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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Itchy eyes, runny nose, never having enough tissues in your house—if you have seasonal or environmental allergies, you know these feelings well. Which allergy medications are available, and which are most likely to give you relief? Let’s take a look.
What are the different types of allergy treatments?
There are many things you can try for your allergies. We’ll look at each of these in detail below, but your options fall into these eight general categories:
- Avoidance of allergens
- Combination medications
- Leukotriene modifiers
- Mast cell stabilizers
Before we examine each of these, it’ll be helpful to understand what causes allergies and what the symptoms include.
What are allergies?
An allergy is when your body’s immune system is sensitive to a substance that most people aren’t. That substance is called an allergen. Allergy symptoms can occur when you breathe in, swallow, or touch an allergen, depending on your particular allergies (Akhouri, 2019).
Your allergic symptoms will vary depending on where your allergen exposure is. Most people’s allergies affect their nose, airway, eyes, and skin.
Most people with allergies have some of these common symptoms (Akhouri, 2019):
- Post-nasal drip (mucus draining from your sinuses down your throat)
- Runny nose
- Nasal congestion (stuffiness)
- Itchy eyes
Seasonal allergies are often responsible for these symptoms when you’re exposed to tree pollen, grass, weeds, and molds. This type of allergy is called allergic rhinitis. Other allergies can be to animals (mostly dog and cat dander), food, and medications.
How to get rid of allergies: 7 helpful remedies
Who gets allergies?
The number of people with allergies has continually increased in the past few decades (Schmidt, 2016).
Allergic rhinitis affects 15–30% of people and has high healthcare costs and work productivity loss. Scientists now recognize that allergies can affect the whole body, not just your nose. About 20% of people with allergies have seasonal allergies, while 40% of those with allergies experience their symptoms year-round (Akhouri, 2019).
Almost anyone can develop allergies at any age. Still, you’re at higher risk for developing allergies if you have the following (Akhouri, 2019):
- A family history of allergic reactions
- Born male
- Have a higher socioeconomic status
- Have higher levels of allergic-specific components in your blood (like an antibody type called IgE)
Your environment can also play a role, especially if you already have a sensitivity to and are exposed to an allergen repeatedly when you are young. Though there are a lot more children with allergies today, people in their 20s to 40s have the most allergies. As you get older, allergies seem to get better for many people (Akhouri, 2019).
How do you know if you have allergies?
It’s best to visit a healthcare professional to assess you thoroughly. If you can’t get to one, look at your symptoms, when they happen, how frequently they occur, how long they last, what exposures you’ve had, and what makes them better or worse.
People with seasonal allergies often report sneezing, runny nose, and watery eyes after being outdoors. People with chronic allergies often say they have chronic nasal congestion, stuffy nose, and post-nasal drip. Other people complain they get allergy symptoms from “triggers” like dog dander, cigarette smoke, mold, perfumes, pollen, and humidity.
If you breathe mainly through your mouth, sniff or clear your throat frequently, or have dark circles under your eyes, you may be suffering from allergies. (Akhouri, 2019).
How does the body respond to allergens?
Your body responds to allergens by creating a protein called IgE in your immune system to grab the allergen. This protein then tells special cells called mast cells to release histamine and other inflammatory chemicals into the blood. Histamine and these other chemicals allow the blood vessels to become leaky. This leakiness enables protective immune cells to attack the allergen. On the flip side, it also ends up causing nasal congestion, teary eyes, itching, hives, and swelling. If this response happens in the lungs, it can tighten your breathing muscles, making it more difficult to breathe (Galli, 2012).
The most dangerous histamine reaction is called anaphylaxis, which can be life-threatening. Anaphylaxis is when breathing stops because of a swollen airway. When this happens, blood pressure drops, blood doesn’t get to the organs, and the person can die if untreated (Reber, 2017).
Anaphylaxis is an emergency and requires immediate medical attention. Part of the treatment of anaphylaxis is epinephrine to open the airway. Some people carry an EpiPen, a self-administered shot of epinephrine, if they are diagnosed with severe allergies (Reber, 2017).
Most people with allergies, though, deal only with allergic rhinitis. What can you do to treat the symptoms and stop feeling so miserable? Let’s examine the treatments we touched on above.
1. Avoidance of allergens
The most straightforward treatment for allergic rhinitis triggered by dust, animal dander, or seasonal allergies may be avoidance. However, for some people avoiding the allergen is not always possible or may take some lifestyle changes, including (Akhouri, 2019):
- Allergy-reducing or allergy-eliminating bedclothes (sheets, pillows, mattress covers)
- Removal of carpet and draperies
- Having no pets or low allergy pets in the home
- Using a vacuum with a special high-efficiency particulate air (HEPA) filter
Some regular over-the-counter (OTC) products can help with specific allergy symptoms. You can treat itchy, red, or watery eyes with artificial tears. These contain no medicine but instead help to flush allergens out of your eyes. One popular brand is Refresh. You can use a similar approach to treat mild congestion and thick mucus with a saline or saltwater nasal spray. One brand is Ayr (Akhouri, 2019).
