Recommended anti-histamines for year-round allergy sufferer?

October 21, 2012 9:47 PM

Allergy filter: I have year-round allergies. Loratadine works wonders for me, but I develop an immunity in about a month or so. Which other non-drowsy antihistamines would you recommend?

I believe I've read and re-read all the allergy posts here on Metafilter, and they've helped me manage my allergies. I'm pretty sure I'm allergic to cats and dust, not sure what else. I do have a test coming up, but it's not for a while.

So what seems to work out well for me is a daily low dose of Nasonex + 10 mg of Loratadine. Loratadine takes away the brutal post-nasal drip and eases the irritated throat (although I still often take cough drops and must watch humidify levels). Nasonex keeps the nasal passages open and clear, although I still have to sleep upright because it feels like my nasal passages like they're collapsing each other if I sleep in a completely flat position. I don't have sleep apnea, but nasal problems and sleep apnea runs in my family.

The last time I developed an immunity to Loratadine, I tried 10 mg Reactine (Zyrtec for you Yanks), but I found it ineffective. Should I up my dosage next time of Reactine and see, or should I try Allegra, or another OTC anti-histamines? I know it's really all trial and error, but they're not cheap, and money's a bit tight. So I'd like to streamline this process as much as possible. I'd like to hear your anti-histamine recommendations!

(And my question is specific to anti-histamines. I have the other parts of allergy management down: cleaning like a maniac, no carpets, Neti pot, etc.)

posted by Hawk V to health & fitness (19 answers total)

Astelin spray, an expensive prescription in the US, works well for me.
posted by JimN2TAW at 10:13 PM on October 21, 2012

I take Telfast myself (which is apparently fexofenadine, who knew), which works wonders for me, but I don't know if it's effective in low doses.
posted by Xany at 10:23 PM on October 21, 2012

According to my allergist, it really is trial and error as some people in his clinic love Zyrtec and I hate it.

But since we do sound similar... I'm a tried and true daily loratadine (and steroid spray) user, though AFAIK don't become immune. But during high-allergy periods, my allergist wants me to be on Allegra and he's awesome so I do it. I still prefer loratadine, but my ranking goes:

1. Claritin/loratadine
3. Allegra
5. Sudafed or Benadryl depending on time of day
10. Zyrtec

The blank spots are just spacing the preference level.

Also, at higher allergy times and with the allergist's blessing, I'll up the spray count of Nasonex or flunisolide (equally effective for me) from once each nostril to twice and then if still not effective enough do two or even three evenly spaced sessions daily. And when I go to get allergy shots (which have no joke improved the quality of my life) he also likes me to spray Astepro.
posted by vegartanipla at 10:43 PM on October 21, 2012 [1 favorite]

Claritin has never really worked for me. I use fexofenadine, and I'll double the dose (2 24 hr pills a day) during really high season. Things I add as needed are flonase (fluticasone nasal spray), sudafed, pataday eye drops (there's also zatidor), and I also use a steroid inhaler (also fluticasone) when I get allergy-induced asthma symptoms.

I don't use zyrtec because it makes me stupid, but of course your side effects may vary. There are also prescription options that are actually the metabolites of zyrtec and claritin; my sister takes one of those and finds it more effective with less side issues. Depending on your prescription insurance (or lack thereof) these could be good ideas too.

I assume you have allergy covers for your bedding (at least for your pillow), and that by "cleaning like a maniac" you mean that someone *else* does the cleaning (at least on your bad days-- the cleaning act can kick up some extra dust at first). But there is a non-medicine thing I think is useful-- last year during a time when all of these things weren't enough, I got a pollen mask. It meant I could walk the 20 min to work without having to take my rescue inhaler, and that was good. I think that's my last-resort option now, and it's what I add when all the meds aren't working.
posted by nat at 11:13 PM on October 21, 2012

@vegartanipla: Thanks, I'll try Allegra. I haven't tried it out yet because there's no generic versions, but if it's better than Reactine/Zyrtec then I'll give it a shot. Benadryl isn't bad for going to sleep, but it's not enough of a cough suppressant for me, and I tend to wake up every half hour or so with a dry cough.

@nat: No, I do not have allergy covers but I know I should look into it once I have more funds. Anybody recommend particular brands? It would be nice if I could buy it in person in Vancouver, Canada, or at least ships it to here. I do have a steam cleaner though that I could try to use on the mattress. I've also heard tips of throwing pillows into the dryer for 20 minutes on high heat to "cook" them. Does that work? Would that be okay for memory foam pillows?

I live alone and have limited funds, so I just wear a dust mask whenever I clean. I still feel like crap for 30 minutes after cleaning, but I expect it and it goes away. I bought a pack of five masks for like a bit over a dollar, and the first one is still going strong. Actually, I wear it whenever I'm fed up with allergies because that's the time I feel completely normal, but it's not comfortable for long periods of time. Although I am kind of ogling nicer masks on etsy.

Also, what does anyone know about desloratadine? Is it a good alternative to switch to when my immunity to loratadine kicks in?
posted by Hawk V at 11:28 PM on October 21, 2012

This is not an antihistamine, but as a supplement/alternative to my Zyrtec (which makes me soooo sleepy!), I have had good luck with Advil Cold & Sinus (or any acetaminophen & pseudoephedrine combo pill, I guess). It's just about the only thing that will unstuff my head and nose, especially when used in conjunction with a Neti pot.
posted by désoeuvrée at 11:48 PM on October 21, 2012

brutal post-nasal drip and eases the irritated throat (although I still often take cough drops and must watch humidify levels). Nasonex keeps the nasal passages open and clear, although I still have to sleep upright because it feels like my nasal passages like they're collapsing each other if I sleep in a completely flat position.

