Welcome to Allergy Week, our complete guide to finding relief this spring. 25.7% of adults in the US suffer from seasonal allergies, with women disproportionately affected by symptoms. Here at Glamour, our staff is full of allergy sufferers determined to make this time of year a little bit less miserable. Tune in all week as allergists and experts share their best knowledge, tips, and recommendations so you can live your best life this season and beyond.
While we all wish our allergies could be resolved in a single drugstore run, most sufferers know that it’s not that simple. With so many over-the-counter allergy medications available, it can be difficult to determine which option is best for your symptoms and lifestyle. And even when a daily treatment seems perfect on paper, finding the right match (while avoiding the dry mouth, drowsiness, headaches, and other common side effects) can take some trial and error.
Most over-the-counter allergy pills work by blocking histamine receptors, which helps to soothe allergic reactions and symptoms like runny nose, itchy throat, and irritated eyes. Increasingly, experts are turning to nasal sprays over oral antihistamines for effective symptom relief (more on that later). The good news? According to Kanao Otsu, MD, MPH, allergist and immunologist at National Jewish Health, it’s generally safe to use oral and nasal allergy medications together as needed.
It’s also worth noting that brand name isn’t always better when it comes to OTC allergy treatment. “In general for oral antihistamines, I always tell patients to try the generic medication first,” says Christopher Brooks, MD, allergist and immunologist at The Ohio State University Wexner Medical Center. (That means looking out for the main ingredient, which you’ll see in parentheses next to each popular brand ahead.) “For about 95% of patients, the generic is going to be just as effective.” That said, Dr. Brooks grants that a small group of patients will see additional improvement from brand-name medications.
Even if you’ve sworn by one brand for years, switching things up might actually improve your symptoms. “I encourage people to rotate their allergy pill of choice every few months, as you can stop responding to any given pill if used for a long time,” says Alexa Mieses Malchuk, MD, MPH, FAAFP. “Rotating is a good idea to maintain effectiveness.”
To lend a little clarity to your allergy haze, we asked the experts for a crash course on common over-the-counter allergy medications, and how to decide which is best for you. Concerned about oral tablets making you sleepy? Not müddet what the difference is between a steroid and an antihistamine nasal spray? We’ve got you covered. Ahead, take the doctors’ best advice for choosing an over-the-counter remedy that’ll help you thrive—not just survive—this allergy season.
Zyrtec (cetirizine)
Zyrtec 24 Hour Allergy Relief Tablets
Amazon
Allergy season itch, meet your match. “Zyrtec (cetirizine) tends to be my go-to recommendation for someone who does not want to use a nasal spray and needs improvement for nasal symptoms, eye symptoms, or skin itching,” Dr. Brooks says, noting the lots of his patients report improvement. “It’s a great once-per-day medication, or it can be used as needed.”
“Generally, if you get allergies and you’re itchy everywhere—or seeing a rash or hives— Zyrtec is actually a better antihistamine for skin itch,” says Dr. Otsu. As for side effects, Dr. Brooks says that cetirizine causes sleepiness in some patients.
Claritin (loratadine)
Claritin Allergy Medicine for Adults
Amazon
If you’re only suffering mild allergy symptoms, or if you’ve had strong reactions to other allergy pills, Claritin might be a good choice for you. “Claritin (loratidine) is a really mild antihistamine. You won’t get drowsy because you don’t see as many side effects, but it’s also not very potent,” Dr. Otsu says. She notes that for this reason, people with more intense symptoms may not find Claritin as effective.
“Similar to Zyrtec, Claritin is great option if someone wants a pill for those nasal, eye, and skin symptoms,” Dr. Brooks says. “I find that through my own experience, on average people might not see as much improvement as they do with with cetirizine.”
Allegra (fexofenadine)
Allegra Adult 24-Hour Allergy Relief Tablets
Amazon
If drowsiness is a concern (or a side effect you’ve dealt with from other over-the-counter options), opt for Allegra. Dr. Otsu considers it the only true nondrowsing oral antihistamine, because unlike many other allergy medications, including Zyrtec and Xyzal, it doesn’t cross the blood-brain barrier. Generally speaking, “Allegra is really well-tolerated,” she says.
Dr. Brooks also says that Allegra (fexofenadine) is his “go-to” recommendation “when someone wants really good relief, like Zyrtec, but the Zyrtec is causing them sleepiness.” He also recommends it as a first choice for older patients who may be more susceptible to drowsiness, dizziness, or fall risks.
“With Allegra, the thing to know is that there are different doses—12-hour and 24-hour,” Dr. Otsu says. “In adults, I recommend the 180 milligrams, which is the 24-hour medication.”
Xyzal (levocetirizine dihydrochloride)
Xyzal 24 Hour Allergy Relief Medicine
Amazon
“Xyzal was marketed as a nonsedating cetirizine,” Dr. Otsu says. “So it’s levocitazine—essentially, the molecule is a mirror image of Zyrtec—and it’s not supposed to cross the blood-brain barrier, but it does.” Main takeaway: It might make you sleepy.
“When Xyzal came out, we thought it was going to be this great medication because it’s basically this purified form of Zyrtec,” Dr. Brooks says. He elaborates that while the hope was to harness the benefits of Zyrtec with fewer side effects, he finds the two fairly interchangeable. In general, he usually recommends Zyrtec or Claritin first, since they tend to be more affordable. However, some patients report more symptom improvement from Xyzal—meaning it’s a worthwhile switch if you’re not experiencing relief.
