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Comment by tyrfing | Hacker News Reader

2nd gen antihistamines (Fexofenadine, Cetirizine, Loratidine) are definitely what you want for allergies. 1st gen like Benadryl/Diphenydramine have awful side effects. I highly recommend nasal sprays like Fluticasone as well, available OTC in the US these days and amazing stuff.

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Beware of corticosteroid side effects [0][1]. Not stated directly here is retinopathy

[0] https://www.mayoclinic.org/drugs-supplements/corticosteroid-...

[1] https://www.mayoclinic.org/drugs-supplements/corticosteroid-...

Ironically, whilst having terrible hayfever... Not taking Antihistamines at all seems to have had the most profound effect on me between the gen 1 and 2 meds. If I didn't know any better, I would almost figure I was having some sort of rebound effect from taking them in the first place. Which is odd, because I have been diagnosed with having Allergic Sinusitis, which triggers an inflammatory asthma if not careful.

I used 1st gen stuff like Chlorpheniramine and Diphenhydramine to start. Tried some second gen stuff not too long ago, and it worked pretty well too; but not as well just not taking any? It's weird. Meanwhile if I have an actual allergy attack, I keep Benadryl around for just in case. Because again, not taking any of these seems to just leave me without any allergies now? Or as bad at least. But Benadryl seems to still have some effect, where as I need a couple days of taking the 2nd gen stuff to actually get any effect; if any at all.

All in all, I'm confused now as to which I should even take considering everything in how my reactions have been to it all. So I just don't take any unless things are real bad now. Which they usually aren't.

Maybe I outgrew my allergies? I doubt it, cause I still sneeze around cats and stuff. heh.

> Fluticasone

A corticosteroid, it has awful side effects as well

Maybe. But I would say for me the benefits of not suffering "breakthrough" hayfever attacks far outweigh the side effects.

Antihistamines are great - but the nasal corticosteroids are what really control my hayfever (1) when used consistently.

1 - Hayfever so bad that I used to have to get custom serum shots containing the local pollen profile, every 2 weeks as a kid. Had anaphylaxis twice.

Best to limit corticosteroids if you can. Azelastine was approved to go OTC last year and is a half-decent antihistamine nasal spray. Hopefully it will be available stores this summer.

Nothing works quite as good as a corticosteroid of course, but azelastine controls my symptoms without having to rely on steroids.

Administered nasally it has very poor systemic bioavailability.

I thought so at first. My personal experience was different though.

Fluticasone changed my life. It's a wonder drug.

I would argue that, whatever “generation” it is, cetirizine does not deserve credit for being second generation. I know plenty of people with extremely obvious CNS effects from it. In contrast, loratadine seems innocuous.

Second that, cetirizine definitely feels more like clemastine or meclizine than a proper second gen "non sedating" antihistamine. And with hay fever AND an allergy to nuts, I've tried them all, haha.

Unfortunately its justifiably classified as 2nd gen and IIRC studies show that it's generally more effective for hay fever. Personally, I've found that loratadine is pretty ineffective, especially after regular use.

I found loratadine very effective but it takes time to work. At least a week

For me, loratadine was ineffective, and I can't distinguish cetirizine and fexofenadine - both are maybe 50-60% effective with no notable side effects, and allergy season means extra fatigue no matter what. Cetirizine does have the shortest half life.

Cetirizine is a "no go" for pilots. Fexofenadine and loratadine are OK to fly on though, as is fluticasone.

These are great. Europe has some even newer 2nd (or "3rd gen") antihistamines such as bilastine and rupatadine. They're apparently even more effective than what we have in the states.

Would love to try them out, but unfortunately I don't think they're seeking FDA approval. Anyone abroad have any experience with these compared to loratadine/cetirizine?

+1 to Fexofenadine (Allegra) and Fluticasone. Loratadine (Claritin) is too weak for my needs and Cetrazine (Zyrtec) has side effects are too similar to a stimulant for me.

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