I get this sometimes, due to pollen and leaf mold.

I take nettle extract, which works extraordinarily well.
http://www.ncbi.nlm.nih.gov/pubmed/19140159

One can get it from health food stores. It's generally regarded as safe:
http://www.webmd.com/vitamins-supplements/ingredientmono-664-STINGING%20NETTLE.aspx?activeIngredientId=664&activeIngredientName=STINGING%20NETTLE
If you start taking it, tell your physician, keep your physician and pharmacist informed.

I know it's really all trial and error, but they're not cheap, and money's a bit tight.
It's about $10/bottle which is good for a large number of doses, at my dosage. (I take an eyedropper of it in water at night when I've allergies, and again in the morning. This may not be an appropriate dosage for other readers)
posted by sebastienbailard at 12:26 AM on October 22, 2012

I take nettle extract, which works extraordinarily well.
EDIT: Works extraordinarily well for me, but I don't know about other folk.
posted by sebastienbailard at 12:37 AM on October 22, 2012

I've been round and round with allergy medication for well over a decade now, trying to alight on some sort of combination that works. Loratadine never seemed to be effectivefor me: an immense frustration because if its low cost. Finally, in the last six months, with some good doctorin' advice, I finally seem to have found a regime that really works: fexofenadine pills and nasonex spray. I'd echo what others have said upthread: after suffering from all manner of allergy related nonsense for years, this combination has really been effective for me.
posted by hydatius at 3:32 AM on October 22, 2012

I use Allegra and a combination of sudafed and Advil (a DIY take on Advil Cold and Sinus.) I don't feel like Allegra is quite the same as it was when it was prescription-only, but when paired with Advil, it is great for cutting down on the amount of puffiness and internal inflammation of the nasal passages that come with incessant allergy symptoms. Sudafed or Allegra-D alone do not work as well for me. Obviously, this isn't something to take every day, but it helps me stay together during the worst of allergy season. (I have had a Flonase nasal spray thing, but it turns out I hate applying it so I never used it. Some of this really is trial and error.)
posted by jetlagaddict at 4:37 AM on October 22, 2012

My therapist, who is a doctor but not really that kind of doctor, but is a long term health nut (and looks great at 72, fwitw) swears by butterbur
posted by Jacen at 6:09 AM on October 22, 2012

I also do allergy pill + nasal spray.* I use Zyrtec, but you might find Allegra works better for you. For the nasal spray, I use Nasacort AQ with a bit of Afrin in it. My allergist recommended this nasal spray combination to me, and it is amazing -- you know how well Afrin works, but you can only use it for a few days or you get the rebound thing? With the Nasacort, the rebound doesn't happen, so it just works and continues to work, forever. Nasal passages almost always totally clear, which I've never had before in my life.

*I also do allergy shots, which I think helps keep my allergies in the treatable range, but I have exceptionally bad allergies; for most people, I think the pills + spray are sufficient.
posted by rabbitrabbit at 9:18 AM on October 22, 2012

I also get immune to antihistamines. I decided to alternate medicine. So now I take Claritin and Zyrtec on alternate days. Both pills have roughly a 24 hours effective range so it's easy to maintain the regimen. I've been doing this for about a year and it's working great for me.

I also use fluticasone, the generic of Flonase. It seems to work better for me and doesn't cause nose bleeds.

A tip on cost: Get a CostCo membership if you can. They have the lowest prices on Claritin and Zyrtec I've seen. You can easily get a 2 year supply for about $40.
posted by chairface at 9:54 AM on October 22, 2012

Claritin/loratadine worked for me back when I had bad allergies. I took it every day, year-round. Important note: I was taking regular Claratin, not the decongestant kind -- Claratin D gave me insomnia.
posted by The corpse in the library at 10:53 AM on October 22, 2012

Thanks, I'll try Allegra. I haven't tried it out yet because there's no generic versions

Generic Allegra is available dirt cheap by prescription under the name Fexofenadine. However it is still not over-the-counter which might be what you meant.

You might also try one of the new antihistamine nasal sprays such as Astepro. It applies the antihistamine directly to your nasal passages, avoiding the side effects of oral antihistamines. Relief can occur within minutes of a dose. Since this is a new family of patented drugs, they are fairly expensive, but what is your health worth?
posted by JackFlash at 1:05 PM on October 22, 2012

Ah yeah, I was looking for generic Allegra OTC, but I guess it's time to schedule an appointment with the doc for some fexofenadine! How much is it usually? (in Canadian dollars preferably).
posted by Hawk V at 12:15 AM on October 23, 2012

In the US fexofenadine (generic Allegra) is available OTC. You can order it online, but I'm not sure how you'd get it delivered to your locale, but if you end up a little bit south you can just buy it (I'm not sure of the Canadian situation on fexofenadine).

Desloratidine, btw, is an active metabolite of loratidine. In the US it's prescription but in Canada it's OTC. I don't know the situation with the active metabolite of Zyrtec, but maybe that's an OTC option for you too.
posted by nat at 3:23 PM on October 26, 2012

Okay, two weeks after I started using loratadine again, I'm starting to getting allergy attacks throughout the day, urgh. Immunity, why! I'll buy a small pack of Allegra tomorrow and find generics once it's been confirmed that the active ingredient does work for me. Thanks everyone for the suggestions!
posted by Hawk V at 12:49 AM on October 29, 2012

An update:

Allegra doesn't work for me, but desloratadine is a beauty! Try it if loratadine also works for you.
posted by Hawk V at 6:58 PM on November 22, 2012