Hay Fever and Rhinitis: Medication and When to See a Doctor | How to Choose Over-the-Counter Drugs
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Hay fever is an allergic reaction caused by pollen from plants such as cedar, cypress, and ragweed entering the body. Medically, it is classified as "seasonal allergic rhinitis" and, along with "perennial allergic rhinitis" caused by dust mites and house dust, is collectively referred to as allergic rhinitis.
Symptoms occur when the immune system, which protects the body, overreacts to pollen, which is essentially harmless, recognizing it as a "foreign substance." Substances such as histamine, released from mast cells during this reaction, irritate the mucous membranes of the nose and eyes, causing various uncomfortable symptoms.
Main Symptoms
The following symptoms may be observed in hay fever and allergic rhinitis. The manifestation and severity of symptoms vary from person to person.
- Repeated sneezing
- Runny nose with clear, watery discharge
- Nasal congestion (both nostrils or one)
- Itchy eyes, redness, watery eyes
- Itchiness or discomfort in the throat or skin
In severe cases, symptoms can interfere with daily life, work, or studies, such as reduced sleep quality due to nasal congestion, decreased concentration, and a feeling of heaviness in the head. While it can be difficult to distinguish from a common cold, persistent clear runny nose, sneezing, and itchy eyes may indicate an allergy.
How to Choose Over-the-Counter Medications
Over-the-counter (OTC) medications available at drugstores include oral medications, nasal sprays, and eye drops. It is important to choose according to the type of symptoms.
Oral Medications (Antihistamines)
When sneezing and runny nose are the main symptoms, antihistamines that suppress the action of histamine are used. The current mainstream is "second-generation antihistamines," which are said to have relatively fewer side effects such as drowsiness. Representative active ingredients available over-the-counter include the following:
| Example of Ingredient | Indication of Characteristics |
|---|---|
| Olopatadine | Used for sneezing, runny nose, and itching. One of the ingredients that balances efficacy and drowsiness. |
| Epinastine | Many are once-daily types and are considered to cause relatively little drowsiness. |
| Fexofenadine | Considered to cause little drowsiness, often chosen for daytime activities. |
| Cetirizine, Loratadine, etc. | Some are once-daily types, allowing choice according to lifestyle. |
However, the likelihood of drowsiness and the effectiveness vary individually. Even second-generation medications can cause drowsiness, and caution may be required when driving a car or operating machinery while taking them. Always check the package insert before use and consult a pharmacist if unsure.
Comparison of Major Antihistamines (Generic Names)
Oral antihistamines differ in dosing frequency and tendency for drowsiness depending on the active ingredient (generic name). You may see rankings like "hay fever medication strength" or "antihistamine strength ranking" online, but the effectiveness and likelihood of drowsiness vary greatly from person to person, and the perceived effect of the same medication can differ. Therefore, it is impossible to definitively state "which is the strongest" based on a simple ranking. Please consider the following as a general guide only.
| Generic Name | Examples of Major Product Names | Approximate Dosing Frequency | Approximate Tendency for Drowsiness |
|---|---|---|---|
| Olopatadine | Alergyl, etc. | Mainly twice daily | May occur slightly |
| Epinastine | Alesion, etc. | Mainly once daily | Considered relatively unlikely to occur |
| Levocetirizine | Xyzal, etc. | Mainly once daily | May occur slightly |
| Desloratadine | Desyrel, etc. | Mainly once daily | Considered relatively unlikely to occur |
| Bilastine | Bilonoa, etc. | Mainly once daily | Considered relatively unlikely to occur |
Even for those "considered unlikely to cause" drowsiness, it does not mean drowsiness will never occur. It is important to choose a medication that balances effectiveness and drowsiness, taking into account the severity of symptoms, lifestyle, and other medications being used. If you are unsure which ingredient suits you, consult a pharmacist or healthcare provider. Always follow the instructions in the package insert or the advice of a doctor or pharmacist for dosage and administration.
Characteristics, Effects, and Precautions for Olopatadine
Olopatadine is a generic name for a second-generation antihistamine. In medical use, it is known by product names such as "Alergyl" and is used to relieve allergic symptoms such as sneezing, runny nose, and itching of the nose and eyes. Recently, over-the-counter (switch OTC) medications containing the same ingredient have also appeared.
