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Guide To Over-The-Counter Allergy Medicines

Most people can relate to the watery eyes, runny nose, itchy throat, and chronic cough associated with allergy symptoms. Molds, dust mites, pet dander, hay fever, grasses, trees, and weeds are common allergens that cause fatigue and uncomfortable symptoms.

Over-the-counter (OTC) allergy medicines treat many of these symptoms, but the vast number of options available can be overwhelming. Whether you choose a single-ingredient product or one with a combination of medications formulated to treat most allergy symptoms, you want one that will provide effective symptom relief with a minimum of side effects.

Types of Anti-Allergy Medication  

Antihistamines, decongestants, corticosteroids, and mast cell stabilizers are all used to treat allergy symptoms. Each medication class has its own benefits and side effects. While there is no strongest over-the-counter allergy medicine, some products may work better for you than others.

Antihistamines

Antihistamines block histamine, a chemical stored in mast cells and released when your body encounters an allergen (something you are allergic to). Histamine causes blood vessels to widen and leak fluid. It causes itching, congestion, a runny nose, hives, and watery eyes. Antihistamines can reduce these symptoms by blocking histamine release.

Pills or Liquids

Common OTC antihistamines include:

1st generation antihistamines: these medications tend to cause drowsiness and are short-acting. They are not typically recommended to treat allergy symptoms. Examples include:

  • Diphenhydramine (Benadryl)
  • Chlorpheniramine

2nd generation antihistamines: these medications are longer lasting and less likely to cause drowsiness. Examples include:

  • Cetirizine (Zyrtec): works the fastest but is most likely to cause drowsiness
  • Fexofenadine (Allegra): long-lasting and is least likely to cause drowsiness
  • Loratadine (Claritin, Alavert)
  • Desloratadine (Clarinex)
  • Levocetirizine (Xyzal)

All 1st and 2nd generation antihistamines block histamine, so there is no “best choice.” However, depending on your genetics and tolerance for fatigue, some may work better for you than others.  

A woman with a graphic showing her sinuses

Nasal sprays

Antihistamines are also available in a nasal spray. Reducing histamine release in the nose can decrease sneezing, itchiness, runny nose, and postnasal drip. Many people complain about the bitter aftertaste when using these medications. Antihistamine nasal sprays can cause drowsiness. Examples include:

  • Azelastine (Astelin)

Eye drops

Antihistamine eye drops reduce eye itchiness and tearing. They may cause a headache or dry eyes. Examples include:

  • Ketotifen
  • Olopatadine
  • Pheniramine and naphazoline

If itching, a runny nose, sneezing, watery eyes, and postnasal dripping are your primary symptoms, an antihistamine can relieve your symptoms. Try a second-generation antihistamine for overall symptom relief. If you have primarily eye or nose symptoms, a nasal spray or eye drops may provide relief with less drowsiness. Antihistamines may also relieve symptoms of allergic asthma.

A woman with itchy eyes

Decongestants

Swollen blood vessels in the nose and sinuses cause congestion. Decongestants constrict blood vessels, opening airways. Because decongestions cause blood vessel narrowing, they are not typically recommended for people with high blood pressure or heart conditions. Examples include:

  • Pseudoephedrine
  • Phenylephrine

Combination products are also available. The 2nd-generation antihistamines combined with a decongestant will have the antihistamine name and a “D” in the product name to indicate that it also contains a decongestant. Pseudoephedrine sales are regulated by law; typically, you need to request this OTC product from a pharmacist. Limit oral decongestant use to five to seven days to reduce side effects.

Decongestant nasal sprays (oxymetazoline, phenylephrine) are also available but not commonly used to treat allergies. Decongestant nasal sprays should only be used for a maximum of three days. Extended or repeated use of these medications can cause rebound congestion that may be worse than the original.

Corticosteroids

Corticosteroid nasal sprays reduce swelling and inflammation. Corticosteroid nasal sprays are typically started two weeks before allergy season and used consistently throughout the season. Steroid nasal sprays can cause nasal irritation, nosebleeds, headaches, sore throats, and an unpleasant aftertaste. Examples include:

  • Budesonide (Rhinocort)
  • Fluticasone furoate (Flonase)
  • Mometasone (Nasonex)
  • Triamcinolone (Nasacort)

In many cases, consistent use of corticosteroid nasal sprays can control allergy symptoms and reduce the need for antihistamines and decongestants.

Mast cell stabilizers

Mast cell stabilizers block histamine and other chemicals released from mast cells. Mast cell stabilizers can reduce runny nose, sneezing, and facial swelling. Nasalcrom nasal spray is the only mast cell stabilizer currently available over the counter. It can take several weeks to reach its full effect. Nasalcrom can cause headaches and a stinging sensation after use.

A woman choosing an allergy medication

Choosing the Right Allergy Medicine

Antihistamines typically work best when taken daily throughout your allergy season. Decongestants should only be used as needed, as they can increase heart rate and blood pressure. Don’t take decongestants for more than a week without talking with your doctor.

Corticosteroid nasal sprays work best when used regularly and started a couple of weeks before allergy season starts. Generally, corticosteroid nasal sprays are the recommended first-line treatment for allergies.

When choosing an allergy medicine, don’t take more than one combination product, as it can lead to an overdose. All medications, including over the counter, have side effects. Consult with your doctor if you are unsure which OTC allergy medication would work best for you, especially if you have chronic health conditions, are pregnant or breastfeeding, or are taking other medications.

Prescription allergy medications are also available. Consult with an online doctor on call on the Telegra MD platform to discuss your allergy symptoms and learn whether OTC or prescription medications are a better option to control your symptoms. Telegra MD physicians provide 24-hour access to help you manage your allergies. Telehealth can be a great alternative for people who need a cost-effective treatment option to manage their allergy symptoms.

A person talking to a telehealth doctor

When to See an Allergist?

If you are unsure whether allergies are causing your symptoms or have severe or persistent allergy symptoms that significantly impact your quality of life, see an allergist for allergy testing and to discuss immunotherapy.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

  1. Farzam K, Sabir S, O’Rourke MC. Antihistamines. In: StatPearls [Internet]. StatPearls Publishing.
  2. NIH National Library of Medicine. Antihistamines for Allergies.
  3. Naqvi A, Gerriets V. Cetirizine. In: StatPearls [Internet]. StatPearls Publishing.
  4. Sidhu G, Akhondi H. Loratadine. In: StatPearls [Internet]. StatPearls Publishing.
  5. Sicari V, Zabbo CP. Diphenhydramine. In: StatPearls. StatPearls Publishing
  6. U.S. National Library of Medicine. Oxymetazoline nasal spray.
  7. U.S. National Library of Medicine. Pseudoephedrine.
  8. U.S. National Library of Medicine. Phenylephrine.

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