Choosing an over-the-counter allergy medication

  • If you're struggling with allergy symptoms, you may assume you can resolve them with an over-the-counter (OTC) remedy. And that may be true. Many pharmaceutical-grade allergy drugs once available only by prescription are now as easy to buy as aspirin. But that development forces you to become a doctor in the drugstore aisle as you try to figure out which product is right for you. "People often make the wrong decision about which medication to take and they wind up being undertreated. They try a mix of medications, but don't get relief," says Dr. Ahmad Sedaghat, an ear, nose, and throat specialist at Harvard-affiliated Massachusetts Eye and Ear Infirmary.

    What causes allergies?

    Before choosing a medication, it helps to understand what's causing your allergies. Often it's a matter of inhaling a harmless substance, such as pollen or another allergen, which the immune system mistakenly perceives as a dangerous invader.

    The immune system then "releases the hounds" and generates substances designed to fight the assumed invader. One of these substances is histamine, which stimulates nerves in the nose to trigger sneezing. Histamine also causes the nasal passages to fill with fluid and cells that can fight invaders. The result: inflamed mucous membranes and the production of mucus (lots of it). This condition, called allergic rhinitis, is marked by a stuffy or runny nose, watery or itchy eyes, sneezing, coughing, and sometimes a sore throat. Find more at the

    Strategies to fight back

    There are two primary ways that OTC drugs help you manage allergies. One is by blocking the effects of histamine when alarm bells sound. To do this, you can use a medication called an antihistamine, such as diphenhydramine (Benadryl) or loratadine (Claritin).

    Another way, says Dr. Sedaghat, is by suppressing the immune system response before it even releases histamine. This is done with corticosteroid nasal sprays. OTC versions include budesonide (Rhinocort), fluticasone propionate (Flonase), and triamcinolone (Nasacort). Sometimes a combination of an antihistamine and a corticosteroid nasal spray is the most effective treatment.

    Using antihistamines

    If you're experiencing what seems like your first reaction to an allergen from pollen, grasses, or weeds — maybe from a particularly potent pollen season — or if you're experiencing an isolated reaction to a day of yard work, Dr. Sedaghat recommends trying an antihistamine for quick relief.

    But be careful: first-generation OTC antihistamines such as chlorpheniramine (Chlor-Trimeton) and diphenhydramine can cause drowsiness and confusion in some people, which can also lead to falls. Instead, Dr. Sedaghat suggests taking a second-generation OTC antihistamine that's less likely to cause drowsiness, such as fexofenadine (Allegra), loratadine, or cetirizine (Zyrtec). Compared with first-generation antihistamines, the second-generation ones are no more potent, but they are more expensive.

    Antihistamine eye drops, such as ketotifen (Zaditor), available over the counter, can be used for watery eyes.

    Using corticosteroids

    If an antihistamine isn't resolving your symptoms, or if you know you'll have an allergic reaction in a particular season (tree pollens are bothersome in the spring, grasses can be a problem in early summer, and ragweed is an offender in late summer and fall), you may want to up your game by using a corticosteroid nasal spray. "Head to head, the corticosteroid nasal sprays work better than the oral antihistamines for congestion and stuffy nose," Dr. Sedaghat says.

    The downside is that these sprays take time — usually at least two to four weeks — for their full effect. That can be tough when you're coping with symptoms. If you anticipate seasonal allergy symptoms, you'll need to start using the corticosteroid nasal spray before symptoms typically begin.

    But nasal corticosteroids also have side effects: they can cause bloody noses; they can worsen glaucoma; and in rare cases they can cause a hole in the septum, the wall that separates the right and left side of the nose.