How to choose the allergy medication that's best for you

Itchy, watery eyes? Sneezing? Stuffy nose? If you have seasonal allergies, you probably know these symptoms well.

And you won’t be alone in the allergy medication aisle in the pharmacy. About 25% of adults and 18% of children in the U.S. have allergic rhinitis (also known as hay fever).

So how do you choose a treatment that will help you feel better?

Don Cowin, pharmacy manager for PeaceHealth in Springfield, Oregon, shares a few insights about the array of options available, including:

1. Non-drowsy antihistamines.  These medications are taken by mouth and come in pill or liquid form. Non-drowsy means it doesn’t make you feel sleepy. It works by blocking your body’s response to the allergens that cause your symptoms. It’s especially helpful to alleviate several symptoms at once. A dose is normally taken once a day, and they can provide up to 24 hours of relief. Examples of this type include fexofenadine (Allegra) and loratadine (Claritin).  Side effects can include headache and some stomach discomfort.
2. Nasal corticosteroid. This is a nasal spray which is delivered as a mist into your nose. It reduces inflammation (puffiness or swelling) inside the area behind your nose and eyes. It helps relieve symptoms such as sniffling, sneezing, and stuffiness.  You normally take 1-2 sprays in each nostril daily, and they are most helpful after you use them for a few weeks.  Examples of this type of medication include fluticasone (Flonase) and mometasone (Nasonex).  Side effects can include headache and nasal irritation.
3. Nasal saline (plus a neti pot). Saline is mild salty water that comes in a can or bottle with a spritz top. You use it to clean and remove irritants inside your nose.   The saline can also be used with a neti pot to flush out pollen and mucous.  While saline flushes are not a medication, you should use it only once or twice a day to avoid further irritation.   If you make saline at home, use distilled or sterile water. Learn more about neti pot use.
4. Eye drops. Several choices are available for relief.  Moisturizing or lubricating drops can help cleanse your eyes and decrease dryness.  Examples of these include products like Systane and Refresh.  Antihistamine drops are also available, ketotifen (Zaditor) and olopatadine (Pataday) work to provide direct relief to itchy eyes. The number of choices in eye drop solutions can be overwhelming. To be on the safe side, review these cautions and ask your healthcare provider or pharmacist for a recommendation.
5. Decongestant. This comes in pill form and a nasal spray.  Pseudoephedrine (Sudafed) is an oral pill that is best used for severe stuffiness.  While you can buy this without a prescription, you will need to ask your pharmacist for it.  Side effects can include nervousness and difficulty peeing.  Oxymetazoline (Afrin) is a nasal spray used to relieve stuffiness.  If choosing this product, it is normally not recommended to be used more than 3 days, as it can cause an increase in congestion after that.
6. Prescription medications. If over-the-counter medications don’t work for your severe allergies, talk with your primary care provider or allergy specialist about prescription-strength options.
7. Allergy shots. Shots may be helpful if you have intense allergies. You’ll have to commit to getting a shot every few days or weeks at your provider’s office, though. Use this tool to see if allergy shots would be a good choice for you.

“What you choose can depend on your symptoms and how bad you feel,” Cowin says. “You also need to consider any other medications you are taking and other conditions you are trying to manage.”  

For example, patients who have benign prostatic hyperplasia (BPH), should usually avoid decongestants (Sudafed, oxymetazoline) and older generation antihistamines (Benadryl, chlorpheniramine).  “Generally, the newer non-drowsy antihistamines are well tolerated, but always check with your provider or pharmacist.”

“Some people use a combination of treatments to feel better. Talk to your provider or pharmacist about what might work well for you,” he says. “Using more than one approach can give you greater relief, but it has to be done safely.”

You might consider having a backup choice if your preferred medication is hard to find.  Also, you can always explore other options if your standby medications don’t seem to work as well as they used to.  Ask your pharmacist about what is available and the generic alternatives.

Along with treating your symptoms, you can also try to reduce your exposure to things that trigger your allergies. Read tips on preparing for allergy season.