Allergy Medicine: Comparing the Best OTC Allergy Medications

Sneezing, runny nose, and itchy eyes — these are all telltale signs of allergies. And whether you have them seasonally or year round, they can make you feel pretty miserable. Allergy medicine can help keep your symptoms in check.

But with so many choices, there’s a chance you could be taking the wrong one and not getting enough allergy relief. Here are some questions to consider before popping more allergy pills. This way, you can find one that best meets your needs.

What are the best allergy medicines to take?

Depending on how long your allergy symptoms last, certain allergy medicines will likely work better than others. Here are the four most common kinds of allergy medicines people use.

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Antihistamines

If your allergies only appear sporadically — say, when the pollen count is high, or you have that random encounter with your friend’s cat — oral antihistamines may be your best bet. Many of these are readily available over the counter (OTC). And they typically start working within a few hours of your first dose.

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Examples of oral OTC antihistamines include:

• Benadryl (diphenhydramine)

• Claritin (loratadine)

• Allegra (fexofenadine)

• Zyrtec (cetirizine)

• Xyzal (levocetirizine)

There’s also an OTC antihistamine nasal spray available: Astepro (azelastine). It works much faster than oral antihistamines — within 15 to 30 minutes. And some studies have found that intranasal antihistamines may work better than antihistamine pills for nasal allergy symptoms, such as congestion.

Is there a “strongest” oral antihistamine? Not really. However, a review of multiple studies suggests Allegra may work better for eye-related symptoms and Xyzal may help with sneezing and nasal itching more than others. Claritin seems to be slightly less effective overall.

Histamine is a chemical our immune system releases when we come into contact with something we’re allergic to. It then triggers allergy symptoms, like a runny nose or itchy eyes. Antihistamines work by blocking areas of your body where histamine would normally attach to cause these symptoms.

While some people take antihistamines as needed for allergy symptoms, daily use is currently expert-recommended and may be an option for people looking to prevent symptoms.

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In the case of seasonal allergies, you can take antihistamines before you’re exposed to an allergy trigger — like pollen. Starting the medication at least 2 weeks before allergy season typically begins can help you get the best results. This can be particularly helpful if you have frequent seasonal allergy symptoms.

Nasal steroids

If you experience daily or year-round allergies, you’ll want to look into nasal steroids. They can also be helpful if you know your seasonal allergy symptoms tend to last for several weeks or months. Experts recommend trying nasal steroids before other allergy medicines, as they tend to be the most effective option.

OTC nasal steroids include:

• Nasacort (triamcinolone)

• Flonase (fluticasone propionate)

• Rhinocort (budesonide)

• Nasonex (mometasone)

Similar to antihistamines, there’s no “strongest” nasal steroid. However, a review of multiple studies suggests Nasonex may be the most effective for seasonal allergies. The same review found Rhinocort to be the most effective for year-round allergies.

Nasal steroids generally take longer to work than antihistamines. But healthcare professionals consider them to be the most effective for keeping nasal allergy symptoms in check over time. As a group, they may also be more effective at preventing nasal congestion compared to oral antihistamines.

Here’s how they’re thought to work: When you have allergies, a complicated series of reactions occur in your immune system between the moment you sense an allergen and when you get that runny nose. Nasal steroids act early on in these reactions — even before histamine is made — and prevent the processes that lead to a full-blown allergic response.

Decongestants

Decongestants help improve symptoms by relieving nasal and sinus congestion. They typically work quicker than other allergy medicines. This makes them an attractive option for fast relief.

Decongestants available without a prescription include:

• Sudafed (pseudoephedrine) — kept behind the pharmacy counter

• Afrin (oxymetazoline)

• Neo-Synephrine (phenylephrine nasal spray)

Some allergy medicines, such as Allegra-D (fexofenadine / pseudoephedrine) and Claritin-D (loratadine / pseudoephedrine), combine both decongestants and antihistamines into the same pill so that they can target congestion and other allergy symptoms at the same time.

Decongestants can help you breathe a little easier if you’re stuffed up, but they shouldn’t be taken long term. Also, it’s important to know that nasal decongestant sprays, like Afrin, can make your congestion worse if they’re used for more than a few days (called rebound congestion). So it’s best to use them sparingly.

Oral decongestants, like Sudafed, also shouldn’t be taken if you have certain heart conditions, including high blood pressure. If you have these health conditions, talk to a pharmacist or other healthcare professional first before giving them a try.

Mast cell stabilizers

Mast cell stabilizers are another allergy medicine option. But they’re not a good option for quick relief, as they take longer to start working. NasalCrom (cromolyn sodium nasal spray) is the only OTC nasal mast cell stabilizer currently available.