Antihistamines have been available for many years. You can find them in the form of pills, eye drops, and nasal sprays. They come as both prescription and OTC (Scadding, 2017).
How do antihistamines work?
Almost all allergy symptoms are caused by histamine, so it makes sense that you can treat them with an antihistamine. Antihistamines work by blocking the release of histamine, stopping swelling, itching, redness, and changes in your nose and airway secretions.
Both older and newer antihistamines effectively control histamine release and decrease allergy symptoms (Scadding, 2017).
Adult allergies: can you get allergies at any age?
Antihistamine side effects
Older antihistamines or “first-generation” medications can make you drowsy. This category includes well-known OTC medications like diphenhydramine (Benadryl), chlorpheniramine (Chlor-Treimton), and hydroxyzine (Atarax; see Important Safety Information). That’s why these medications have warnings not to drive or use heavy machinery after taking them (Scadding, 2017; Akhouri, 2019).
They also can cause dry mouth, constipation, urinary retention (where it’s hard to pee), and tachycardia (rapid heartbeat). Their effect doesn’t last long, so they have to be taken more frequently to relieve allergy symptoms. Newer or “second and third-generation” antihistamines have non-drowsy formulas, lasting longer in the body, and with far fewer side effects (Scadding, 2017; Akhouri, 2019).
Types of antihistamines
Oral OTC first-generation antihistamines (can make you sleepy) include (Akhouri, 2019):
- Diphenhydramine (Benadryl)
- Brompheniramine (Dimetapp allergy)
- Chlorpheniramine (Chlor-Trimeton)
- Clemastine (Tavist)
Oral OTC second/third generation (won’t make you sleepy) include (Akhouri, 2019):
- Cetirizine (Zyrtec)
- Fexofenadine (Allegra)
- Levocetirizine (Xyzal)
- Loratadine (Claritin, Alavert)
Desloratadine (Clarinex) is another non-drowsy oral allergy medication that’s only available with a prescription. There’s also a prescription antihistamine nasal spray available, called Azelastine nasal (Astelin) (Akhouri, 2019).
Decongestants relieve nasal congestion. They’re often used with antihistamines, and they’re available in pill, liquid, and nasal spray forms. Some eye drops are formulated as decongestants as well (Malone, 2017).
How do decongestants work?
An allergic reaction can cause swelling in the nose and airway blood vessels, causing congestion. A decongestant removes the congestion by narrowing the blood vessels, reducing inflammation and swelling. This allows more air to move freely throughout the entire airway, making you breathe better.
Allegra vs. Claritin vs. Zyrtec for allergies
Decongestant side effects
Side effects are more common with oral decongestants than with nasal decongestants. They include digestive side effects like nausea and vomiting, neurological side effects like anxiety, headache, dizziness, and seizures, and heart issues like high blood pressure, stroke, abnormal heart rhythms, and heart attack (Malone, 2017).
Who shouldn’t take decongestants?
Decongestants aren’t for everyone. Those who should avoid them include:
- People with heart disease
- People with high blood pressure
- People with diabetes
- People with thyroid disease
- Men with enlarged prostates
- Those who take monoamine oxidase inhibitors (a type of antidepressant).
These people should avoid decongestants because they narrow the blood vessels, creating a dangerous situation for anyone with these conditions.
It’s not a good idea to use decongestants for an extended time, whether you use oral medication or nasal spray. Decongestant nasal sprays can cause “rebound” nasal congestion, where the stuffiness comes back even stronger (Akhouri, 2019).
Healthcare professionals say not to use these sprays for longer than one week. Oral decongestants come with several potentially dangerous side effects, and most healthcare professionals say to limit your use to 10 days (Akhouri, 2019).
Types of decongestants include (Malone, 2017; Akhouri, 2019):
- Pseudoephedrine (Sudafed tablets or liquid)
- Phenylephrine (Sudafed PE, Neo-Synephrine)
Decongestant nasal sprays
- oxymetazoline (Afrin) nasal sprays
Treating seasonal allergy symptoms: medications that help
Because pseudoephedrine can be misused, many drug companies have replaced it with phenylephrine. You can find these products on the shelf in the drug store. If you specifically want pseudoephedrine, you may need to pick it up at the pharmacy counter and present your driver’s license, even though it is considered over-the-counter (Malone, 2017).
4. Combination medications
There are some allergy medications that combine both an antihistamine and a decongestant to relieve many allergy symptoms (Scadding, 2017).
How do combination medications work?
Combination allergy drugs combine known allergy medications to block histamine from multiple areas—a two-for-one punch!
Combination medication side effects
If you are sensitive to either of the single drugs, you might experience some of that drug’s common side effects in the combination allergy medication.
Types of combination allergy medications
There are several types of combination allergy drugs available. These include:
- Allegra-D: fexofenadine and pseudoephedrine
- Benadryl Allergy and Sinus: diphenhydramine and pseudoephedrine
- Claritin-D: loratadine and pseudoephedrine
- Zyrtec-D: cetirizine and pseudoephedrine
- Semprex-D: acrivastine and pseudoephedrine
5. Leukotriene modifiers
Leukotriene receptor antagonists (LTRAs) or modifiers are prescription-only oral medications that treat nasal allergy symptoms and asthma. You can use them with other allergy medications (Pyasi, 2016).
