The Best Over-the-Counter Allergy Medications

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It's allergy season: You constantly need to blow your nose, your eyes itch, and your head feels like it might explode. On top of all this, you're not sure how to choose from all the over-the-counter (OTC) allergy medicine options.

This article will provide some pointers on how to choose the right allergy medication. It also discusses the different types and forms of allergy medication.

Woman blowing her nose
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Types of Allergy Medication

All allergy medications are not the same. Some are designed to prevent allergies, while others treat certain symptoms.

Antihistamines

Antihistamines work by blocking the action of histamine, a chemical released by the immune system in response to substances like pollen or dust. Histamine is what causes symptoms like sneezing, runny nose, and itchy eyes.

  • Active ingredients: Diphenhydramine, chlorpheniramine, loratadine, cetirizine, azelastine
  • Common brand names: Benadryl, Chlor-Trimeton, Claritin, Zyrtec, Allegra, Astepro (expected to be available OTC in 2022)
  • Effects: Antihistamines relieve runny noses, sneezing, itching, and watery eyes.
  • Typical dosage: As a pill, Benadryl is taken 25 to 50 mg at a time, three or four times a day; 4 mg of Chlor-Trimeton can be taken up to six times a day. Claritin and Zyrtec are taken once daily, usually 10 mg at a time. Astepro is a nasal spray with a dosage of one or two sprays per nostril twice daily.
  • Important information: If you are taking sleeping medication, muscle relaxants, or high blood pressure medicine, talk to your healthcare provider before taking antihistamines. You should also discuss with a healthcare provider if you have glaucoma, asthma, a stomach ulcer, or difficulty urinating. Benadryl and Chlor-Trimeton cause drowsiness. Alcohol consumption can increase this effect. Claritin and Zyrtec do not cause drowsiness.

First generation antihistamines like Benadryl and Chlor-Trimeton tend to cause drowsiness. You can avoid this side effect by opting for second-generation antihistamines like Claritin and Allegra.

Decongestants

Decongestants constrict nasal blood vessels, which reduces swollen tissue. This helps you breathe better.

  • Active ingredients: Pseudoephedrine, phenylephrine, oxymetazoline
  • Common brand namesSudafed, Sudafed PE, Afrin nose spray. These drugs are also available as generics.
  • Typical dosage: You can take up to eight 30-mg Sudafed tablets in 24 hours. Take no more than six 10-mg Sudafed PE in 24 hours. Take Sudafed with a full glass of water, with or without food. Afrin can be used twice a day.
  • Important information: Talk to your physician before taking decongestants if you're also taking monoamine oxidase inhibitors (MAOIs), or medications for appetite control, asthma, or high blood pressure. A rebound effect with worse symptoms may occur after using nasal decongestants, such as Afrin, for more than three or four days in a row.

Even though it does not require a prescription, OTC pseudoephedrine is kept behind the counter. This is because it can be used to make the illegal drug methamphetamine. Before buying this medicine, you must first speak to a pharmacist to register your purchase.

A 2007 study found that pseudoephedrine works better than phenylephrine, the active ingredient in Sudafed PE.

Mast Cell Stabilizers

NasalCrom (cromolyn sodium) differs from antihistamines in that it stabilizes mast cells. This prevents the allergic response that releases histamine. Cromolyn is available as either a nasal spray or eye drops.

Cromolyn prevents swelling but doesn't reduce it. For this reason, it should be used when symptoms are first noticed, or before exposure to allergens, if possible. The nasal spray can be used four times a day. NasalCrom nasal spray is available OTC. Cromolyn eye drops are only available by prescription.

Pataday (olopatadine) eye drop is a mast cell stabilizer and antihistamine used to treat itchy, red eyes due to allergies. Pataday comes in a once or twice a day formula. Pataday 0.2% is once daily and Pataday 0.1% is twice daily for children 2 years and older. An extra-strength formula (0.7%) is also available OTC.

Corticosteroids

Nasal corticosteroid spray brands include:

  • Flonase (fluticasone)
  • Nasacort (triamcinolone)
  • Rhinocort (budesonide)
  • Flonase Sensimist (fluticasone)

They work by reducing inflammation caused by allergies. These medicines can be used long-term without causing rebound nasal congestion.

Skin-related allergy symptoms can be treated with OTC corticosteroid creams.