Mast cell stabilizers work by preventing certain cells (called mast cells) from releasing histamine. They’re generally less effective than other allergy medicines, especially for seasonal allergies. But they could be an option if you have year-round allergies. And they’re considered one of the safest allergy medicines to use during pregnancy.

What is the best allergy medicine?

The short answer is — it depends. There are a few things to consider when selecting the right allergy medicine for you:

• How quickly you need relief

• Your symptoms

• Side effects

• Cost

Fast-acting medications, like decongestants and antihistamines, work quickly if you’re experiencing symptoms. But while antihistamines can be taken daily, decongestants should only be taken as needed in the short term.

Antihistamines and nasal steroids can be good options for preventing symptoms if taken daily before allergy season hits. Experts currently recommend nasal steroids as the first-choice treatment for people with persistent symptoms. If your symptoms only happen every now and then, an oral or intranasal antihistamine would be a good first choice.

Keep in mind that not all antihistamines are created equal — certain ones have a higher risk of drowsiness. But all antihistamines can potentially make you sleepy. So it’s best to see how you respond to them before engaging in activities that require alertness or concentration.

How long will it take for your allergy medicine to work?

When you’re experiencing allergy symptoms, you want to feel better — and fast. But each product works differently and treats specific symptoms. So you should select the allergy medicine that will help you the most.

• Decongestants: These offer the fastest relief. Nasal spray options should work within about 10 minutes, and oral options work within 30 to 60 minutes.

• Oral antihistamines: These are another quick-relief option. Many work within about 1 to 2 hours.

• Nasal antihistamine sprays: These also start working fast, about 15 to 30 minutes after using them.

• Nasal steroids: These take longer to start working — a few days to 2 weeks for full effects.

• Mast cell stabilizers: These take the longest to work, about 2 to 6 weeks.

Will your allergy medicine make you drowsy?

Like all medications, allergy medicines can have side effects. This can include drowsiness, depending on which type of medication you take. We’ve broken down the potential side effects that different allergy medicines can cause below.

Nasal steroids side effects

Nasal steroids don’t typically cause drowsiness. Serious side effects with nasal steroid sprays are rare because the body absorbs very little of these medicines. They do, however, carry the risk of nasal tissue inflammation. That’s why it’s important to have regular checkups with your primary care provider when using these medications for long periods of time.

Decongestants side effects

Decongestants aren’t associated with drowsiness. In fact, they can even keep you awake if you take them too close to bedtime. Other common side effects of oral decongestants include headache, anxiety, and raised heart rate or blood pressure.

First-generation antihistamines side effects

Drowsiness is a common side effect of older, first-generation antihistamines like Benadryl. These medications work quickly to control allergy symptoms. But they can pass into your brain and cause drowsiness along with other neurological symptoms, like dizziness.

Second-generation antihistamines side effects

Drowsiness and other brain-related side effects are less of an issue with newer, second-generation antihistamines, such as Claritin. This is because they’re less likely to enter the brain.

Zyrtec, however, is an exception — while it is a second-generation antihistamine, you may be more likely to get sleepy from taking it compared to Claritin or Allegra.

Possible side effects of second-generation antihistamines include:

• Dry mouth

• Headache

• Dizziness

• Ringing in the ear (tinnitus)

Take our quiz: Allergy medications

Prescription vs. OTC allergy medicines

Many allergy medicines are available OTC. But there are some that you need a prescription to purchase. These are some examples of prescription allergy medicines:

• Clarinex (desloratadine) — an oral antihistamine

• Vistaril (hydroxyzine) — an oral antihistamine

• Patanase (olopatadine) — a nasal antihistamine spray

• Flunisolide — a nasal steroid

• Qnasl (Beclomethasone) — a nasal steroid

• Omnaris (ciclesonide) — a nasal steroid

Prescription allergy medicines aren’t necessarily better than OTC options. Experts generally don’t recommend specific medications within a class for allergy symptoms.

However, some prescription-only medications have other uses besides allergies. For instance, Vistaril can be prescribed for itching or anxiety. And Qnasl can help prevent nasal polyps after surgery. So, if you have allergies and certain non-allergy symptoms, your prescriber may recommend a medication that can treat both.

How to save on your allergy medicine

There are many ways to save on your allergy medicine. GoodRx can help you navigate your options. You can find allergy medications for as low as $5 with a free GoodRx coupon. And if a healthcare professional writes you a prescription for an OTC allergy medicine, you can apply a GoodRx coupon to it.

The table below lists some common OTC allergy medicines and how much you might save if you use GoodRx.

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Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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