Type of therapy	Mechanism of action	Minimum age for use	Cost*	FDA pregnancy category
Intranasal corticosteroids
Beclomethasone (Qnasl)	Inhibits multiple inflammatory cytokines	4 years	— ($250) for one inhaler	May use during pregnancy; no human data but considered low risk
Budesonide		6 years	$9 (—) for one nasal spray
Ciclesonide (Omnaris)		6 years	— ($300) for one nasal spray
Flunisolide		6 years	$25 (—) for one nasal spray
Fluticasone furoate (Flonase Sensimist)		2 years	$5 ($20) for one nasal spray
Fluticasone propionate		4 years	$5 (—) for one nasal spray
Mometasone		2 years	$30 (—) for one nasal spray
Triamcinolone		2 years	$21 (—) for one nasal spray
Oral antihistamines
Cetirizine (Zyrtec)	First-generation antihistamines nonselectively antagonize central and peripheral histamine H1 receptors; second-generation antihistamines selectively antagonize peripheral H1 receptors	6 months	$2 ($20) for 30 tablets	May use during pregnancy based on limited human data
Chlorpheniramine		6 years	$1 (—) for 30 tablets
Desloratadine (Clarinex)		6 months for perennial use and 2 years for seasonal use	$8 ($230) for 30 tablets
Diphenhydramine		6 years	$4 (—) for 30 tablets
Fexofenadine		12 years	$5 (—) for 30 tablets
Levocetirizine		6 months for seasonal use and 6 years for perennial use	$5 (—) for 30 tablets
Loratadine		2 years	$4 (—) for 30 tablets
Intranasal antihistamines
Azelastine	Antagonizes central and peripheral H1 receptors (nonselective antihistamine)	5 years for seasonal use and 6 years for perennial use	$15 (—) for one nasal spray	May use during pregnancy; no human data although fetal harm not expected based on limited systemic absorption (40%)
Combination intranasal corticosteroid and antihistamine
Azelastine/fluticasone (Dymista)	Inhibits multiple inflammatory cytokines; antagonizes central and peripheral H1 receptors (nonselective antihistamine)	6 years	$70 ($120) for one nasal spray	May use during pregnancy; no human data, although fetal harm not expected based on limited systemic absorption
Mometasone/olopatadine (Ryaltris)		12 years	— ($250) for one nasal spray
Oral decongestants
Pseudoephedrine	Stimulates smooth muscle alpha-adrenergic receptors, producing vasoconstriction and reducing nasal congestion (sympathomimetic)	6 years	$4 (—) for 30 tablets	Avoid use in first trimester; weigh risks and benefits in second and third trimesters; limited human data suggest risk of teratogenicity including gastroschisis, small intestinal atresia, and hemifacial microsomia; risk of vasoconstriction based on animal data and mechanism of action
Intranasal cromolyns and anticholinergics
Cromolyn	Inhibits mast cell degranulation (mast cell stabilizer)	2 years	$7 (—) for one nasal spray	May use during pregnancy; no human data, although fetal harm not expected based on limited systemic absorption (< 7%)
Ipratropium	Antagonizes acetylcholine receptors, inhibiting nasal serous/seromucous gland secretions	5 years for seasonal use and 6 years for perennial use	$14 (—) for one nasal spray	May use during pregnancy; no human data, although fetal harm not expected based on limited systemic absorption (< 20%)
Leukotriene receptor antagonists
Montelukast	Selectively binds to cysteinyl leukotriene receptors, decreasing inflammation and swelling	6 months for perennial use, 2 years for seasonal use	$15 (—) for 30 tablets	Weigh risks and benefits during pregnancy; no known risk based on limited human and animal data
Sublingual immunotherapy
Timothy grass pollen allergen extract, cross-reactive with six other grass pollens (Grastek)	Exact mechanism unknown: alters immune response and promotes tolerance through repeated allergen-specific exposure	5 years	— ($320) for 30 tablets	Weigh risks and benefits during pregnancy; no human data, although risk of fetal harm not expected based on human data with other allergen immunotherapy agents
House dust mite allergen extract (Odactra)		18 years	— ($315) for 30 tablets
Five-grass pollen extract (Oralair)		5 years	Only available at specialty pharmacies
Peanut allergen oral powder (Palforzia)		4 years	— ($1,100) for one dose pack at maintenance dose
Short ragweed pollen extract (Ragwitek)		5 years	— ($305) for 30 tablets