How to Choose an Over-the-Counter Allergy Medicine

With the return of warmer spring days comes the resumption of seasonal allergies. Persistent sneezing, itchy eyes, and a stuffy or runny nose are all signs you’re being affected by pollen that trees and other plants are spewing into the air.

There are many things you can do to combat seasonal allergies (check out our 10 tips from an earlier blog article). One of the most effective is to take medications that reduce or alleviate the symptoms. In this article, we’ll discuss the different kinds of seasonal allergy medications available without a prescription.

It’s important to note you should talk to your health care provider first before starting any new medications, even over-the-counter drugs. Many medications may not be safe to take if you are pregnant or breastfeeding.

How to Tell If It’s Allergies

Knowing whether you have a cold or seasonal allergies can be confusing, as they share some of the same symptoms. Here are key differences:

• Colds typically run their course in 7 to 10 days. Allergy symptoms often last longer.
• With a cold your mucus is thick or colored. Mucus from allergies is clear and watery.
• Allergy symptoms often include itchy, watery eyes. Colds rarely affect your eyes.
• Colds may include a fever. Allergies never cause fevers. 

Different Medication Types

At your local pharmacy or grocery store, you’ll find dozens of choices in the allergy medicine section. There are products that tout their ability to be fast-acting, long-lasting, and non-drowsy. Some have brand names while others are generics. Despite this dizzying array of options, all allergy medicines can be grouped into four broad categories:

• Oral antihistamines. When your immune system detects pollen or other allergens, it releases chemicals called histamines, which help your body get rid of allergens. Unfortunately, histamines make us feel bad while they are doing their job, causing symptoms such as runny nose and sneezing. Oral antihistamines block the effects of histamines and help control allergy symptoms. 
• Nasal sprays. These sprays decrease inflammation in your nasal passages, reducing swelling and mucus so that you can breathe more freely.
• Decongestants. When histamines are released, one of the things they do is prompt your nose membranes to make more mucus. A decongestant helps you feel less stuffy. 
• Eye drops. Many allergy sufferers experience itchy, red eyes. They may also tear up often. Allergy eye drops are aimed at easing these symptoms.

Oral Antihistamines

Taken by mouth, oral antihistamine drugs work throughout your body via the bloodstream. Products available over-the-counter (OTC) include:

• Benadryl (diphenhydramine)
• Claritin (loratadine)
• Allegra (fexofenadine)
• Zyrtec (cetirizine)
• Xyzal (levocetirizine)

One of the side effects of oral antihistamine drugs can be drowsiness. Older allergy medications like Benadryl (diphenhydramine) are most likely to cause drowsiness. Newer drugs like Claritin, Zyrtec, and Xyzal are less likely to make people feel sleepy. Allegra is considered the least likely to cause drowsiness. The first time you try an oral antihistamine, take it when your performance is non-critical so you can safely determine its effect.

Which oral antihistamine is best for you? The only way to tell which one your body will respond to best is to pick a product and try it out. Buy a small number of doses to start. If the drug relieves your symptoms, keep taking it and purchase a larger quantity. 

One strategy is to begin taking an oral antihistamine before you start to feel bad. Find pollen forecasts for your area using an online pollen tracking tool like this one. As pollen production begins to ramp up, start taking the antihistamine so that it will reach its full effect by the time pollen counts hit higher levels.

Nasal Sprays

Almost all allergy sufferers feel it in their nose, as sneezing and a stuffy or runny nose are very common. Fortunately, there are many products available aimed at relieving nasal symptoms caused by allergies.

• Nasal steroids. These sprays work by reducing inflammation in the nasal passages. Nasal steroids don’t have an effect on other parts of the body. OTC nasal steroid products include Nasacort (triamcinolone), Nasonex (mometasone), Flonase (fluticasone), and the generic budesonide. Some people prefer products such as Flonase Sensimist, which has a more gentle spray, while other may prefer traditional products like Flonase. A nasal steroid spray may take several days to work, so you may want to start using it early in the allergy season — before pollen levels increase. Keep taking it, as a nasal steroid works best when used daily. 
• Nasal antihistamines. These sprays work by blocking histamines or stabilizing the mast cells that release histamines. Astepro (azelastine) is an OTC antihistamine spray, while NasalCrom (cromolyn) targets mast cells. Nasal antihistamine spray works quickly because it’s applied directly to the problem area. Results may take longer with NasalCrom.
• Saline sprays and washes. Saline nasal products help to clear allergens and mucus from your nasal passages to make it easier to breathe. They can be used before other nasal sprays and throughout the day to help relieve stuffiness.

Nasal sprays and oral antihistamines can work very well together to fight severe symptoms. However, you may not need both all of the time (and it will be easier on your wallet). Which should you take first? It’s a matter of personal preference. Some people like that nasal steroids won’t make them drowsy, while others find taking an oral antihistamine once a day to be easier than using a spray several times a day.

Long-time allergy sufferers know to begin taking their go-to drug (either a nasal steroid or an oral antihistamine) when the season kicks off, and to supplement it with other types of allergy medications as the weeks go by, depending on how they feel.   

Decongestants

Not to be confused with nasal steroid and antihistamine sprays are decongestants. They work by constricting blood vessels in the nose, helping to open passages and make breathing easier. Decongestants are available in both spray and pill forms. They include:

• Sudafed (pseudoephedrine)
• Sudafed PE (phenylephrine)
• Afrin spray (oxymetazoline)

Some allergy medicines combine an antihistamine and a decongestant. For example, Claritin-D or Zyrtec-D. If you’re taking one of these, don’t use a separate decongestant at the same time. Some people shouldn’t take decongestants at all. Talk to your healthcare provider before taking a decongestant if you have high blood pressure, diabetes, glaucoma, heart problems, prostate issues, or a thyroid condition. 

Nasal decongestant sprays should be used sparingly. For example, Afrin nasal spray should not be taken for more than three days, as using it longer causes “rebound congestion” — making you feel even worse. Because of this time limit, it’s best to reserve use of a nasal decongestant spray for when you are having severe allergy symptoms and need some short-term help to relieve congestion.

Eye Drops

A lot of attention in fighting allergy symptoms is focused on the nose, but your eyes can suffer greatly as well. Histamines can make your eyes feel itchy and appear red. They may be more watery than normal and have a discharge as well.

Taking an oral antihistamine can reduce eye symptoms, but if your eyes are still troublesome, you may want to supplement that with allergy eye drops. Products available OTC include:

• Pataday (olopatadine)
• Lastacaft (alcaftadine)
• Alaway (ketotifen)

These are antihistamines applied directly to the eyes to reduce inflammation. They tend to work very quickly to ease symptoms but may not last long and need to be reapplied. Some products, such as Pataday, are used twice a day and should not be used more often than that. 

You can use antihistamine eye drops at the same time you’re taking an oral antihistamine like Zyrtec. The labeling for antihistamine eye drops recommends only using for 72 hours and consulting a health care provider if symptoms have not improved in that time.

Should You Get Tested?

We hope the information in this article has helped clear up any confusion about OTC allergy medications. For many people, their spring allergies will subside after a few weeks and they will have a trouble-free summer. Allergy symptoms that don’t go away with the seasonal change may mean you have persistent year-round allergies. 

If your allergies last several months, or it seems you get sick often, talk with your health care provider. You may want to also consider seeing an allergist to get an allergy test. Results of the test will help pinpoint what you are allergic to, and an allergy specialist will be able to discuss specific treatment options with you. To find an allergist, please use our Find a Doctor tool.