Rising pollen counts don’t just usher in spring’s arrival but also an annual ritual for 80 million Americans: the pharmacy run, the trial and error of meds, and the groggy mornings after one too many Benadryl.

The good news is there are more strategies than ever—some in the medicine aisle, some at the doctor’s office, and some at home—to help both the occasional sufferer and those for whom textbook treatments fall short.

“I think we’re at a pretty incredible point in research and clinical therapeutics for allergic disease broadly,” Kara Fitzgerald, a naturopathic doctor and faculty member at the Institute for Functional Medicine, told The Epoch Times. “The incidence of allergies are increasing globally, but we’re also beginning to understand mechanisms and how to address them.”

Is It Really Allergies?

Allergies that flare in spring, known as hay fever, are a form of rhinitis, inflammation of the nasal passageways. A thorough patient history is the best way for doctors to sort out whether you’re dealing with an acute or chronic reaction and to start determining what could be triggering your symptoms, according to Dr. Juan Carlos Murillo, board-certified allergist and spokesman for the American College of Allergy, Asthma & Immunology.

“To really say that a therapy is going to be effective for a patient with chronic rhinitis, the first thing is to know, is it really allergies or not? And then we take it from there,” Murillo told The Epoch Times.

Environmental irritants, medications, structural issues, and other issues can also cause nasal inflammation.

Allergy testing can definitively reveal if you have hay fever, an immune system reaction to pollen and molds that affects 25 percent of American adults and 20 percent of children and accounts for more than 4 million annual doctor visits.

At-home allergy tests can be ordered online. However, only tests that measure IgE (immunoglobulin E) antibodies can diagnose true allergic reactions.

First-Line Relief

Many doctors recommend intranasal steroid sprays such as Flonase, which can be used alone or with antihistamines, as first-line treatment for hay fever. They tend to work better than antihistamine tablets, according to the National Library of Medicine, but may take 12 hours to a few days to notice an improvement in symptoms—which is why it’s often recommended to start using them a couple weeks before allergy season begins.

Administration technique matters more than most people realize. “Make sure that you’re aiming toward your ear—up and out is the right technique—a gentle sniff, two sprays each side,” Murillo said, adding that proper usage makes intranasal steroids the most effective single treatment for nasal congestion.

Intranasal steroids should be used for only two to four months at a time due to possible side effects. Headaches, nosebleeds, and the loss of smell were reported adverse reactions in a Netherlands analysis published in Drugs—Real World Outcomes.

Steroid sprays shouldn’t be confused with decongestant nasal sprays. Decongestants offer immediate relief by reducing nasal membrane swelling and opening the nasal passageways, but they are not recommended for extended use. They can cause nosebleeds and increase membrane swelling, creating dependence and ultimately worsening congestion. They should always be discontinued after a few days, Murillo said.

What Else to Use–and What to Avoid

Some fast-acting, over-the-counter nasal sprays, eye drops, and antihistamines are better than others.

Benadryl has been a standard for years, but many doctors no longer recommend it. Diphenhydramine, its active ingredient, blocks the neurotransmitter acetylcholine, leading to cognitive issues, sedation, dry mouth, and constipation.

A meta-analysis published in Neurourology and Urodynamics found that using anticholinergic medications for more than three months was associated with a 46 percent increased risk of dementia. The risks are particularly pronounced in older adults, who also face withdrawal symptoms and potential heart problems.

“Make sure that you’re reading the boxes,” Murillo said. “Just because it is over-the-counter doesn’t mean that it may be good for your health.”

For additional relief, second-generation antihistamines such as loratadine (Claritin), fexofenadine (Allegra), or cetirizine (Zyrtec) are the safer choice. They have low or negligible anticholinergic effects, meaning they’re far less likely to cause the sedation, dry mouth, and cognitive fog associated with older medications, such as Benadryl.

For eye symptoms, olopatadine, sold under the brand name Patady, is an over-the-counter allergy eye drop with both antihistamine and mast cell stabilizers, which prevent the release of histamine. Combination nasal prescription sprays such as Dymista or Ryaltris pair an antihistamine with a steroid in a single dose. Antihistamine nasal sprays work within 15 minutes; tablets take about an hour.

“Some people who have mild hay fever might just use antihistamines through the season and call it good and get on with their lives,” Fitzgerald said, noting that nasal sprays, eye drops, and antihistamines offer fast relief but don’t address the reason for allergies. “They’re symptom maskers, and they can come with their own set of problems.”

Immunotherapy: Beyond Symptom Relief

For allergy sufferers who want more than seasonal management, immunotherapy—slowly introducing allergens either subcutaneously (allergy shots) or sublingually (dissolving tablets under the tongue) can help patients build a tolerance that can last years. The treatment process can take a few years, but the result may be lasting changes to the immune system.

“I’ve had patients suffer so much during the springtime that they say to me, ‘I’ve dealt with this long enough. How can we get this fixed?’” Murillo said. “This is a natural way that we can desensitize our immune system to have that disease-modifying effect.”

The U.S. Food and Drug Administration has approved sublingual immunotherapy for ragweed, two grass pollens, and dust mites. Some doctors offer oral immunotherapy that’s not typically covered by insurance—shots and sublingual immunotherapy are likely to be covered—that uses custom-made drops targeting each patient’s allergens, such as plants, pets, and foods. Reactions such as anaphylaxis tend to be lower with sublingual and oral immunotherapies, and they don’t always require frequent trips to the doctor.

“I’m a huge fan of this [immunotherapy] approach, and I see good outcomes,” Fitzgerald said. “It’s awesome as a standalone intervention. However, the response is variable.”

Diverse outcomes are often due to functional issues—such as an imbalanced gut microbiome, known as dysbiosis—which can be resolved. Other reasons could be nutrient deficiencies, commonly vitamin D and zinc, and a poor omega-3 to omega-6 ratio, she said.

Reduce Total Allergen Load for More Relief

Lifestyle changes can have a big effect on hay fever and may include keeping windows closed or installing fine-mesh screens to trap pollen, saline nasal rinses after you’ve been outside, showering often, removing shoes in the house, and using HEPA filters, particularly in bedrooms.

You can also monitor the pollen count in your area with apps like the one at pollen.aaaai.org before you go outside. Generally speaking, Murillo said pollen counts are lowest before 9 a.m., after rain, and on calm and cloudy days.

For hay fever sufferers who also have other allergies, which is common, reducing exposure to those allergens in spring can lower overall allergen load and lead to greater symptom relief, Murillo said. That might mean keeping pets out of bedrooms or home offices and avoiding triggering foods.

Hay fever is worth taking seriously, Fitzgerald said. Letting it run amok keeps histamine circulation high and the immune system on high alert, creating the perfect storm for developing new allergies. For instance, you might notice something on your plate that’s never been a problem, but is now triggering obvious symptoms.

“But when you drop the inflammatory burden collectively, you can reduce the severity of the inhalant reactions as well.”