View as List Allergy Relief: OTC Medications

  • Allergy Relief: OTC Medications?>

    Allergy symptoms can often be treated successfully with over-the-counter (OTC) drugs. If these are not sufficient, your doctor can prescribe alternatives, some of which are stronger versions of OTC products. Here, we discuss the options.

  • 1

    Preventive Strategies

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    Many allergy medications work best when taken before you come in contact with allergens and develop symptoms. That way the drugs can prevent or reduce the productions of chemicals responsible for the allergic reaction. 

  • 2

    Antihistamine Options

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    OTC antihistamine pills, nasal sprays and eye drops are usually the first choice. They treat the effects of histamine—sneezing, runny nose and itchy eyes—but not nasal congestion. Newer, second-generation antihistamines are long-lasting (12 or 24 hours) and usually do not cause drowsiness. These include cetirizine (Zyrtec), desloratadine (Clarinex), fexofenadine (Allegra) and loratadine (Claritin, Alavert). Most are available as less expensive OTC generics. Some also contain a decongestant, as indicated by a “-D” appended to the brand name.

  • 3

    Antihistamine Cautions

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    Older, first-generation antihistamines—diphenhydramine (as in Benadryl) and the “pheniramines” (such as chlorpheniramine {Chlor-Trimeton})—can cause drowsiness that can last more than 12 hours, and can impair driving the next day, even if you don’t feel drowsy. What’s more, these drugs interfere with the neurotransmitter acetylcholine, which can cause or worsen memory problems, confusion and cognitive impairment in older people, and can also worsen urinary symptoms in men with prostate enlargement

  • 4



    Decongestants shrink dilated blood vessels in the nose, lessening swollen nasal passages. They come as OTC pills, capsules, liquids and nasal sprays. Oral products contain pseudoephedrine (e.g., Sudafed products, sold behind the counter) or phenylephrine (e.g., Contac). Sprays contain phenylephrine (e.g., Neo-Synephrine) or oxymetaxoline (e.g., Afrin or Dristan). Pseudoephedrine given orally and oxymetazoline nasal sprays provide symptom relief longer than cold formulations containing phenylephrine.

  • 5

    Decongestant Warnings

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    Don't use nasal sprays for more than two or three consecutive days. They lose effectiveness and can worsen congestion. Talk with your health care provider or pharmacist before using decongestants if you have high blood pressure, heart disease, glaucoma, thyroid disease, enlarged prostate or diabetes; are pregnant or breastfeeding; or are taking other medications that may interact. You may be able to use nasal sprays even if you are advised against pills or capsules. Decongestants may cause nervousness, sleeplessness and palpitations.

  • 6

    Cromolyn Sodium Nasal Spray

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    Sold OTC as NasalCrom or as a generic, it is safe and effective for preventing hay fever symptoms in adults and children as young as six. Called a mast-cell stabilizer, it blocks the release of histamine from mast cells. It is best started before allergy season begins; it won’t help as much after symptoms appear. Unlike decongestant nasal sprays, it doesn’t produce rebound congestion and has the fewest side effects of any allergy drug, but it isn’t as effective as nasal steroid sprays.

  • 7


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    Saline nasal sprays help wash out nasal mucus; they can be used long-term. Neti pots (which look like a genie pot) work similarly.

  • 8

    Nasal Steroids

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    Corticosteroid sprays are the most effective drugs for nasal allergy symptoms. Most are prescription-only but ecently, triamcinolone acetonide (Nasacort Allergy 24HR), became available OTC. These drugs start working within 12 hours, but maximal effect may not occur for seven days or more. The drugs may cause dryness, irritation, burning or bleeding of nasal passages and sore throat. Long-term use in children may reduce growth. If you have severe rhinitis and do not respond to other drugs, oral corticosteroids may be prescribed for short-term use.

  • 9

    Eye Drops

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    Eye drops with antihistamines (pheniramine) may help relieve itchiness. Some (such as Naphcon-A or Opcon-A) also contain a decongestant that constricts blood vessels in the eyes; don't use for more than a few days to avoid rebound redness and swelling. Don’t use get-the-red-out eye drops, which contain only vasoconstrictors (decongestants). People with glaucoma should never use eye drops with vasoconstrictors. Doctors may prefer prescription eye drops or nonsedating antihistamines. Artificial tears, preferably without preservatives, can be used.

  • 10

    Topical Steroids

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    For allergic skin conditions such as atopic dermatitis (eczema) and hives (urticaria), topical steroids are sometimes prescribed. There can be side effects with long-term use. OTC hydrocortisone cream is usually least effective, but also has fewer side effects.