6 Best OTC Allergy Medications, According to Doctors and Pharmacists

For this article, author Erica Sweeney interviewed four allergists and one pharmacist. She also researched seasonal allergies and the most common treatments for the condition. She then scoured the internet to read customer reviews about OTC allergy medications to learn which were most effective.

“Everyone is different,” Dr. Younus says. So, the best way to choose which medicine will work for you is to chat with your doctor about your symptoms and overall health.

Some ingredients that doctors recommend looking for in antihistamines include cetirizine (Zyrtec), fexofenadine (Allegra), loratadine (Claritin), and levocetirizine dihydrochloride (Xyzal), Dr. Smith says. For nasal sprays, seek out fluticasone (Flonase), budesonide (Rhinocort), and triamcinolone (Nasacort) or the nasal antihistamine azelastine (Astepro).

Decongestants, like pseudoephedrine (Sudafed), are best avoided since they don’t offer long-term allergy relief, Dr. Smith says. These ingredients might be included in antihistamines — so, watch for products with a “D” in their name, such as Zyrtec-D or Allegra-D, which means they contain decongestants.

Be careful about allergy medications that cause drowsiness, too, Dr. Strauss says. Otherwise, you might struggle to get through your day, and they can affect your ability to drive or make decisions. Whether to opt for a nasal spray or a pill is up to you. For mild symptoms, an oral antihistamine alone may work, but if they’re mild to severe, layer on a nasal steroid, Dr. Smith says. When congestion is your main problem, Dr. Strauss says a steroid nasal spray is your best bet.

Whichever OTC allergy medication you choose, Dr. Hostoffer suggests choosing a generic or store brand — a cheaper option that’s just as effective.

Allergies are a chronic condition where your immune system reacts to a typically harmless substance, known as an allergen, according to the American College of Allergy, Asthma & Immunology. Common allergens are pollen, dust, pet dander or food. When your immune system encounters the allergen, it reacts to try to ward it off, and that causes symptoms like sneezing, rashes, coughing or nasal congestion. In severe cases, allergies can cause anaphylaxis, which is a life-threatening condition.

Seasonal allergies only occur during certain times of the year, usually from February to early summer in the U.S. when trees, grass, ragweed and other plants pollinate. About a quarter of adults experience seasonal allergies, according to the Centers for Disease Control and Prevention. However, you can develop allergies at any age.

These are the three main types of OTC allergy medications:

• Antihistamines block histamine, a natural chemical that the body releases when it encounters an allergen, Aungst says. It’s the histamine release that causes allergy symptoms, so antihistamines are effective at relieving itching, sneezing and a runny nose, Dr. Smith says. Oral antihistamines include Allegra, Claritin, Zyrtec and Xyzal, says Robert Hostoffer, D.O., an osteopathic physician specializing in allergy and immunology. Recently, Astepro, an antihistamine nasal spray, became available OTC, Dr. Smith says.
• Nasal corticosteroids, including Flonase or Nasonex, reduce inflammation and swelling directly in the nasal passages, says Dr. Younus. “The anti-inflammatory effect leads the mucus-secreting cells to calm down and reduce blood flow, which makes your nose feel less blocked,” Dr. Smith says, adding that these medications also help with dry, itchy eyes. Nasal corticosteroids can take a couple of weeks to kick in, however, so Dr. Strauss recommends combining them with an antihistamine for “maximal effect.” That said, nasal sprays shouldn’t be considered an as-needed medication — you should start taking them daily in early March to get ahead of allergy season, Dr. Smith says.
• Decongestants, like Sudafed, can improve nasal congestion temporarily by shrinking swollen nasal passages, Dr. Younus says. However, doctors typically don’t recommend them for seasonal allergies because they can cause side effects, like irritability, difficulty sleeping and increased blood pressure, adds Dr. Strauss. They’re also not as effective for allergies as antihistamines and steroids. You should also avoid decongestant nasal sprays, such as Afrin, Dr. Strauss emphasizes. Using this medication for more than a few days can cause rebound congestion, which can make your symptoms worse.

These common medications are safe and effective for treating allergy symptoms and work similarly, Aungst says. It really comes down to which one best minimizes your symptoms and doesn’t cause side effects. It might take some trial and error to find your favorite.

Zyrtec might cause drowsiness for some people, Dr. Younus says. Claritin is non-drowsy, but he says some people don’t think it’s as effective as Zyrtec. Allegra is also non-drowsy, but some might find Zyrtec and Claritin to be more effective. All three offer 24-hour relief.

“My favorites, in order of preference, are Allegra, Xysal, Zyrtec and then Claritin,” Dr. Smith says.

Patients with kidney disease, seizure disorders, heart conditions and high blood pressure should check with their doctor before taking OTC allergy medications, says Dr. Strauss. So should pregnant women and men with enlarged prostates. Older adults might also need to avoid the medications, as the drugs could cause drowsiness and increase the likelihood of falls, Aungst says. If you have a kid with allergies, it's also important to make sure to choose a medication that is appropriate for their age.

Tried several OTC allergy meds and still dealing with congestion, sneezing and other symptoms? See your family doctor or an allergist, Dr. Hostoffer urges. Also, make an appointment if you’re not exactly sure what’s triggering your allergies, or if your symptoms are getting worse and lasting longer, Dr. Younus says.

“A good barometer is when you notice that the over-the-counter options are not cutting it, and the symptoms start to affect your quality of life,” Dr. Smith says. Doctors may prescribe stronger versions of OTC medications, allergy shots or the medication Singulair, which he says works a little differently than antihistamines by blocking inflammatory molecules called leukotrienes.

Erica Sweeney, the author of this article, is an experienced health writer whose work has appeared in The New York Times, Men’s Health, HuffPost, Parade, and many other publications. She conducted interviews, researched allergies and allergy medications and read customer reviews to compile this list.