Which Allergy Medicine Works Best?

Wandering down the allergy aisle at the pharmacy can feel overwhelming. Various pills, sprays and combination products promise relief from allergy symptoms — but which one actually works best?

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We asked allergist Dylan Timberlake, MD, for advice on the best allergy medication to quickly and efficiently tame allergy symptoms.

Decongestants and antihistamines can both help you feel better but they work in different ways. Learn which to reach for depending on your symptoms.

Understanding allergies and common symptoms

Allergies kick into gear when your immune system overreacts to something that’s generally harmless — things like pollen, pet dander or dust. Basically, your body produces special antibodies that treat the substance like a threat.

That reaction triggers your system to release chemicals such as histamine, which leads to symptoms like:

Sneezing
Runny or stuffy nose
Itchy or watery eyes
Nasal congestion
Skin itching or hives

“All of those symptoms appear because your body is overreacting to a stimulus that really shouldn’t cause alarm,” explains Dr. Timberlake.

Main types of allergy medications

Common types of OTC allergy medications, uses, brands and side effects

The goal of an allergy medication is to interrupt your body’s overreaction to allergens or tame the resulting symptoms. The most common allergy treatment products found on pharmacy shelves include:

Here’s what you should know about each option.

Antihistamines

Antihistamines are one of the most common allergy treatments. These medications block histamine — the chemical responsible for many allergy symptoms.

You’ll find many over-the-counter antihistamines in pill form, including:

Cetirizine (Zyrtec®)
Loratadine (Claritin®⁾
Fexofenadine (Allegra®)
Levocetirizine (Xyzal®)
Diphenhydramine (Benadryl®)

Which antihistamine works best?

Antihistamines have evolved — and the newer “second-generation” products tend to be preferred, emphasizes Dr. Timberlake. That includes medications like Allegra, Claritin, Xyzal and Zyrtec.

Older medications like Benadryl are considered first-generation antihistamines. While they still can work, they’re more likely to cause side effects, like significant drowsiness.

“We typically avoid recommending the first-generation antihistamines for regular daily use,” he notes. “The newer ones provide the same benefits with fewer side effects.”

So, of the second-generation options, does one stand out? Not really, says Dr. Timberlake. Zyrtec works a bit more quickly than the others, but beyond that, there’s little difference between them.

“I have some patients who say Claritin works best for them, while others swear by Zyrtec or Allegra,” he shares. “If one doesn’t seem to work well for you, switching to another may get you the results you want.”

Nasal sprays

Nasal steroid sprays reduce inflammation directly inside your nose. Many allergy specialists now consider them the most effective first-line treatment for frequent or seasonal allergies, says Dr. Timberlake.

“They’re effective and work right where the problem is,” he states.

Common sprays include:

Fluticasone (Flonase®)
Triamcinolone (Nasacort®)
Budesonide (Rhinocort®)

How are nasal sprays most effective?

Unlike antihistamine pills, nasal steroids take time to build up — so they may not offer immediate relief. You might need to use them daily for several days or weeks before seeing the full preventative benefit.

If you’re looking for fast relief out of a nasal spray, a newer option — azelastine (Astepro^®) may be worth trying. It’s an antihistamine delivered directly into your nose.

Decongestants

As the name suggests, decongestants help relieve the severe congestion that can come with allergies. They can help relieve the pressure and pain that comes from being stuffed up.

When are decongestants most effective?

Decongestants are best used only as a short-term solution, emphasizes Dr. Timberlake. That’s because long-term use of decongestant pills or liquid medication can raise your blood pressure and cause other side effects.

And using a nasal decongestant spray like oxymetazoline (Afrin®)for more than three to five days in a row can cause rebound congestion — meaning your symptoms get worse. (That’s not the result anyone wants.)

When to use allergy medications

The “best” allergy medicine for you to use often depends on how and when your symptoms occur, clarifies Dr. Timberlake. For example:

Occasional symptoms: An antihistamine pill or nasal antihistamine taken on an as-needed basis may be enough. (For example, consider taking a pill in advance of visiting a home with cats or dogs if pet dander triggers your allergies.)
Seasonal allergies: A daily nasal steroid spray may provide stronger relief while allergens are in the air. “If you’re miserable every spring, we often suggest starting a daily nasal steroid before the season to give it time to build up,” says Dr. Timberlake.
Sudden flare-ups: Fast-acting antihistamines can help quickly reduce symptoms. Ditto for decongestants if you suddenly feel congested.

Can you use multiple types of allergy medications?

It’s common to combine allergy treatments. For example, some people use a daily nasal spray and take an antihistamine pill if they’re experiencing severe symptoms when seasonal allergies peak.

Some over-the-counter products also combine different types of medications, like antihistamines and decongestants. (Examples of these two-in-one medicines include Allegra-D, Claritin-D and Zyrtec-D.)

Bottom line? Always read the instructions on any medication you’re taking to ensure you’re taking it properly. Talk to a pharmacist if you have unanswered questions.

When to see a doctor for allergies

Over-the-counter allergy medicines help many people manage symptoms effectively. But you may want to talk with a healthcare provider if:

Your symptoms persist despite trying multiple treatments
You consistently need several medications daily for relief
Your allergies interfere with sleep, work or daily activities
You’re unsure whether allergies are causing your symptoms

An allergist can help identify triggers and recommend treatments that go beyond over-the-counter options. They may also suggest ways to reduce your exposure to triggers, which can help make medications work better.

“There are a lot of allergy treatments available,” says Dr. Timberlake. “Talk to your doctor about your options.”