigger your allergies:

-- Stay indoors as much as possible when pollen counts are high (before 10 a.m. and after sunset).
-- Keep windows closed, especially bedroom windows. Run an air conditioner on hot days.
-- Drive with your external vents closed and air conditioning on.
-- Minimize activities with heavy pollen exposure -- lawn mowing and leaf blowing, for example.
-- Take a shower or wash your hair before going to bed at night. This removes pollen that has accumulated during the day.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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