Ask A Pharmacist

The Best OTC Medications For Seasonal Allergies

Our Customers Asked:

I want to take something for my seasonal allergies, but there are so many choices. How do I know which is best for me?

Our Pharmacists Answered:

It seems like allergy season is always just around the corner, and there is nothing worse than waking up unable to breathe out of your nose because you’re unprepared. Seasonal allergies are one of the easiest conditions to treat with OTC medications, but picking a specific drug for  treatment is not as simple. There are tons of allergy medications available today and we know it can be overwhelming to try and pick the one that will work best for you. Thankfully, our team of pharmacists has put together this brief, foolproof guide to keeping sneezes at bay when the flowers start to bloom. Firstly…

What causes allergies?

“Allergies are caused by “allergens” (like pollen, animal fur, mold, and dust) that your body perceives as foreign invaders.”

Allergies are caused by “allergens” (like pollen, animal fur, mold, and dust) that your body perceives as foreign invaders. When it senses one of these allergens, the body signals special cells called mast cells to release histamine. Histamine stimulates inflammation in the areas where allergens have been detected, as well as localized defense mechanisms (AKA allergy symptoms) like increased mucus production in the nose, sneezing, and watery eyes. This is why most allergy medications aim to stabilize mast cells and block the action of histamine.

So how do I know I’m suffering from seasonal allergies and not something else?

Seasonal allergies share symptoms with many other conditions like cold/flu and asthma, so it’s important to know the differences to look for if you are aiming to self-treat, otherwise you can risk treating the wrong condition and make symptoms worse. Common allergy symptoms include red/watery eyes, sneezing, itchy eyes, nose, and throat, and a congested/runny nose with a clear discharge. However, if you start to see mucus that is colored or not-clear, or congestion in your chest rather than your nose, these are signs that you are probably suffering from something other than allergies. A sore (rather than itchy) throat, as well as coughing, are also not usually allergy-related. While allergies can make it hard to breathe, wheezing, chest tightness, and feeling out of breath are signs that you are suffering from asthma rather than allergies. If you exhibit any of these non-allergy symptoms, speak to a doctor or pharmacist for some guidance on treatment, as you may not be able to treat with over-the-counter meds.

Ok, I’ve figured out I am definitely feeling allergy symptoms, what do I do now?

There are over 30 different OTC allergy treatment options, and we know how confusing it can be to decide which is right for you. All of these medications have their own pros and cons, but a couple stand out above the rest (in the opinions of our pharmacists) and these are the ones we will focus on here. Our picks are centered on three main medication classes that each should play a role on your allergy treatment team: oral antihistamines, nasal corticosteroids, and antihistamine eye drops.

  1. Oral antihistamines are the drugs most commonly associated with allergy treatment and the fastest acting. You probably recognize the main meds in this class like Zyrtec (cetirizine), Allegra (fexofenadine), Claritin (loratidine), and Xyzal (levocetirizine). These are great because they are all taken once daily and serve to block histamine activity throughout the entire body. The only drawback is that they can cause drowsiness. As for picking one over another, our pharmacists feel that is patient-specific. None have been proven to be significantly more effective than the others, and drowsiness varies from patient-to-patient (although Allegra is generally regarded as the least sedating). We recommend trying one, and if you find it isn’t working like you want it to, give another a shot. If you find you are becoming too sleepy, you can try taking the pill at night, as it is effective for 24 hours, and often times the sleepiness subsides after the first few hours.
  1. Nasal corticosteroids are the most effective allergy medications in the eyes of Bigelow pharmacists. These include Rhinocort (budesonide), Flonase and Veramyst (fluticasone), Nasonex (mometasone), and Nasacort (triamcinolone). These medications act locally in the sinus area to fight the inflammation caused by allergens, thus reducing congestion/mucus production and sneezing. Side effects are usually mild but include unpleasant smell or taste and nasal irritation. Like the oral antihistamines, we don’t recommend any one over any other, and results vary between patients. That being said, it is important to note that Rhinocort is the only one that is OK to use in pregnancy. Also, while they act relatively quickly, you will not see a max effect until 2-4 weeks of use, so get ahead of the game! Start using these sprays daily a couple weeks before allergy season begins to ensure you’re preventing symptoms rather than treating them when they arrive.
  1. Lastly, antihistamine eye drops are important to have on hand for those days when allergens are everywhere and you just can’t keep them out of your eyes. While we recommend using oral antihistamines and nasal corticosteroids daily, our pharmacists recommend using antihistamine eye drops symptomatically during times when your eyes are suffering despite other treatment. The drugs in this class include Zaditor and Alaway (ketotifen), Pataday (olopatadine), and Visine-A and Opcon-A (pheniramine). We all have those days where we just can’t stop itching our eyes, and while these drops are approved for daily use, our pharmacists feel that they don’t provide much added benefit outside of these “itchy eye days” if you are already using an oral antihistamine or nasal corticosteroid. Be sure to keep them close for times when your eyes start to water.

But wait…I’ve tried all of these options and I still can’t get any relief! Help!!!

If that’s the case, then you might be someone who needs prescription-strength treatment. There are a couple options like Singulair (montelukast) or even immunotherapy injections that require a prescription from your physician. Talk to your physician or see an allergist if these options interest you.

While this is by no means an all-inclusive guide to every option you have to treat seasonal allergies, this is the information our team of pharmacists finds ourselves sharing most often with patients at C.O. Bigelow. Armed with these helpful tips, you should be able to stop sniffling and breathe happily throughout allergy season! Bring it on, springtime!