Montelukast (Singulair) is a leukotriene inhibitor approved by the US Food and Drug Administration for treatment of hay fever. It is available with a prescription and comes in tablet, chewable tablet, or granule forms. The granules may be sprinkled directly on the tongue or mixed with cold or room temperature soft food like applesauce or pudding.

Leukotrienes are powerful chemical substances that promote the inflammatory response seen during exposure to allergens. By keeping these chemicals from producing swelling, leukotriene inhibitors reduce inflammation. Leukotriene inhibitors are particularly effective when used with an antihistamine.

Available in aerosol (Nasalcrom) and in eyedrops (Crolom), cromolyn sodium makes your mucous membranes less sensitive to allergens. It gives better relief if you take it as a preventive measure, even when you do not have symptoms. Decongestants are available in oral versions (such as pseudoephedrine [Sudafed]), eyedrops, or sprays (such as phenylephrine [Sinex])

Eyedrops are effective for relieving annoying eye itch. Nasal sprays are very useful, especially in relieving nasal congestion. However, they can cause a rebound effect and inflammation called rhinitis medicamentosa if overused. Oral decongestants can cause high blood pressure, rapid heartbeat, and nervousness. Use all decongestants according to package instructions usually no more than 3 days.

Be sure to tell your health care provider if you are pregnant, plan to become pregnant, or become pregnant while taking these medications. Nonprescription antihistamines (diphenhydramine [Benadryl], clemastine [Tavist], tripelennamine [PBZ], hydroxyzine [Atarax]) are the most commonly used drugs. Loratadine (Claritin), a long-acting, nonsedating antihistamine is also now available without a prescription.

These antihistamines are inexpensive and readily available. The effects do not last long. They may make you too drowsy to drive a car or operate machinery safely. You may start using them at bedtime. Drowsiness often lessens with continued, regular dosage.

Many hay fever sufferers choose to take longer acting prescription antihistamines, such as fexofenadine (Allegra), loratadine (Claritin), and desloratadine (Clarinex). These drugs are more expensive, but they have to be taken only once or twice a day. The biggest advantage of these drugs is that they cause only mild sleepiness, if any at all.

These sprays work very well in most people with few of the side effects of corticosteroids taken by mouth or by injection. They reduce congestion (stuffiness) and swelling. Examples are beclomethasone (Beconase), triamcinolone (Nasacort), and fluticasone (Flonase).

These are not the steroids taken by some people to increase athletic performance. Sprays take a few days to work, but when they reach an effective level, they do a very good job of decreasing symptoms without causing drowsiness. They must be used daily if they are to work properly.

The best treatment overall is to avoid contact with your allergen. Since this is rarely possible, you may want to take medication to reduce the symptoms. The treatment of hay fever depends on the severity, symptoms, and consequences of the disease.