Type of therapy	FDA pregnancy category	Minimum age for use	Mechanism/onset of action	Adverse effects	Cost*
Intranasal corticosteroids			Decrease the influx of inflammatory cells and inhibit the release of cytokines; onset of action is less than 30 minutes	Bitter aftertaste, burning, epistaxis, headache, nasal dryness; possible systemic absorption, rhinitis medicamentosa, stinging, throat irritation
Beclomethasone	C	4 years			NA ($150) for 1 inhaler
Budesonide (Rhinocort Aqua)	B	6 years			$120 ($160) for 1 nasal spray
Ciclesonide (Omnaris)	C	6 years			NA ($210) for 1 nasal spray
Flunisolide	C	6 years			$55 (NA) for 1 nasal spray
Fluticasone furoate (Veramyst)	C	2 years			NA ($175) for 1 nasal spray
Fluticasone propionate (Flonase)	C	4 years			$15 ($15) for 1 nasal spray
Mometasone (Nasonex)	C	2 years			NA ($230) for 1 nasal spray
Triamcinolone acetonide	C	2 years			$70 ($130) for 1 nasal spray
Oral antihistamines			Block histamine H1 receptors; onset of action is 15 to 30 minutes	Dry mouth, sedation at higher than recommended doses
Cetirizine (Zyrtec)	B	6 months			$10 ($20) for 30 tablets
Desloratadine (Clarinex)	C	6 months			$40 ($210) for 30 tablets
Fexofenadine (Allegra)	C	2 years (allergic rhinitis)			$15 ($20) for 30 tablets
Loratadine (Claritin)	B	2 years			$13 ($25) for 30 tablets
Combination intranasal corticosteroid and antihistamine			See intranasal corticosteroids and intranasal antihistamines	See intranasal corticosteroids and intranasal antihistamines
Azelastine/fluticasone (Dymista)	C	6 years			NA ($170) for 1 nasal spray
Intranasal antihistamines
Azelastine (Astelin)	C	5 years	Block H1 receptors; onset of action is 15 minutes	Bitter aftertaste, epistaxis, headache, nasal irritation, sedation	$50 ($145) for 1 nasal spray
Olopatadine (Patanol) [corrected]	C	6 years	Block H1 receptors; onset of action is 30 minutes	Bitter aftertaste, epistaxis, headache, nasal irritation, sedation	$50 ($250) for 1 nasal sprays
Oral decongestants
Pseudoephedrine	C	2 years (usually not started until 4 years)	Vasoconstriction; onset of action is 15 to 30 minutes	Headache, elevated blood pressure and intraocular pressure, tremor, urinary retention, dizziness, tachycardia, and insomnia	$5 ($10) for 24 tablets
Intranasal cromolyns
Cromolyn	B	2 years	Inhibits histamine release	Epistaxis, nasal irritation, sneezing	NA ($18) for 1 nasal spray
Intranasal anticholinergics
Ipratropium (Atrovent)	B	5 years	Block acetylcholine receptors; onset of action is 15 minutes	Epistaxis, headache, nasal dryness	$30 ($120) for 1 nasal spray
Leukotriene receptor antagonists
Montelukast (Singulair)	B	6 months	Block leukotriene receptors; onset of action is 2 hours	Elevated levels of alanine transaminase, aspartate transaminase, and bilirubin	$15 ($215) for 30 tablets
Immunotherapy			Not well understood, believed to shift immune response from immunoglobulin E mediated to immunoglobulin G mediated	Minor local mouth irritation, diarrhea, vomiting; rare anaphylaxis
Sublingual Grastek (timothy grass pollen extract, cross reactive with 6 other grass pollens)	B	5 years			NA ($260) for 30 tablets
Sublingual Oralair (5-grass pollen extract)	B	10 years			NA ($345) for 30 tablets
Sublingual Ragwitek (short ragweed pollen extract)	C	18 years			NA ($260) for 30 tablets
Subcutaneous allergen extracts: several tree, grass, weed pollens; cat and dog dander; dust mites; certain molds; and cockroaches; administered by a physician	Should not be initiated during pregnancy; maintenance therapy is considered safe	Has not been established; usually 5 years so that the child is old enough to cooperate		Local injection site reactions and, less commonly, systemic allergic reactions	Varies