How do LTRAs work?
Leukotrienes are released by mast cells and eosinophils (a type of white blood cell) in response to an allergic substance or trigger. They cause inflammation in the body, including the swelling of blood vessels. Leukotriene modifiers or antagonists help to decrease the inflammatory effect of leukotrienes (Pyasi, 2016).
Allegra vs. Claritin vs. Zyrtec for allergies
LTRA side effects
Side effects are not common but can include stomach upset, heartburn, fever, stuffy nose, cough, rash, and headache (Choi, 2020).
Types of leukotriene modifier drugs include:
- Montelukast (Singulair)
6. Mast Cell Stabilizers
Mast cell stabilizers are allergy treatments that come as eye drops or nasal sprays (Zhang, 2016).
How do mast cell stabilizers work?
Mast cells are filled with histamine and other chemicals that contribute to allergic reactions. Allergens latch onto the allergy antibody IgE that’s on mast cell surfaces, causing the mast cells to release histamine and leading to allergy symptoms (Zhang, 2016).
Mast cell stabilizer side effects
Mast cell stabilizers are drops or sprays and most of their side effects are limited to the area where they were applied. Nasal spray side effects include coughing, throat irritation, and skin rash (Zhang, 2017).
Available mast cell stabilizer medications
Types of mast cell stabilizers:
- Cromolyn sodium (generic Opticrom)
- Lodoxamide-tromethamine (Alomide)
- Nedocromil (Alocril)
- Pemirolast (Alamast)
Steroids help to reduce inflammation and swelling from seasonal and chronic allergic reactions. They are available in many different forms: oral pills or liquids you ingest, inhalers for asthma, and topicals including nasal sprays, skin creams, or eye drops. Some require a prescription and others can be purchased over the counter (Scadding, 2017).
Xyzal vs. Zyrtec: antihistamines go head-to-head
Research shows that steroid nasal sprays, even OTC versions, are much more effective than antihistamines to reduce inflammation in the nose, though they may take several days to reach their full impact (Carr, 2017).
How do steroids work?
Steroids decrease inflammation and calm down the immune system from reacting too strongly against an allergen or trigger.
Steroid side effects
Steroids work well, but they can come with many side effects. Side effects are more pronounced when the steroids are given orally and for a long time. Most healthcare providers will prescribe topical steroids such as inhalers, nasal sprays, and eye drops for allergies. There are a few you can purchase over-the-counter. The most common side effects from these topical steroids for allergies are cough, hoarseness, and fungal infections in the mouth (Scadding 2017).
Available steroid allergy medications
Prescription nasal spray steroids:
- beclomethasone (Beconase, Qnasl, Qvar)
- mometasone (Nasonex)
- ciclesonide (Alvesco, Omnaris, Zetonna)
- fluticasone furoate (Veramyst)
OTC nasal spray steroids:
- Flonase Allergy Relief
- Nasacort Allergy 24 HR
- Rhinocort allergy
Here’s an important note about nasal sprays. Administration technique is critical to get the best results from your prescribed or over-the-counter nasal spray. First, use regularly as it may take a few days to take effect. Second, tip your head down, so your chin is meeting your chest. Place the bottle tip into your nostril and aim away from the center of your nose. Squeeze the bottle the number of times prescribed or recommended for best results (Scadding, 2017; Akhouri, 2019).
How does Flonase work to help relieve allergies?
Immunotherapy treatment for allergies is available either as an allergy shot or a pill placed under the tongue (Larsen, 2016).
How does allergy immunotherapy work?
Immunotherapy shots or pills are similar to a vaccine where your body’s immune system does the work. You receive small and progressively increased doses of the allergen either by shot or pill to build up your tolerance to the specific allergen. This lowers your sensitivity and decreases your allergic reaction. This treatment is very effective for allergic rhinitis, especially if you suffer from these allergies for more than three months of the year (Larsen, 2016).
Allergy immunotherapy side effects
Immunotherapy shots should only be given in a healthcare setting. Immunotherapy pills can cause itching and swelling in the throat. The first dose of the pills should be given in a healthcare setting under observation to check for a reaction. After that, you take it daily at home (Calderon, 2021).
Prescription under-the-tongue tablets include:
- Odactra (for dust mites)
Subcutaneous injection immunotherapy is available only at a healthcare provider.
What the future holds for allergy treatments
Allergies and allergic rhinitis have continually increased in the past few decades. They don’t just make people miserable—there are significant economic and financial consequences to allergies (Kuehl, 2015).
In addition to improvements in all of the above treatments, advances in nanotechnology may be an exciting tool in diagnosing, treating, and maybe even in preventing allergic reactions (Mayorga, 2021).
If you have allergies, there are multiple ways of dealing with the symptoms from avoidance to prescription medications. Please consult with your healthcare provider to find the best solution for you!
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Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.