Approximate Effects of Olopatadine
Olopatadine is an ingredient expected to alleviate symptoms such as sneezing, runny nose, and itching by suppressing the action of histamine involved in allergic reactions. Medical tablets are available in 5mg doses, and generally, adults are advised to take 5mg once twice daily, but the actual dosage and frequency vary depending on symptoms and age. The perceived effect varies from person to person, and not all symptoms will necessarily disappear completely. Do not change the dosage or administration on your own; follow the instructions in the package insert or the advice of a doctor or pharmacist.
Olopatadine and Drowsiness
Olopatadine is considered an ingredient that may cause some drowsiness among second-generation antihistamines. You may feel drowsy or sluggish while taking it, and the package insert warns against operating vehicles or other dangerous machinery. If drowsiness is severe or interferes with daily life, do not push yourself; consult a pharmacist or healthcare provider.
Precautions for Interactions and Contraindications
Antihistamines may require caution regarding interactions with other medications. In particular, medications that may enhance drowsiness include other antihistamines, cold medications, cough and expectorant medications, tranquilizers, sleep aids, and alcohol. Also, individuals who have previously experienced an allergy (hypersensitivity) to the ingredient cannot use it. If you have an underlying medical condition, are pregnant or breastfeeding, or are taking other medications, always consult a doctor or pharmacist before use. Since specific contraindications and permissible co-administration vary by product, it is essential to check the package insert.
How to Take and Side Effects of Bilonoa (Bilastine)
Bilonoa is a product name for a second-generation antihistamine with the generic name bilastine. It is a once-daily type that is considered to cause relatively little drowsiness, but it has a specific timing for administration.
When to take Bilonoa? (Primarily on an empty stomach)
Bilonoa is easily affected by food, and taking it after meals may reduce absorption of the active ingredient and potentially weaken its effectiveness. Therefore, it is generally recommended to take it on an empty stomach. As a guideline, it is often advised to take it at least 1 hour before a meal or at least 2 hours after a meal. Taking it at a time when there is a gap from meals, such as before bedtime, may make it easier to continue.
What if I accidentally took it after a meal?
Accidentally taking it after a meal will not immediately lead to a dangerous dose, but absorption may be reduced, potentially making it less effective. Do not take an additional dose to make up for a missed one, as this could lead to an overdose. From the next dose, try to take it on an empty stomach, and if you are concerned about how to take it, consult a pharmacist or healthcare provider.
Side Effects of Bilonoa and the "Weight Gain" Rumor
Reported side effects of Bilonoa include drowsiness, headache, and fatigue. The frequency and severity vary among individuals. While you may see comments online like "Bilonoa causes weight gain," weight gain is not generally considered a prominent side effect of Bilonoa. Although some antihistamines have been discussed for their effects on appetite, weight changes are influenced by many factors, including diet and lifestyle. If bothersome symptoms persist, do not stop taking the medication on your own; consult a pharmacist or healthcare provider. Always follow the instructions in the package insert or the advice of a doctor or pharmacist for dosage and administration.
What is Montelukast (Leukotriene Receptor Antagonist)?
Montelukast is a generic name for a medication classified as a "leukotriene receptor antagonist," which works differently from antihistamines. By suppressing the action of leukotrienes involved in allergic reactions, it is particularly expected to improve nasal congestion and is also used in the treatment of bronchial asthma. It is a prescription medication and not available over-the-counter.
Approximate Effects of Montelukast
Montelukast is often used for nasal congestion rather than sneezing or runny nose, and may be used in combination with antihistamines. The perceived effect varies individually, and whether it is actually prescribed is determined by a doctor based on symptoms and constitution.
Why take Montelukast before bedtime (at night)?
Montelukast is often prescribed for once-daily administration before bedtime. This is said to be based on the body's rhythm related to symptoms and the timing when the drug's effects are expected. It is important to continue taking it consistently at the prescribed time each day; do not change the time or dose on your own, and follow the instructions in the package insert or the advice of a doctor or pharmacist.
Distinguishing Between Nasal Sprays and Eye Drops
If symptoms are limited to the nose or eyes, topically applied nasal sprays and eye drops can be helpful.
