Allergies (allergic rhinitis): symptoms and treatment online in Puerto Rico

Allergic rhinitis is an allergy in the nose: your body reacts to something you breathe in. It can be seasonal (from tree, grass and plant pollen) or year-round. The most common year-round triggers are dust mites, mold, pet dander and cockroaches.

Allergies run in families: a child is more likely to have them if one parent does, and much more likely if both parents do.

Some symptoms start soon after contact with your trigger, and others develop later. Allergies do not cause fever:

• Sneezing
• Runny nose with clear mucus
• Stuffy nose
• Itchy nose, mouth, eyes or throat
• Watery eyes
• Dark circles or puffiness under the eyes
• Cough, sore throat or throat clearing
• Tiredness and poor sleep from congestion

The best treatment is avoiding your triggers, though that isn’t always possible. These are the most used treatments; the doctor evaluates which is appropriate for you, and this information does not replace her evaluation.

• Steroid nasal sprays (fluticasone): the most effective treatment for allergic rhinitis. Fluticasone (one well-known brand is Flonase) is sold over the counter; symptoms may start to improve in 1 to 2 days, but the full benefit takes longer and it works best used every day. It does not treat colds. If you are not better after a week of daily use, see a doctor.
• Antihistamines (cetirizine): as pills, liquids, nasal sprays or eye drops. Cetirizine (one well-known brand is Zyrtec) is one of the newer antihistamines, which cause less drowsiness than the older ones, but it can still make you sleepy: don’t drive until you know how it affects you, and avoid alcohol.
• Loratadine: another newer over-the-counter antihistamine (one well-known brand is Claritin). It relieves sneezing, a runny nose and itchy nose, eyes or throat, and is also used for the itch of hives. Like cetirizine, it causes less drowsiness than the older antihistamines, but some people still feel sleepy, especially after the first dose, and the label warns that taking more than directed may cause drowsiness. If you have liver or kidney disease, ask before taking it. "D" versions also contain a decongestant (pseudoephedrine), which is not for everyone.
• Decongestants: ease a stuffy nose, but decongestant nasal sprays should not be used for more than 3 days in a row, and decongestant pills are not for everyone (for example, if you have high blood pressure).
• Saline nasal rinses: wash mucus and allergens out of the nose.
• Montelukast: a prescription pill also used for allergies, but it is not a first-line treatment for allergic rhinitis: since 2020, the FDA says to reserve it for people who do not do well on, or cannot tolerate, other allergy medicines, because of its boxed warning about mental health side effects. If you take it and notice changes in mood or sleep, or thoughts of harming yourself, stop taking it and call your doctor; in a crisis, call or text 988 or call Línea PAS at 1-800-981-0023. More on our asthma page.
• Immunotherapy (allergy shots): when symptoms are hard to control. If your symptoms are severe or don’t respond to treatment, the doctor advises you on allergy testing with a specialist.
• Oral steroids: for a very severe allergy that does not respond to usual treatment, the doctor may prescribe a steroid pill such as prednisone for a few days. It is not an everyday treatment.

When to see the doctor: if over-the-counter allergy pills do not control your symptoms, you need them most of the year, you have wheezing, a night-time cough or shortness of breath (allergies and asthma often go together), or the medicine is for a child under 2. Doctor online 24/7: book a visit and the doctor helps you choose a treatment.

Video doctor visits 24/7 — book online and choose your time right away.

Allergies are handled in a doctor visit, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the clinic can’t see you. A doctor’s note after your visit is included at no extra charge.

We do not bill insurance; the pharmacy charges separately. See all prices. The service is run by The Health Initiative, a nonprofit.

A cold is caused by a contagious virus, comes on gradually, often brings thick mucus and sometimes fever and aches, and lasts 3 to 10 days. Allergies aren’t contagious, flare as soon as you meet your trigger, cause clear mucus and itchy eyes, never cause fever, and can last weeks or months.

A sinus infection causes facial pain or pressure, thick mucus and sometimes fever, and often follows a cold. Poorly controlled allergies can lead to sinus infections. If your eyes are red and itchy too, see pink eye. If allergies leave you with a dry cough that won’t go away, see cough. According to the NIH, allergies can also swell the vocal cords and leave you hoarse or without a voice: see laryngitis. And because allergy irritation can cause nosebleeds, see also nosebleed. If an allergy gives you hives or a rash on your skin, see hives or dermatitis.

In a warm, humid climate like Puerto Rico’s, two triggers deserve special attention. Mold grows wherever there is moisture, leaks or flooding, and can cause nasal congestion, cough, burning eyes and skin rash. The CDC recommends keeping indoor humidity at 50% or lower with air conditioning or a dehumidifier, and fully drying anything wet from flooding within 24 to 48 hours, for example after a hurricane. More in mold exposure and health.

Cockroaches live year-round in warm climates and are hard to get rid of; the allergy is caused by their droppings and body parts, not the insects themselves. Having them doesn’t mean a home is dirty. In summer, Saharan dust can also irritate your nose and eyes. If you have just moved to the island and your allergies changed, new triggers like these may be why.

The doctor evaluates your child by video with you on camera and, if appropriate, prescribes and we send the prescription to your pharmacy. Allergy medicines for children should be given only on a doctor’s advice, even when sold over the counter: each label says the minimum age, and the dose depends on the child’s age and weight.

According to the American Academy of Pediatrics (AAP), "old-generation" antihistamines cause drowsiness, so if used they are best given in the evening, and newer ones can also cause mild drowsiness, especially after the first dose. For children, loratadine and cetirizine come as liquids and chewable tablets: the children’s loratadine liquid label allows use from age 2 and says to ask a doctor for children under 2. Several steroid nasal sprays are approved for children as young as 2; if a child aged 2 to 11 needs over-the-counter fluticasone for more than 2 months a year, check with their doctor. Decongestants taken by mouth can make children jittery, give them a racing heart or trouble sleeping. The AAP does not recommend "cough and cold" products under age 4, and from 4 to 6 only if a doctor advises it.

If your child wheezes or is short of breath, tell the doctor: it could be asthma. Patients under 21 need a parent or legal guardian on camera with ID. See our online doctor for kids.

These signs can mean anaphylaxis, a severe allergic reaction. For your safety, call 911 and use epinephrine if it has been prescribed for you. See when to go to the ER.

• Swelling of the face, lips, eyes or tongue
• Trouble breathing, wheezing or a very hoarse voice
• Hives or itching all over with dizziness or vomiting
• Trouble swallowing
• Fainting, severe dizziness or slurred speech after contact with something you are allergic to