Benadryl (diphenhydramine)
Benadryl Ultratabs Antihistamine Allergy Relief Medicine
Amazon
While it can be helpful for unexpected allergy attacks, most experts advise against using Benadryl as a daily seasonal allergy defense. “Side effects are more pronounced with older antihistamines such as diphenhydramine (Benadryl),” Dr. Malchuk says. “In general, I tell folks to avoid diphenhydramine altogether and reserve it for severe allergy attacks (such as hives).”
“This is a first-generation antihistamine, which means it’s older, it crosses the blood-brain barrier a lot more, and there are more side effects associated with Benadryl,” Dr. Otsu says. She also notes that this medication stays active for about four to six hours. “It’s not a 24-hour medication, but it’s highly sedating and it can cause impaired motor skills, cognitive dysfunction like brain fog, dry mouth, dry eyes, all sorts of things.”
Dr. Brooks says there’s a common misconception that experiencing side effects means your daily allergy medication is working better—one reason why he suspects patients are “so attached” to Benadryl. “But generally I would rather someone have tried Zyrtec, Claritin, Allegra, or Xyzal first,” he says. Dr. Brooks also notes that some research shows that when people take Benadryl before bed, it reduces their sleep quality in the same way that alcohol does.
Nasal Sprays
Both Dr. Otsu and Dr. Brooks actually recommend intranasal allergy sprays over oral pills as a first line of defense for nose and eye symptoms (also known as allergic rhinitis and rhinoconjunctivitis). But not all sprays are created equal. Ahead, the experts break down the difference between two common types of nasal spray.
Flonase, Nasacort, Nasonex, and Rhinocort are all common steroid nasal sprays. These medications are applied directly to the inner nasal passageways and work to reduce both inflammation and mucus in order to make breathing easier. Dr. Brooks notes that steroid sprays need to be used consistently—at least a week or two at a time—in order to be effective.
If you experience allergy symptoms around the same time every year, Dr. Otsu recommends starting use before peak allergy season. “You need about two or three weeks of regular use before it becomes effective,” she says. “So people who have springtime allergies, in Colorado we often tell them to start using their intranasal steroids in February.”
If you have any history of glaucoma, Dr. Brooks says to consult your eye doctor before using a steroid nasal spray, which can make the condition worse.
Flonase Allergy Relief Nasal Spray
Amazon
As for which over-the-counter steroid spray is right for you? “I give the same recommendation for topical steroid nasal sprays: Rotate every so often, or switch to another brand if one brand doesn’t work for you,” Dr. Malchuk says. “They’re all pretty equal between the steroid nasal sprays, and you can use them all for similar periods of time,” Dr. Brooks adds; since his patients usually report similar results across brands, he often recommends Flonase as a cost-effective option to start.
Rhinocort 24 Hour Allergy Relief
Walmart
Dr. Otsu prefers Nasacort, Nasonex, and Rhinocort. “Nasonex (mometasone) is very well tolerated; it’s water-based, and it’s probably the mildest steroid,” she says, also noting that Nasocort (triamcinolone) is a sensitive-friendly option for long-term use. Dr. Otsu also notes that since Flonase is alcohol based, it can dry out the nose and cause nosebleeds in some people.
Nasonex 24HR Allergy Nasal Spray
Amazon
Nasacort 24HR Allergy Nasal Spray for Adults
Amazon
While steroid sprays are designed for long-term relief and need consistency, Dr. Otsu says that antihistamine sprays “work very quickly and can be used on an as-needed basis.” Astepro (azelastine) is a common over-the-counter option.
While this type of nasal spray is great for quick relief and unexpected symptom flares, it’s not generally meant to be used every day. “Astepro should be reserved for allergic runny nose and congestion. It can also dry out the nasal passage and has an unpleasant taste,” Dr. Malchuk says. “While it’s considered a topical, it can still produce fatigue and dizziness in some folks, as it’s still an antihistamine.”
Astepro Nasal Spray and Tissue Bundle
Amazon
Unlike oral antihistimines, Astepro can provide relief even if allergies are not the sole cause of your symptoms. “It works for both allergic rhinitis and nonallergic rhinitis,” Dr. Brooks says. “So for people who maybe have both allergies and other respiratory irritants that are also causing symptoms, Astepro is one medication that can help both things.”
When it comes to nasal allergy sprays, your application technique might matter more than the brand you choose. Dr. Otsu recommends tilting the nasal spray applicator away from the septum (the middle of the nose). If you’re spraying your right nostril, think about aiming the applicator outward, toward your right ear.
While dispensing the medication, Dr. Brooks recommends lightly inhaling instead of aggressively sniffing. “If you snort it, you’re actually swallowing some of the medication, which makes it less effective,” he says.
For most nasal allergy medications, the top dose is two sprays in each nostril, twice per day. But you don’t necessarily have to choose between a steroid spray and an antihistamine. For patients with severe allergies, Dr. Brooks recommends combining them: “What I normally tell people is doing one spray of each—Astepro and their steroid nasal spray—in each nostril twice per day, so at least in the morning and the evening. And that’s been shown to be the most effective thing, more than any of these nasal sprays alone and more effective than the oral antihistamines.”
While there’s no universal remedy for allergies, understanding the difference between treatments can get you closer to relief. When in doubt—and whenever you’re concerned about a reaction or an underlying condition—consult your doctor about your over-the-counter deva plan.
Grace McCarty is the associate beauty editor at Glamour.