- Nasal Sprays: Used when nasal congestion is severe. Types containing vasoconstrictors have immediate effects, but continuous use can lead to reduced effectiveness and even worsen nasal congestion, so prolonged use should be avoided. Nasal sprays containing steroids help reduce inflammation.
- Eye Drops: Used when itchy eyes or redness are the main symptoms. Some contain antihistamine or anti-allergy components. Check product information regarding use with contact lenses, as it varies by product.
Limitations and Proper Use of Over-the-Counter Medications
Over-the-counter medications can help alleviate symptoms, but they are not a panacea. Use them with the following points in mind:
- Combining multiple medications on your own can lead to an overdose if they contain the same active ingredients. Be careful about overlapping oral medications, nasal sprays, and multi-symptom cold remedies.
- If you have underlying medical conditions, are pregnant or breastfeeding, are taking other medications, or are elderly or a child, consult a doctor or pharmacist in advance.
- Antihistamines may be more effective in alleviating symptoms if started before pollen season or at the onset of pollen dispersal, rather than waiting for symptoms to appear (early treatment).
- Follow the dosage and administration instructions and do not continue using them indefinitely beyond the prescribed period.
If symptoms are not adequately controlled after using OTC medications for a certain period, it is important to consult a healthcare provider instead of increasing the dose on your own.
Are there "OTC Alergyl" products?
"Alergyl" is a product name for a prescription drug containing the active ingredient (generic name) olopatadine. Alergyl itself is a medication that requires a doctor's prescription and cannot be purchased directly at a drugstore under the same name.
However, in recent years, "switch OTC" products, which convert medical active ingredients into over-the-counter medications, have increased. OTC medications containing ingredients such as olopatadine, fexofenadine, epinastine, and cetirizine are now available. When choosing an OTC medication, check the active ingredient name (generic name), dosage and administration, and precautions. If you are unsure, it is advisable to consult a pharmacist. If you have an underlying medical condition, are taking other medications, or are pregnant or breastfeeding, it is recommended to consult before purchase.
Daily Self-Care (Pollen Avoidance and Lifestyle)
In addition to medication, efforts to reduce contact with pollen can help alleviate symptoms.
- Limit going outdoors on days or at times when pollen dispersal is high (sunny, windy days, around noon and evening).
- When going out, use masks and glasses, and choose clothing made of materials that are less likely to attract pollen.
- When returning home, brush off pollen from clothes at the entrance, and wash hands, face, and gargle.
- Keep window opening and ventilation short, and dry laundry and futons indoors as much as possible.
- Clean frequently to reduce indoor pollen.
- Maintain physical condition with adequate sleep, nutrition, and moderate exercise.
When to See a Doctor and Where to Go
In the following cases, consider consulting a healthcare provider instead of relying solely on self-care or OTC medications:
- Symptoms do not significantly improve with OTC medications.
- Symptoms are severe every year and interfere with daily life, work, or studies.
- Nasal congestion persists, causing inability to sleep or concentrate.
- Concerned about side effects of OTC medications (e.g., severe drowsiness).
- Eye symptoms are severe, or you want to determine the exact cause of symptoms.
For nasal and eye symptoms, an otorhinolaryngologist (ENT) is recommended. For general health and internal medicine concerns, an internal medicine specialist. If you want a thorough investigation of general allergies, an allergist is appropriate. Healthcare institutions may offer prescriptions for medications tailored to your symptoms and tests to determine the cause. If you are unsure which department to visit, it's a good idea to start by consulting a local healthcare provider.
Signs that require early medical attention
If you experience any of the following symptoms, do not hesitate to seek medical attention promptly:
- Difficulty breathing, wheezing or whistling sounds, labored breathing.
- Sudden swelling of the face or lips, widespread hives.
- Severe general malaise or impaired consciousness.
These can be signs of a systemic allergic reaction or other serious conditions. If you experience difficulty breathing or severe systemic symptoms, seek medical attention without hesitation.
Frequently Asked Questions
For persistent or severe symptoms, consult your local healthcare provider
This article provides general information. If OTC medications do not adequately control your symptoms, if your symptoms are severe every year, or if they interfere with your daily life, work, or studies, please consult a healthcare provider such as an otorhinolaryngologist (ENT), internal medicine specialist, or allergist. If you experience difficulty breathing or severe systemic symptoms, seek medical attention promptly.