Many healthcare providers recommend corticosteroid nasal spray as the first-line treatment for people with moderate to severe nasal allergy symptoms.

Combination Drugs

Many OTC remedies, such as Zyrtec-D (cetirizine-pseudoephedrine), combine antihistamines and decongestants. Some also include pain relievers, such as Tylenol Allergy Multi-Symptom (acetaminophen/diphenhydramine and phenylephrine).

Allergy Medicine Formats

Allergy medicines are available in several different formats. Some can be purchased over the counter, while others require a prescription.

Pills

Antihistamines and decongestants are commonly available in pill form. Antihistamine pills work best when taken before you've been exposed to an allergen. Decongestants can be taken to relieve existing symptoms.

Pay attention to product labeling. Antihistamine and allergy products labeled "-D" are typically an antihistamine combined with a decongestant.

Nasal Spray

Decongestants, corticosteroids, and antihistamines are available as nasal sprays. Nasal spray decongestants tend to work faster than pills but may lead to rebound symptoms if they are overused.

Corticosteroid nasal sprays like Flonase can relieve nasal symptoms as well as itchy, watery eyes. Like antihistamine pills, they work best when used before exposure to an allergen.

Recap

Antihistamines and decongestants are available in both nasal spray and pill form. Corticosteroid nasal sprays can also be effective against seasonal allergy syptoms.

Liquid

Liquid antihistamines may be absorbed faster than pills. This may be a good choice if you are already experiencing symptoms or if you don't have time to wait for a pill to take effect.

Liquid antihistamines may also be easier for children to take. Always buy children's forms and check the label for dosage information.

Eye Drops

Eye drops can help relieve itchy eyes associated with eye allergies. Some can be purchased OTC while others are only available with a prescription. 

Antihistamines and mast cell stabilizers are available as eye drops. You can also purchase anti-inflammatory eye drops.

Antihistamine eye drops tend to be short-lasting and can make your eyes feel dry. Mast cell stabilizers like Cromolyn should be used before you've been exposed to an allergen.

Recap

Liquid antihistamines are a good choice if you want something faster acting. Eye drops are an effective way to treat itchy, watery eyes.

Things to Consider

Before using combination drugs, make sure you know what's in them. Taking these drugs with other products that contain the same ingredients can be dangerous.

Decongestants and certain antihistamines should not be given to children under the age of four. Talk to your child's pediatrician about how best to treat your child's allergy symptoms.

If you are pregnant, talk to your doctor before using allergy medication. Some antihistamines are thought to be safe during pregnancy, but others may carry risks. Pseudoephedrine should not be used at all in the first trimester.

Summary

Antihistamines, decongestants, mast cell stabilizers, and corticosteroids can all help treat or prevent seasonal allergies. Antihistamines and mast cell stabilizers tend to work best for prevention, while decongestants and corticosteroids can help relieve existing symptoms.  

Allergy medication can be purchased as pills, nasal spray, liquid, or eye drops. Make sure you pay attention to the ingredients, especially with combination products. That way you won't take too much of any one medication. 

A Word From Verywell

Seasonal allergies can interfere with your quality of life. It's always best to prevent your allergy symptoms rather than try to treat them when they happen. If you can, avoid exposure to your allergy triggers by keeping the windows closed during allergy season, and keeping your bedding and clothing clean. Daily use of an antihistamine or mast cell stabilizer during allergy season can help keep you symptom free.

Frequently Asked Questions

  • What is the strongest over-the-counter allergy medication?

    A 2013 meta-analysis of more than 92,000 patients found that Xyzal (levocetirizine) worked better than Allegra (fexofenadine) and the prescription drug Clarinex (desloratadine). Antihistamines tend to be better at preventing allergy symptoms than relieving them. For best results, take antihistamines daily as directed during allergy season

  • What medication format works fastest for allergies?

    A 2013 study found that Astepro nasal spray worked faster than oral Zyrtec and Claritin. Astepro started to provide relief after only 15 minutes, while Zyrtec and Claritin took 60 and 75 minutes, respectively. In general, antihistamine nasal sprays also work faster than corticosteroid nasal sprays.

  • Is Zyrtec or Allegra better?

    Zyrtec and Allegra are both effective at treating sneezing, runny nose, and itchy eyes, nose, and throat. Some studies have found that Zyrtec lasts longer than Allegra. However, Zyrtec is also more likely to make you drowsy. 

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