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Allergy Rx 101: Your seasonal allergy medication questions answered

Shaili Ghandi, Pharm.D., headshot By | March 10, 2020

More than 50 million people in the U.S. experience allergies every year, according to the American College of Allergy, Asthma & Immunology. In other words, if seasonal allergies have you sneezing, coughing, and blowing your nose—you’re not alone. Fortunately, there are many options to get rid of those pesky symptoms if you’re having an allergic reaction to something in the air?

As pharmacists, we’ve seen it all and know all the choices you have for seasonal allergy medicine. Here are answers to common questions about these options:

1. What is the difference between seasonal and perennial allergies?

Seasonal allergies generally occur around the same time each year, often between January and April, or even into early summer. Common seasonal allergies include pollen from trees, grass, and/or weeds. 

Perennial allergies can affect you throughout the whole year, or occur intermittently at different times. Common causes of perennial allergies include: mold, dust mites, insects, and pet dander.  

Regardless of the type of allergy, when your body tries to fight the cause of the reaction, you may experience any or all of these symptoms: 

  • Coughing
  • Wheezing
  • Sneezing
  • Runny nose
  • Nasal or chest congestion
  • Itchy throat
  • Headaches
  • Fatigue
  • Watery or itchy eyes

Allergy medications, both OTC and prescription can help to alleviate them.

2. What is the best seasonal allergy medicine?

The short answer is it depends on your symptoms. 

If you feel itchy and have a runny nose or watery eyes, you would most likely benefit from an antihistamine, preferably a non-drowsy one such as Claritin. You can add a nasal steroid such as Flonase to help relieve those pesky nasal allergy symptoms. Nasal saline is a great option to keep nasal passages from drying out. OTC allergy eye drops can help relieve itchy eyes.

If you have a stuffy nose, you may want to add a decongestant. Many non-drowsy allergy meds include a decongestant, such as Allegra-D. But if you have high blood pressure, you should avoid these medications, because they can raise your blood pressure further. Also, some antihistamines are not safe for people who have glaucoma or prostate problems. Your pharmacist can help you pick the best product for your symptoms, considering any medical conditions you have and other medications you take. 

3. Is it better to take brand or generic OTC allergy medications? 

Generic medications will provide allergy relief  as effectively as a brand-name product, and at a fraction of the price. Ask your pharmacist if you need help finding a generic product. The allergy aisle can be overwhelming.

And just as an FYI, you can get discounts with SingleCare on OTC allergy meds, but you’ll need to follow these steps.

4. If OTC medications aren’t effective, are there prescription options available?

Most allergy medicine is now available over the counter (OTC). However, several nasal sprays are available by prescription only. These include Astepro (azelastine), Dymista (azelastine/fluticasone), and Nasonex (mometasone). Flonase is available in prescription and OTC strengths. 

OTC medications are often sufficient to treat allergy symptoms, but if your symptoms are not relieved by OTC meds, check with your healthcare provider to see if a prescription medication may be right for you. 

If you have asthma and allergies, there are a variety of treatments available by prescription to alleviate both, including inhalers or oral medication such as Singulair (montelukast).

5. How do you minimize drowsiness?

Older antihistamines, such as Benadryl (diphenhydramine), can cause significant drowsiness. Newer antihistamines, like Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine), and Xyzal (levocetirizine), are less likely to cause drowsiness, but many patients do report some sleepiness. 

Be careful when choosing any combination product (such as NyQuil) for allergies or cough and cold because many of them contain sedating antihistamines. Ask your pharmacist to help you choose a product that won’t immediately put you to sleep. 

6. Which allergy medications can you mix?

Depending on your symptoms, some allergy medications can be safe to use in combination. Generally, you can use an antihistamine with a decongestant (if you have no conflicting medical conditions). 

However, you don’t want to double up allergy medications. For example, you generally wouldn’t want to take Claritin in the morning and Zyrtec in the evening (except in rare cases as directed by your doctor). 

7. Can I drink alcohol with my allergy medications?

Generally, it is not advisable to combine allergy meds with alcohol. Combining the more sedating antihistamines with alcohol can be very dangerous, increasing the risk of side effects and impairment. Combining the newer, less sedating antihistamines with alcohol is less dangerous, but should still be avoided. 

8. Is it safe to take OTC allergy medications every day?

Generally, yes—though you should consult with your healthcare provider for guidance. Nasal steroids may take a few weeks to become effective. If you have occasional symptoms, it is okay to take antihistamines as needed, following the package directions. 

9. Who shouldn’t take allergy medications?

Non-sedating antihistamines are relatively safe for most patients, but you should not take older antihistamines (like Benadryl) if you have prostate problems or glaucoma. You should not take decongestants if you have high blood pressure. If you are pregnant or breastfeeding, consult a healthcare professional before using allergy medications (or any medications). 

10. I’m so confused—the allergy aisle is so overwhelming. Can you break down each medication?   

The allergy aisle can be extremely confusing. You may think you’re going to pop in for a box of Claritin, and then see 24 different kinds of Claritin: brand, generic, different dosage, and forms. 

Allergy medications generally fall into the following categories:

  • Antihistamines: These meds block histamine and can help symptoms of sneezing, itchy or watery eyes, and post-nasal drip. Benadryl (diphenhydramine) is an older, first generation antihistamine, which can cause drowsiness. Newer antihistamines, like Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine), and Xyzal (levocetirizine), are less likely to cause drowsiness. 
  • Decongestants: These help relieve a stuffy nose. A common decongestant is Sudafed (pseudoephedrine or phenylephrine). Decongestants are sold alone and in combination with antihistamines (Allegra-D, Zyrtec-D, Claritin-D). If you have high blood pressure, you should avoid decongestants, as they can increase blood pressure. 
  • Nasal steroids: These help decrease inflammation in your nasal passages, relieving nasal congestion. They may take up to two weeks to work. Some examples are: Flonase (fluticasone), Nasacort (triamcinolone), and Rhinocort (budesonide). When using nasal steroids, you can also use nasal saline drops or sprays so your nasal passages don’t dry out.
  • Eye drops: Allergy eye drops can help relieve symptoms of itchy, red eyes. Some examples are Zaditor (ketotifen) and Pataday (olopatadine), which has been approved by the FDA and should be available OTC soon. 

Always check with your pharmacist if you need help selecting an appropriate OTC allergy medication. If you struggle with allergy symptoms, you should make an appointment with an allergist to talk about testing for triggers, allergen avoidance, and the need for an EpiPen (emergency epinephrine).