What to do when allergy medicine doesn’t work

Environmental allergies, to irritants such as dander and dust mites, are common. More than 19 million adults in the U.S. have allergic rhinitis, also known as hay fever. Seventy-eight percent of SingleCare users with allergies take medication to treat their symptoms. If you’re among them, you may have noticed that your regular treatment with over-the-counter medications has become less effective over time. Or maybe you never experienced full relief. 

Why do allergy medications stop working?

There are many different reasons why your allergy medication isn’t working. Maybe the medication you’re using isn’t appropriate for the true cause of your symptoms. Or, maybe you’ve taken it so frequently that it’s become less effective. Keep reading to learn more.

1. You’re taking the wrong medication

There are different allergy medications for different symptoms. For example, eye drops are appropriate for itchy eyes, while steroid nasal sprays or oral decongestants are appropriate for a stuffy nose or sinus pressure. If you’re taking a medication that’s not appropriate for your symptoms, it might not be effective. The following types of allergy medications are available:

• Antihistamines (first-generation and second-generation)
• Nasal spray corticosteroids
• Decongestants
• Nasal spray decongestants
• Inhalers
• Eye drops
• Leukotriene modifiers
• Immunotherapy tablets

Each is indicated for different symptoms. It’s important to work with your healthcare provider or pharmacist to determine the best treatment plan for your specific allergy.

2. You don’t have allergies

The symptoms of environmental allergies can be similar to non-allergic rhinitis such as runny nose, sneezing, and coughing. “There are times that other conditions can mimic allergy symptoms, but the treatment may be completely different,” says Shyam Joshi, MD, an allergist and assistant professor of medicine at Oregon Health and Science University and chief medical officer at Nectar.

“Other causes of congestion include anatomical or structural abnormalities, heartburn or reflux, exposure to environmental irritants such as smoke, and chronic sinus disease,” says Dr. Joshi.

These irritants cause your body to react with congestion or allergy-like symptoms. However, unlike allergies, they do not trigger the release of histamine. Meaning, an antihistamine medication will not work. When you have environmental allergies your body does produce histamine and that is why medications such as Benadryl (diphenhydramine), Zyrtec (cetirizine), Allegra (fexofenadine), or Claritin (loratadine) are effective.

3. It’s peak allergy season

Depending on what type of allergen causes your symptoms, the changing seasons could cause your allergy symptoms to worsen. “The more common reason their symptoms are flaring is due to more exposure to their allergens or peak allergy season,” says Dr. Joshi. Additionally, the warmer weather that coincides with spring and summer pollen can exacerbate symptoms. Basically, it seems like your medication is ineffective, when it’s really just that you’re having a more severe reaction than usual.

4. You’re skipping medication doses

Often people think that allergy medication is similar to pain relieving medication—once the pain is gone you no longer have to take the medication. But this is not the case with allergy relief. If you stop taking the medication once you feel better, your symptoms will come back as long as environmental allergens like pollen are still present. In other words, you may not be taking your allergy medicine consistently enough for it to be effective. The nasal steroids (fluticasone) particularly require consistent use to be effective.

5. Your allergies are changing

As you age your body changes—including your hormones and immune system function. Over time you can develop new allergies. Or, in some cases your seasonal allergies may be worse year over year due to climate change or other environmental factors. That can make your current allergy medication ineffective. You may experience more stress as well. These factors can cause you to be more susceptible to environmental allergies.

6. Your symptoms are a medication side effect

Certain allergy treatments are only intended for short-term use, such as Afrin nasal spray. When you use it for longer than intended, you can experience side effects such as rebound congestion. Basically, your stuffy nose comes back as soon as you stop using it and is a medication side effect rather than an allergic reaction. Some other medications can cause allergy-like symptoms such as anti-high blood medications (ACE inhibitors) can cause chronic cough.

RELATED: If you have nasal spray addiction, it’s time to put down the Afrin

7. You have a medication tolerance

If you have taken your allergy medicine for a long period of time you may find that the medication is no longer helping relieve your symptoms.“Antihistamines may stop working after a while if the body develops a tolerance to the medication,” says Laura Purdy, MD, board-certified family medicine physician based in Nashville, Tennessee.

While this is most common with antihistamines, it’s also possible with nasal spray. “There may be select individuals in which the effectiveness of antihistamines and nasal sprays may decrease over time, but this is rare,” says Dr. Joshi. “This phenomenon, called ‘tachyphylaxis,’ can occur due to the body developing other strategies to bypass the effects of the medication and lead to uninhibited inflammation.”

What to do when your allergy medicine doesn’t work

“If your allergy medications do not seem to work, it is time to see an allergist,” says Dr. Joshi. This type of specialist may recommend the following strategies to help:

• Trying a new treatment: If an over-the-counter treatment isn’t working, your provider might recommend moving on to prescription strength. Or, simply switching the medication within the same class of treatment could help, for example trying Zyrtec instead of Allegra. “If antihistamines do not work for allergies, there are other types of medications that may be effective such as decongestants, corticosteroids, and leukotriene modifiers,” says Dr. Purdy. Also, some non-medication treatments such as nasal saline rinses or neti pot can be effective.
• Using a higher dosage of current medication: Your provider may recommend this during peak allergy season, or if you’ve been taking allergy medication too inconsistently to relieve symptoms.
• Combining multiple medications: You can “double up” on certain types of allergy medications—such as antihistamines and nasal sprays. “Intranasal steroid sprays like Flonase are very effective in managing sneezing, itchy nose, and congestion. On the other hand, antihistamine tablets are more helpful for rashes associated with direct contact with pets and itchy or watery eyes. Taking both can be helpful for some patients that may suffer from multiple symptoms,” says Dr. Joshi. However, some combinations are unsafe, so always talk to your provider first. 
• Taking a drug holiday:  This is a planned break from your medication that could help reduce tolerance to a particular treatment.
• Evaluating other conditions that could cause symptoms: If no allergy medications are providing relief, it may be time to determine if another condition or medication is causing look-alike symptoms.
• Repeating allergy testing: Even if you had allergy testing in the past, you might have developed new allergies since the testing was completed.  so repeat testing may be necessary. 
• Starting immunotherapy: If you’ve tried all of the available allergy medications and still aren’t experiencing relief from your symptoms or are having symptoms year-round, your allergist may recommend allergy shots. Also known as immunotherapy, this treatment gives small doses of an allergen over time to eventually cure your reaction to the trigger in a period of three to five years.
• Making lifestyle changes: There are other nonmedical treatments that can help relieve allergy symptoms. Some ideas your provider may recommend are avoiding triggers when possible, making environmental changes (such as adding air filters to your home), and trying natural remedies like nasal saline rinses or steam inhalation.

People living with allergies know that symptoms are difficult to deal with and affect your daily functioning. If allergy symptoms are not relieved by medication, don’t give up hope. Working with an allergist or an immunology doctor can help you find relief and may help you avoid unwanted side effects such as drowsiness or sedation. “Your doctor can help you determine the best course of treatment for your specific symptoms and medical history,” says Dr. Purdy.