What Are the Best Over-the-Counter Allergy Medications?

Staff WriterLast Updated Jun 24, 2020 7:09:28 PM ET
Dandelion Pollen Photo Courtesy: @HopkinsMedNews/Twitter

When you’re sniffling, sneezing and constantly reaching for a tissue for your runny nose, it can become more than a little annoying. Add in some watery eyes, throat tickles and maybe even a cough, and you might be willing to try almost anything to make the misery stop. If you’re one of the millions of allergy sufferers in the U.S. — and billions around the world — you know all too well what kind of irritating discomforts are waiting for you with each new allergy season or unexpected exposure.

Whether your symptoms are moderate or severe, they can impact your daily activities, prompting you to seek relief in the form of an allergy medication. You could visit your doctor to request a prescription medication, but with so many former prescription allergy drugs now available in your grocery store medicine aisle, it seems a bit like a waste of time, effort and probably even money. Most people can find an over-the-counter allergy medication to tackle all their symptoms, but that doesn’t mean all the meds work the same. Here’s what you need to know about the best allergy medications.

Antihistamine Allergy Medications

Over-the-counter allergy medications come in many forms, including pills, inhalers, creams, liquids, nasal sprays and eye drops. The most common types of allergies cause a histamine reaction when the body’s immune system mistakenly attacks what should be a harmless substance, such as pollen, to remove it from the body. Antihistamine allergy medications combat this reaction by blocking the production of histamine.

The most common antihistamines are oral tablets and liquids formulated to target sneezing, runny nose, itchy eyes, watery eyes, hives and other common allergy symptoms. Antihistamines like diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton) have been around for quite some time and are known to cause drowsiness, making them a poor choice when you’re at work or driving. Newer antihistamines like cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra), levocetirizine (Xyzal) and desloratadine (Clarinex) are much less likely to cause drowsiness.

Antihistamine nasal sprays are only available by prescription, but eye drops are available over the counter if your most bothersome allergy symptoms are itchy, red, watery eyes. Top options include naphazoline and pheniramine combinations (Visine Allergy, Clear Eyes, Opcon-A), ketotifen (Alaway and Zaditor) and olopatadine (Pataday and Patanol). 

Decongestant Allergy Medications

Decongestants are often preferred by allergy sufferers who experience moderate to severe sinus congestion as a symptom of their allergies. Many of the top oral antihistamines offer a secondary option with pseudoephedrine added to their formulas to provide greater relief from nasal congestion. Examples include cetirizine pseudoephedrine (Zyrtec-D), loratadine pseudoephedrine (Claritin-D), fexofenadine pseudoephedrine (Allegra-D) and desloratadine pseudoephedrine (Clarinex-D).

Over-the-counter allergy decongestants may also come as a nasal spray. The most popular examples would be oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine). These types of nasal sprays only help with limited short-term use, as they can cause the congestion to become worse when used more than three consecutive days.

Corticosteroid Allergy Medications

As a type of steroid, corticosteroid allergy sprays reduce the inflammation that goes with allergies. This helps relieve stuffy noses without causing sneezing or running when the nose clears. Over-the-counter allergy spray options include fluticasone furoate (Flonase Sensimist), fluticasone propionate (Flonase Allergy), budesonide (Rhinocort), mometasone (Nasonex) and triamcinolone (Nasacort Allergy). Stronger versions of corticosteroids are available in prescription inhaler form for those with particularly severe allergies or asthma.

Some corticosteroids also offer over-the-counter relief of allergic skin reactions like rashes and hives. Hydrocortisone, for example, comes in cream or ointment forms and has been popular for itchy rash relief for many years. It also comes in prescription strength for more severe allergic reactions.

Mast Cell Inhibitor Allergy Medications

Mast cell inhibitors prevent histamine from being released from mast cells, which blocks an allergic reaction. The allergy nasal spray known as NasalCrom is the only over-the-counter mast cell inhibitor currently available.

Potential Side Effects of Allergy Medications

The transition to over-the-counter availability of many allergy medications has made it much easier for allergy sufferers to enjoy quick, effective relief without having to schedule unnecessary doctors’ appointments. This saves insurance companies and patients money and doctors and patients valuable time. However, just like any other medication, over-the-counter allergy medications can have bothersome side effects. It’s important to be aware of the possible risks before taking any of these medications.

The most common side effects associated with antihistamine medications are drowsiness and confusion. This is particularly true for older antihistamines — referred to as first-generation antihistamines — that have been around for decades. First-generation medications like Benadryl are widely known for decreasing alertness and making those who take them want to indulge in a nice, long nap. Newer antihistamines — referred to as second-generation antihistamines — don’t tend to cause this impairment. Antihistamine eye drops also don’t cause drowsiness, but they can cause headaches, dry eyes and stinging or burning when first dropped into the eye.

Decongestants sometimes come with side effects as well. Some people who take decongestants for allergies have reported sleep problems, headaches and irritability. Additionally, the chemical compounds in these medications can increase blood pressure, which is why these medications aren’t recommended for anyone with cardiovascular issues.

Many people who use corticosteroid sprays complain about the unpleasant taste that occurs when the spray runs down the back of the throat from the sinus passages. In some cases, nasal irritation and nosebleeds can also occur.

Resource Links:

https://www.aaaai.org/conditions-and-treatments/allergies

https://www.mayoclinic.org/diseases-conditions/allergies/in-depth/allergy-medications/art-20047403

https://www.health.harvard.edu/diseases-and-conditions/choosing-an-over-the-counter-allergy-medication

https://health.usnews.com/drugs/conditions-symptoms/respiratory-allergy-medicine